Allan C Skanes

The University of Western Ontario, London, Ontario, Canada

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Publications (293)1399.24 Total impact

  • Umjeet S Jolly · Kevin K Ng · Allan C Skanes
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2015; DOI:10.1016/j.hrthm.2015.05.033 · 4.92 Impact Factor
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    ABSTRACT: Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 01/2015; 115(7). DOI:10.1016/j.amjcard.2015.01.016 · 3.43 Impact Factor
  • Mahta Khoshnam Tehrani · Allan C. Skanes · Rajni V. Patel
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    ABSTRACT: The efficacy of catheter-based cardiac ablation procedures can be significantly improved if real-time information is available concerning contact forces between the catheter-tip and cardiac tissue. However, the widely used ablation catheters are not equipped for force sensing. This paper proposes a technique for estimating the contact forces without direct force measurements by studying the changes in the shape of the deflectable distal section of a conventional 7-Fr catheter (henceforth called the "deflectable distal shaft", the "deflectable shaft" or the "shaft" of the catheter) in different loading situations. Method: First, the shaft curvature when the tip is moving in free space is studied and based on that, a kinematic model for the deflectable shaft in free space is proposed. In the next step, the shaft shape is analyzed in the case where the tip is in contact with the environment, and it is shown that the curvature of the deflectable shaft provides useful information about the loading status of the catheter and can be used to define an index for determining the range of contact forces exerted by the ablation tip. Results: Experiments with two different steerable ablation catheters show that the defined index can detect the range of applied contact forces correctly in more than 80% of the cases. Based on the proposed technique, a framework for obtaining contact force information by using the shaft curvature at a limited number of points along the deflectable shaft is constructed. Conclusion: The proposed kinematic model and the force estimation technique can be implemented together to describe the catheter's behavior before contact, detect tip/tissue contact and determine the range of contact forces. Significance: This study proves that the flexibility of the catheter's distal shaft provides a means of estimating the force exerted on tissue by the ablation tip.
    IEEE transactions on bio-medical engineering 01/2015; 62(5). DOI:10.1109/TBME.2015.2389615 · 2.23 Impact Factor
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    ABSTRACT: The objectives of this national chart audit (January to June 2013) of 6,346 patients with atrial fibrillation (AF; ≥18 years without a significant heart valve disorder) from 647 primary care physicians were to (1) describe the frequency of stroke and bleed risk assessments in patients with nonvalvular AF by primary care physicians, including the accuracy of these assessments relative to established predictive indexes; (2) outline contemporary methods of anticoagulation used; and (3) report the time in the therapeutic range among patients prescribed warfarin. An annual stroke risk assessment was not undertaken in 15% and estimated without a formal risk tool in 33%; agreement with CHADS2 score estimation was seen in 87% of patients. Major bleeding risk assessment was not undertaken in 25% and estimated without a formal risk tool in 47%; agreement with HAS-BLED score estimation was observed in 64% with physician overestimation in 26% of patients. Antithrombotic therapy included warfarin (58%), dabigatran (22%), rivaroxaban (14%), and apixaban (<1%). Among warfarin-treated patients, the median international normalized ratio was 2.4 and time in therapeutic range (TTR) was 73%; however, the TTR was <50% in 845 (25%), 50% to 69% in 674 (20%), and ≥70% in 1,827 (55%) patients. In conclusion, we describe a contemporary real-world elderly population with AF at important risk for stroke. There is apparent overestimation of bleeding risk in many patients. Warfarin was the dominant stroke prevention treatment; however, the suggested TTR target was achieved in only 55% of these patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 12/2014; 115(5). DOI:10.1016/j.amjcard.2014.12.022 · 3.43 Impact Factor
  • Lorne J Gula · Allan C Skanes
