Alan Bulava

University of South Bohemia in České Budějovice, Budejovice, Jihočeský, Czech Republic

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Publications (49)72.31 Total impact

  • Cor et vasa 09/2015; DOI:10.1016/j.crvasa.2015.08.006
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    ABSTRACT: Left atrial appendage (LAA) plays a crucial role in the etiopathogenesis and the prevention of the stroke in patients with nonvalvular atrial fibrillation (AF). This paper presents our first experience with thoracoscopic LAA occlusion using an external clip. We performed a total of 30 LAA occlusions with the AtriClip from left thoracoscopy approach during the period from July 2012 to July 2013. AtriClip was implanted during the bilateral thoracoscopic radiofrequency (RF) as part of left atrial ablation procedure. Among the 30 procedures, AtriClip was once periprocedurally partially positioned. In the remaining procedures, the implantation was successful without complications. Of the 30 patients, 29 underwent transesophageal echocardiography and computer tomography examination at 3 months after the procedure. Apart from the patient with the partial clip placement, a residual pouch of 18 mm was detected in another patient. In the remaining group (28/30 patients, 93%), the exclusion was complete. No migration or any other clip implantation-related complications occurred during the follow-up. None of the patients experienced an embolization event. Endoscopic AtriClip implantation appears to be a reproducible and safe method of LAA occlusion, with a minimal risk and a high efficiency. In our opinion, the AtriClip implantation is a reasonable part of thoracoscopic AF treatment and should be considered as an alternative tool for stroke risk reduction in patients with AF.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 07/2015; 10(3). DOI:10.1097/IMI.0000000000000169
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    ABSTRACT: The aim of the study was to evaluate whether the sequential hybrid approach combining surgical CryoMaze followed by the radiofrequency catheter ablation can improve freedom from atrial arrhythmias. Thirty-five patients with persistent atrial fibrillation underwent a CryoMaze procedure in conjunction with cardiac surgery for structural heart disease. Three months after surgery, all patients underwent a 7-day ECG Holter followed by an electrophysiological study and mapping of the left and right atria. All pulmonary veins were re-isolated and all ablation lines were completed, if necessary, using radiofrequency energy. Patients were followed-up at 3, 6 and 12 months after the catheter ablation. Before the mapping study and radiofrequency ablation, 9 patients (26%) had ongoing atrial fibrillation or atrial tachycardia, 10 patients (28%) had paroxysmal atrial tachyarrhythmia and 16 patients (46%) had sinus rhythm on the 7-day Holter monitoring. During the electrophysiological procedure, complete cryoablation lines around the left pulmonary veins were found in 29 patients (83%), around the right pulmonary veins in 25 patients (71%), between the superior veins in 20 cases (57%), between the inferior veins in 27 cases (77%), across the mitral isthmus in 12 patients (34%) and across the cavo-tricuspid isthmus in one patient (3%). Arrhythmia-free survival rate off antiarrhythmic drugs after re-isolation of the veins and completion of the lines was 86% at 12 months. Ablation lines created using surgical CryoMaze are often incomplete. Sequential surgical CryoMaze procedures followed by catheter ablation significantly increase freedom from arrhythmia in patients with persistent atrial fibrillation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 07/2015; DOI:10.1111/pace.12686 · 1.13 Impact Factor
  • Alan Bulava · Martin Eisenberger · Jiri Hanis ·

    Europace 04/2015; 17(7). DOI:10.1093/europace/euv051 · 3.67 Impact Factor
  • Alan Bulava · Jiri Hanis · Martin Eisenberger ·
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    ABSTRACT: Recent advances in 3D mapping systems, such as simultaneous visualization of multiple catheters and contact force measurement have allowed a significant reduction in fluoroscopic times during radiofrequency ablation (RFA) procedures. The objective was to investigate whether RFA of paroxysmal atrial fibrillation (PAF) using the CARTO 3 system and intracardiac echocardiography (ICE) can be performed safely without fluoroscopy. Eighty patients with PAF were randomized in 1:1 ratio to undergo either fluoroscopically guided pulmonary vein isolation (PVI) (X+) or PVI without fluoroscopy (X-). In the X- fluoroscopy group, catheter placement, transseptal puncture, left atrial (LA) geometry