Abstract
When I was asked to write this tribute to Bramah N. Singh MD, DPhil, DSc, I quickly accepted. I was saddened by his recent death (September 20, 2014 at his home in Encino, California), at the age of 76, and sobered by the loss of a leader of the arrhythmia and antiarrhythmic pharmacology field for the last 50 years.
Bramah N. Singh, MD, DPhil, DSc, was born in Fiji on March 3, 1938. He received his MD degree in 1963 from the University of Otago in New Zealand. He completed his rotating internship, residency in medicine/nephrology, and cardiology fellowship at Green Lane Hospital in Auckland. In 1969, he was awarded the Nuffield Traveling Fellowship to Oxford where he worked with EM Vaughan Williams in the Pharmacology department of Hertford College. Dr Singh received his DPhil from Oxford based on groundbreaking work that led to the Vaughan Williams classification of antiarrhythmic drugs, still used with modification today. His work concentrated on the electrophysiologic properties of amiodarone and sotalol. 1,2 From 1971 to 1976, he served as a Nuffeld Demonstrator at the University of Oxford, an International United States Public Health Service fellow at Harvard and the Peter Bent Brigham Hospital, and a senior lecturer at Auckland University School of Medicine. He was recruited as an associate professor of Medicine at the University of California, Los Angeles School of Medicine in 1976 and continued clinical work and research at Cedars-Sinai Medical Center in Los Angeles. He was promoted to professor of Medicine in 1980. From 1988 to 1996, he served as the director of the Cardiovascular Research Laboratory at the Wadsworth Veterans Administration Hospital. Because of his numerous contributions to our understanding of arrhythmias, he received a DSc degree from both the University of Oxford and the University of Otago. Over the course of over 40 years of work, Bramah published over 500 scientific papers and book chapters, mainly concentrating on the electrophysiology and clinical use of antiarrhythmic drugs. His publications and research on antiarrhythmic drugs were true cell to bedside scientific contributions. He chaired and published the Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) study in 2005. 3 This study presented new information on both amiodarone and sotalol adding to 3 decades of scientific contributions on these drugs. Bramah trained and influenced hundreds of cardiology trainees in addition to all of us who learned from his writings and lectures all over the world.
I first met Bramah when I was a cardiac electrophysiology fellow at Indiana. Similar to Bramah, our group under Douglas P Zipes, MD, had an immense interest in amiodarone and other antiarrhythmic drugs such as verapamil, sotalol, and the emerging class IC agents, encainide and flecainide. We had presented and published some differing opinions related to the use of amiodarone. Although we had some scientific thought differences, Bramah always treated me with respect and kindness. I was still a cardiac electrophysiology fellow and his kindness this early in my career had a lasting impression on our relationship. Given my similar interest in antiarrhythmic drugs, I often shared teaching and consulting relationships and we and others tried to study the safety and efficacy of these “newer antiarrhythmic agents.”
Although I met with Bramah in many cities worldwide at scientific congresses and also at consultant meetings, there were several instances that are most memorable. We were part of a televised panel on amiodarone from HBO studios in New York City, including several other experts on the drug. All of us were much more comfortable teaching by the bedside and giving scientific presentations at cardiology congresses.
I visited Bramah as a visiting professor at the Wadsworth Veterans Affairs hospital 2 times. The first was right after the major earthquake in Los Angeles that caused the collapse of many of the highways. The second occurred after I had been elected to the Association of University Cardiologists of which he was a member. After teaching at Wadsworth, we traveled together to Monterey, California, to our annual Association of University Cardiology meeting.
I was fortunate to help participate with Bramah in the development of dronedarone 4,5 and multiple studies needed to obtain regulatory approval of this drug. It was a fitting ending to his career that he would help get the son of amiodarone approved by the Food and Drug Administration, decades after being one of the fathers of amiodarone.
Bramah was the founding editor of the Journal of Cardiovascular Pharmacology and Therapeutics (JCPT). Bob Kloner took over for him a few years ago and wrote a fitting tribute to Bramah. 6 My last interaction with Bramah related to coediting a supplement on dronedarone for the JCPT. Dr Kloner asked me to help Bramah as a coeditor of this important JCPT supplement, 7 since I was on the editorial board, an author, a colleague, friend, and an expert on the subject. I accepted this assignment and worked with Bramah with the help of his wife through phone calls from his home and the help of coworkers put the finishing touches on some of his last contributions to the literature.
Bramah is survived by his wife Roshni Singh, 2 sons, Dr Pramil Singh and Dr Sanjiv Singh, and a daughter Dr Nalini Singh. He is also survived by 4 siblings, Vimla Singh, Dr Nirbhay Singh, D. Yadhu Singh, and Urmila Singh.
There are many other colleagues who were closer to Bramah and might have been more fitting to write this tribute. Bramah’s friendship and collaboration through the years had a positive impact on my career. The same can be said for others, especially his students. All of us in cardiac electrophysiology, cardiovascular pharmacology, cardiology, and our patients have benefitted from the seminal work on antiarrhythmic drugs that have helped us treat all of our patients with arrhythmic disorders. It will be hard to write a prescription for amiodarone, sotalol, or dronedarone without remembering the impact that Bramah had on the development of these antiarrhythmic drugs.