reconstruction, and PVI were accomplished solely using ICE imaging and CARTO mapping. The total procedure duration and RF application time in both the X- and X+ groups were comparable (92.5 ± 22.9 min vs. 99.9 ± 15.9 min, p = 0.11 and 1785 ± 548 s vs. 1755 ± 450 s, p = 0.79, respectively). Zero fluoroscopic time was achieved in all patients in the X- group with the exception of one patient, where 8 s of fluoroscopy was needed to assess proper position of the guide-wire in the femoral vein. No serious procedure-related complications were recorded and no differences in arrhythmia-free survival at 12 months were found between the groups. RFA using ICE imaging and the CARTO 3 mapping system with contact force measurement is capable of eliminating fluoroscopy in patients undergoing PVI. Exclusion of fluoroscopic imaging does not seem to compromise patient safety and does not affect overall procedure duration, RF application time, or mid-term efficacy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 03/2015; 38(7). DOI:10.1111/pace.12634 · 1.13 Impact Factor
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    ABSTRACT: Catheter ablation of persistent atrial fibrillation yields an unsatisfactorily high number of failures. The hybrid approach has recently emerged as a technique that overcomes the limitations of both surgical and catheter procedures alone. We investigated the sequential (staged) hybrid method, which consists of a surgical thoracoscopic radiofrequency ablation procedure followed by radiofrequency catheter ablation 6 to 8 weeks later using the CARTO 3 mapping system. Fifty consecutive patients (mean age 62±7 years, 32 males) with long-standing persistent atrial fibrillation (41±34 months) and a dilated left atrium (>45 mm) were included and prospectively followed in an unblinded registry. During the electrophysiological part of the study, all 4 pulmonary veins were found to be isolated in 36 (72%) patients and a complete box-lesion was confirmed in 14 (28%) patients. All gaps were successfully re-ablated. Twelve months after the completed hybrid ablation, 47 patients (94%) were in normal sinus rhythm (4 patients with paroxysmal atrial fibrillation required propafenone and 1 patient underwent a redo catheter procedure). The majority of arrhythmias recurred during the first 3 months. Beyond 12 months, there were no arrhythmia recurrences detected. The surgical part of the procedure was complicated by 7 (13.7%) major complications, while no serious adverse events were recorded during the radiofrequency catheter part of the procedure. The staged hybrid epicardial-endocardial treatment of long-standing persistent atrial fibrillation seems to be extremely effective in maintenance of normal sinus rhythm compared to radiofrequency catheter or surgical ablation alone. Epicardial ablation alone cannot guarantee durable transmural lesions. URL: Unique identifier: cz-060520121617. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
    Journal of the American Heart Association 02/2015; 4(3). DOI:10.1161/JAHA.114.001754 · 4.31 Impact Factor
  • Zdeňka Pavelková · Alan Bulava ·
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    ABSTRACT: The importance of nursing and patient quality of life is a top concern for medical professionals. Therefore, participation by medical professionals in raising awareness and continuously supporting improvements in nursing care is an essential part of improving patient quality of life. Modern medical techniques and procedures are changing rapidly, particularly in the field of cardiology. This has resulted in changing roles and increased responsibility for nurses and confirms the necessity for changing the perception of nurses relative to their role in the medical environment and to patient care. This paper presents the results from the first phase of a research project and focuses on quality of life and problematic areas associated with the needs of patients with atrial fibrillation before and after radiofrequency catheter ablation. Atrial fibrillation is one of the most common supraventricular arrhythmias. Its incidence in the general population has risen significantly over the last twenty years. The objective of this research was to assess those areas, which are considered by patients to be problematic before therapeutic intervention. The research was realized through a quantitative survey using a modified questionnaire. Results showed that AF reduced the quality of life both physically and psychologically (i.e. increased levels of anxiety and depression). Results also showed that radiofrequency catheter ablation was able to alleviate symptoms associated with AF and was also able to increase patient quality of life.
    Neuro endocrinology letters 11/2014; 35(Suppl):49-53. · 0.80 Impact Factor
  • Ondřej Ošmera · Alan Bulava ·
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    ABSTRACT: The increasing number of patients with implantable cardiac devices raises the need for more efficient outpatient follow-up care. Due to technological progress in communication and transmission systems and in the implantable devices themselves, telemonitoring can be widely used as an important part of care for patients and devices. Our objective was to evaluate the benefits of continuous remote monitoring using the BIOTRONIK Home Monitoring® (HM) system compared to standard outpatient follow-ups. 198 patients with single- or dual-chamber implantable cardioverter-defibrillator (ICD) implanted for primary or secondary prevention of sudden cardiac death were randomized into a group of patients followed through standard outpatient visits ( HM-) and a group telemonitored by the HM system (HM+). Planned and emergency visits, ICD-related hospitalizations, and delivered shocks and their appropriateness were evaluated in the respective groups. A significant reduction was achieved in the number of planned (by 48%, p<0.001) and total visits (by 45%, p<0.001) during a three-year evaluation. A comparable number of patients experienced one or more shocks. Mortality rates were equivalent, as was the number of patients hospitalized in relation to their ICD. However, there was a significant reduction in the number and proportion of inappropriate shocks delivered in the HM+ patient group: by 80% (p=0.002) in outpatient follow-up care and by 90% (p<0.001) when multiple shocks requiring hospitalization were included. The HM system was an effective and safe method of follow-up in patients with an implanted ICD. Remote monitoring reduces the number of outpatient visits and inappropriate shocks.
    Neuro endocrinology letters 11/2014; 35(Suppl):40-48. · 0.80 Impact Factor
  • Alena Kajanová · Alan Bulava · Martin Eisenberger ·
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    ABSTRACT: Various mental and social problems can negatively impact the quality of life and overall health in patients with implantable cardiac defibrillators (ICD). In this report, we review and summarize the main studies and research related to this topic. Depression, anxiety, panic attacks, stress and post-traumatic stress are the most common symptoms of ICD-related disorders that can negatively impact mental status. Factors than can influence the impact of these psychological disorders include socio-demographic variables (younger age, gender, and employment), variables related to the ICD (number of ICD shocks, generator size, time from ICD implant, etc.) and psycho-social variables (negative coping strategies, lack of social support and personality type). Fortunately, these disorders, and their symptoms, can be prevented, treated or managed, if recognized.
    Neuro endocrinology letters 11/2014; 35(Suppl):54-58. · 0.80 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy is now recognized as an effective and safe therapeutic modality in heart failure patients and leads to a reduction in mortality and morbidity. Today, transvenous implantation is considered to be the gold standard for lead placement. However, transvenous LV lead implantation fails in 2-10% of patients undergoing the implantation procedure. In these cases surgical LV lead implantation is preferred. The present article reviews LV pacing lead implantation strategies in cases where standard transvenous implantation failed.
    Neuro endocrinology letters 11/2014; 35(Suppl):34-39. · 0.80 Impact Factor
  • A. Bulava · M. Eisenberger · A. Mokracek · J. Hanis · V. Kurfirst ·

    Acta cardiologica 10/2014; 69(5):586-586. · 0.65 Impact Factor
  • M. Eisenberger · A. Bulava · A. Mokracek · J. Hanis · V. Kurfirst ·

    Acta cardiologica 10/2014; 69(5):574-574. · 0.65 Impact Factor
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    ABSTRACT: Factors influencing the postoperative health-related quality of life (HRQOL) after cardiac surgery have not been well described yet, mainly in the older people. The study's aim was to explore differences in clinical conditions and HRQOL of patients before and after cardiac surgery taking into account the influence of age and to describe factors influencing changes of HRQOL in the postoperative period. This was a prospective consecutive observational study with two measurements using the SF-36 questionnaire before surgery and 1 year after surgery. It considered main clinical characteristics of participants prior to surgery as well as postoperative complications. At baseline assessment the study considered 310 patients, predominantly male (69%). Mean age was 65 (SD 10.4) years and 101 patients (33%), who were older than 70, constituted the older group. This older group showed greater comorbidity, higher cardiac operative risk and lower HRQOL in the preoperative period as well as a higher prevalence of postoperative complications than the younger group. Thirty-day mortality was 1.4% in the younger group and 6.9% in the older group (p < 0.001). One year mortality was 3.3% in the younger group and 10.9% in the older group (p < 0.001). There was a significant improvement in all 8 health domains of the SF-36 questionnaire (p < 0.001) in the overall sample. There was no significant difference in change in a majority of HRQOL domains between the younger and the older group (p > 0.05). Logistic multivariate analysis identified a higher values of preoperative PCS (Physical component summary) scores (OR 1.03, CI 1.00 - 1.05, p = 0.0187) and MCS (Mental component summary) scores (OR 1.02, CI 0.997 - 1.00, p = 0.0846) as the only risk factors for potential non-improvement of HRQOL after cardiac surgery after correction for age, gender and type of surgery. Older patients with higher operative risk have lower preoperative HRQOL but show a similar improvement in a majority of HRQOL domains after cardiac surgery as compared with younger patients. The multivariate analysis has shown the higher preoperative HRQOL status as a only significant factor of potential non-improvement of postoperative HRQOL.
    Journal of Cardiothoracic Surgery 03/2014; 9(1):46. DOI:10.1186/1749-8090-9-46 · 1.03 Impact Factor
  • Michal Snorek · Alan Bulava ·
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    ABSTRACT: Implanted cardiac pacemaker (PM) or implantable cardioverter defibrillator (ICD) has been so far considered a contra-indication to magnetic resonance imaging (MRI). In the last few years MRI conditional cardiac implantable electronic devices have been marketed enabling patients undergo MRI under specific conditions. We present current state of the art and provide overview of available MRI conditional devices. Magnetic resonance imaging in these patients should be performed only in cases where the requested information can not be obtained using alternative imaging technique. Key words: cardiac pacemaker - implantable cardioverter defibrillator - magnetic resonance imaging.
    Vnitr̆ní lékar̆ství 02/2014; 60(2):123-7.
  • Alan Bulava · Jiří Haniš ·
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    ABSTRACT: Background Circular ablation catheters (PVAC) have been shown to be effective in the treatment of patients with paroxysmal atrial fibrillation (PAF). The electrophysiological characteristics of the pulmonary veins (PVs) during repeat procedures remain unknown. Objective To assess the efficacy of PV isolation (PVI) using PVAC and to determine the typical sites of electrical reconnection (ER) of PVs. Methods 79 patients with PAF underwent PVI using PVAC. Those who remained symptomatic underwent repeat procedure using a high-density 3D electroanatomical mapping to determine the sites of ERs. Results In total, AF recurrence was documented in 33 patients (41.7%) during the mean follow-up of 1427±378 days. Twenty-two patients had a further ablation. ER of at least one PV was found in all patients. Left upper, left lower, left common, right upper and right lower PV showed ER in 15, 13, 3, 13 and 12 patients, respectively. There was no difference in the number of ERs between individual PVs. In the left upper and left lower PV, 91.7% and 87.5% of gaps, respectively, were localized on the lateral ridge or carina. Sites of ER in the right upper PV were clustered either in the posterior superior (75%) or in the anterior inferior (25%) quadrants of the vein. Reconnection sites in the right lower PV were scattered equally around its whole circumference. Conclusion Typical sites of PV ER are carina and the lateral ridge of the left PVs and superior-posterior aspect of the right upper PV, whereas right lower PV seems to have no typical “reconnection profile”.
    Cor et vasa 02/2014; 56(1). DOI:10.1016/j.crvasa.2013.12.002
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    ABSTRACT: The treatment of persistent and long-standing persistent atrial fibrillation (AF) has unsatisfactory results using both medical therapy and/or catheter ablation, where incomplete ablation lines remain a significant problem. This study evaluates the feasibility, efficacy and safety of the sequential, two-staged hybrid treatment combining thoracoscopic surgical and transvenous catheter AF ablation. Thirty patients with persistent and long-standing persistent AF underwent surgical thoracoscopic radiofrequency (RF) ablation procedure using a predefined protocol (pulmonary veins isolation, box lesion, isthmus line lesion, dissection of the ligament of Marshall, left atrial appendage exclusion with an epicardial clip and ganglionated plexi ablation) followed by diagnostic catheterization and RF ablation 3 months later. In this session, electrical mapping of the left atrium was performed and any incomplete isolation lines were completed. Mitral and cavotricuspid isthmus ablation lines were performed during this session as well. The preoperative mean duration time of AF was 33 ± 27 months with 17% patients with persistent and 83% patients with long-standing persistent AF. The mean size of the left atrium was 48 ± 5 mm. The complete surgical ablation protocol was achieved in 97% of patients, with no death, and no early stroke or pacemaker implantation in the early postoperative period. In 63% of patients, the left atrial appendage was excluded with an epicardial clip. An endocardial touch-up for achievement of bidirectional block of pulmonary veins was necessary in 10 patients (33%) and on the box, (roof and floor) lesions in 20 patients (67%). Freedom from atrial fibrillation was 77% after surgical ablation and 93% after the completed hybrid procedure. The sequential, two-staged hybrid strategy (surgical thoracoscopic followed by catheter ablation) is feasible and safe with a high post-procedural success and seems to represent the optimal treatment with low risk load and potentially long-term benefit for patients with a persistent and long-standing persistent form atrial fibrillation.
    Interactive Cardiovascular and Thoracic Surgery 01/2014; 18(4). DOI:10.1093/icvts/ivt538 · 1.16 Impact Factor
  • Alan Bulava · Jiří Haniš ·
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    ABSTRACT: IntroductionPulmonary vein isolation (PVI) is considered to be a cornerstone of invasive therapy of paroxysmal atrial fibrillation (PAF). However, numerous technologies appeared on the market during last 10 years and besides typical “point-by-point” ablation, other “single-burn” technologies or remote navigation emerged.GoalThe aim of this article is to summarize single center experience with PVI using different technologies.Methods and resultsThe study was conducted in partially retrospective and mainly prospective manner. Consecutive cohorts of patients with PAF were followed after their index procedure using four different systems (CARTO XP, pulmonary vein ablation catheter (PVAC), CARTO3 and Sensei robotic system). After 3 month blanking period, repeated 7 day-Holters were carried out every 3 months following the index procedure, which consisted of catheter-based radiofrequency PVI. Documented episodes of AF lasting >60 s on any of these 7-day Holters were considered a failure of treatment. Using of the PVAC technology was associated with the shortest procedure duration when compared to any other system (p<0.0001 for all) and significant shortening of fluoroscopic time when compared to CARTO XP (p<0.0001). Using of novel CARTO3 mapping system or robotic navigation led to significant decrease of procedural time when compared to older 3D mapping system (p<0.0001). Arrhythmia free survival at 12 months following the index procedure was 65.8%, 68.7%, 75% and 76.1% when using CARTO XP, PVAC, CARTO3 and robotic navigation, respectively. Using of either CARTO3 or robotic navigation system led to significant improvement of AF-free survival (log rank p<0.01). One major vascular complication was recorded in the robotic group of patients while none in other groups. No minor or major late complications (beyond 30 days following the index procedure) were noted in any of the groups.Conclusions Novel technologies bring significantly better results in terms of arrhythmia recurrence and allow for shorter procedure duration and lower radiation burden both for patients and the operating physicians.
    Cor et vasa 11/2012; 54(6):e393–e400. DOI:10.1016/j.crvasa.2012.11.005
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    ABSTRACT: AimTo find out whether it is possible to anaesthetize patients safely without analgesia and sedation, using burst pacing prolonged until the patient becomes unconscious.Methods One hundred and four patients undergoing implantation or reimplantation of a cardioverter-defibrillator were included. Patients randomized into Group B underwent prolonged burst pacing without analgesia and sedation. Patients in Group T underwent a T-wave shock under analgesia and sedation. Blood samples for measurement of serum neuron-specific enolase were taken before surgery and 6, 24, and 48 h after the procedure.ResultsFrom the 104 patients, 51 were randomly assigned to Group B and 53 to Group T. Four patients from Group B were switched to Group T (ventricular fibrillation not induced by burst pacing). The clinical characteristics of both groups were similar. The mean total time of cardiac arrest was significantly longer in Group B (23.0 ± 4.4 s, median 22.7) vs. Group T (10.3 ± 3.0 s, median 10.0), P < 0.0001 (Mann-Whitney U-test). The effectiveness of both induction methods was similar (92.1% in Group B and 100% in Group T). The mean neuron-specific enolase levels after 6, 24, and 48 h were similar in Groups B and T (13.1 ± 6.3 and 11.6 ± 5.8 mg/L, 14.5 ± 7.5 and 13.4 ± 6.0 mg/L, and 14.9 ± 5.9 and 12.2 ± 6.0 mg/L, respectively) as were these levels compared with baseline neuron-specificenolase levels (14.0 ± 5.9 and 13.4 ± 4.0 mg/L, respectively), P = NS for all.Conclusion Despite a longer time of total cardiac arrest, prolonged burst pacing appears to be a safe and effective method for induction of ventricular fibrillation during cardioverter-defibrillator testing, which enables omission of analgesia and sedation or general anaesthesia.
    Europace 10/2012; 15(1). DOI:10.1093/europace/eus250 · 3.67 Impact Factor
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    ABSTRACT: Catheter ablation for paroxysmal atrial fibrillation is widely used for patients with drug-refractory paroxysms of arrhythmia. Recently, novel technologies have been introduced to the market that aim to simplify and shorten the procedure.  To compare the clinical outcome of pulmonary vein (PV) isolation using a multipolar circular ablation catheter (PVAC group), with point-by-point PV isolation using an irrigated-tip ablation catheter and the CARTO mapping system (CARTO group; CARTO, Biosense Webster, Diamond Bar, CA, USA).  Patients with documented PAF were randomized to undergo PV isolation using PVAC or CARTO. Atrial fibrillation (AF) recurrences were documented by serial 7-day Holter monitoring. One hundred and two patients (mean age 58 ± 11 years, 68 men) were included in the study. The patients had comparable baseline clinical characteristics, including left atrial dimensions and left ventricular ejection fraction, in both study arms (PVAC: n = 51 and CARTO: n = 51). Total procedural and fluoroscopic times were significantly shorter in the PVAC group (107 ± 31 minutes vs 208 ± 46 minutes, P < 0.0001 and 16 ± 5 minutes vs 28 ± 8 minutes, P < 0.0001, respectively). The AF recurrence was documented in 23% and 29% of patients in the PVAC and CARTO groups, respectively (P = 0.8), during the mean follow-up of 200 ± 13 days. No serious complications were noted in both study groups. Clinical success rates of PV isolation are similar when using multipolar circular PV ablation catheter and point-by-point ablation with a three-dimensional (3D) navigation system in patients with PAF, and results in shorter procedural and fluoroscopic times with a comparable safety profile.
    Pacing and Clinical Electrophysiology 09/2010; 33(9):1039-46. DOI:10.1111/j.1540-8159.2010.02807.x · 1.13 Impact Factor

Publication Stats

202 Citations
72.31 Total Impact Points


  • 2014-2015
    • University of South Bohemia in České Budějovice
      • Faculty of Health and Social Studies
      Budejovice, Jihočeský, Czech Republic
    • Hospital for Special Surgery
      New York City, New York, United States
  • 2009-2014
    • Nemocnice České Budějovice
      Budejovice, Jihočeský, Czech Republic
  • 2001-2012
    • University Hospital Olomouc
      • Department of Nuclear Medicine
      Olmütz, Olomoucký, Czech Republic
  • 2003-2007
    • Palacký University of Olomouc
      • Faculty of Medicine and Dentistry
      Olmütz, Olomoucký, Czech Republic
    • A.C.O. San Filippo Neri
      Roma, Latium, Italy