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    ABSTRACT: Pulmonary vein isolation (PVI) has rapidly become a common procedure for management of atrial fibrillation (AF). With a success rate higher than antiarrhythmic medication and a relatively low risk, ablation is now a reasonable consideration for most patients with AF. The main argument against routine use of ablation as first line therapy for AF is the rare but real risk of life-threatening complications. Among the most concerning of the potential late complications is atrial-esophageal fistula. This complication is difficult to study given its fortunately low incidence, with 5 fistulae reported among 45,115 procedures in a study of 546 worldwide centers(1) . But with a mortality rate close to 100% - a recent report(2) detailed deaths in all 5 patients within a week of esophageal stenting, in contrast to 2+ year survival in all 4 patients undergoing surgery within 4 hours of diagnosis - it has remained a high priority to attempt to study, understand, and prevent this devastating complication. As with any condition that is too rare to study directly, many investigators have looked to a surrogate outcome, in this case mucosal erosions and ulceration detected by esophageal imaging after ablation. We have been tempted to consider such ulcers as minor forms of potential fistulas, and therefore investigate these lesions with the belief that we are learning more about the full blown condition. But it seems we may need to learn more about the ulcers themselves, specifically, whether a subset of these lesions are in fact due to mechanical trauma from a TEE probe and unrelated to ablation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 12/2014; 26(2). DOI:10.1111/jce.12594 · 2.88 Impact Factor
  • Kevin K. Ng · Allan C. Skanes
    The Canadian journal of cardiology 11/2014; 31(1). DOI:10.1016/j.cjca.2014.11.019 · 3.94 Impact Factor
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    ABSTRACT: The acceptance and yield of family screening in genotype-negative long QT syndrome (LQTS) remains incompletely characterized. In this study of family screening for phenotype-definite Long QT Syndrome (LQTS, Schwartz score ≥3.5), probands at a regional Inherited Cardiac Arrhythmia clinic were reviewed. All LQTS patients were offered education by a qualified genetic counselor, along with materials for family screening including electronic and paper correspondence to provide to family members. Thirty-eight qualifying probands were identified and 20 of these had family members who participated in cascade screening. The acceptance of screening was found to be lower among families without a known pathogenic mutation (33 vs. 77 %, p = 0.02). A total of 52 relatives were screened; fewer relatives were screened per index case when the proband was genotype-negative (1.7 vs. 3.1, p = 0.02). The clinical yield of screening appeared to be similar irrespective of gene testing results (38 vs. 33 %, p = 0.69). Additional efforts to promote family screening among gene-negative long QT families may be warranted.
    Journal of Genetic Counseling 10/2014; 24(4). DOI:10.1007/s10897-014-9776-6 · 1.75 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10):S299-S300. DOI:10.1016/j.cjca.2014.07.740 · 3.94 Impact Factor
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    ABSTRACT: Background-Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. Methods and Results-Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66 +/- 8 years and 26 +/- 8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction >= 15%), 18 patients (58%) for super-response (LV end-systolic volume reduction >= 30%). LV ejection fraction improved at 6 months (31 +/- 8 versus 26 +/- 8%, P=0.04). Conclusions-This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed.
    Circulation Arrhythmia and Electrophysiology 09/2014; 7(6). DOI:10.1161/CIRCEP.114.001729 · 5.42 Impact Factor
  • Lorne J Gula · Allan C Skanes
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    ABSTRACT: It has been almost twenty years since the discovery that pulmonary vein ectopy is largely responsible for initiation of paroxysmal atrial fibrillation (PAF). We have spent the better part of those twenty years seeking effective ways of eliminating pulmonary vein ectopy or its effect on the atrial rhythm. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 09/2014; 26(1). DOI:10.1111/jce.12537 · 2.88 Impact Factor
  • Lorne J Gula · Peter Leong-Sit · Allan C Skanes
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; 11(9). DOI:10.1016/j.hrthm.2014.05.033 · 4.92 Impact Factor
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    ABSTRACT: BACKGROUND Early repolarization (ER) is associated with an increased risk for death from cardiac causes. Recent evidence supports ER's role as a modifier and/or predictor of risk in many cardiac conditions. OBJECTIVE The purpose of this study was to determine the prevalence of ER among genotype-positive patients with long QT syndrome (LOTS) and evaluate its utility in predicting the risk of symptoms. METHODS ER was defined as QRS slurring and/or notching associated with >= 1-mV QRS-ST junction (3-point) elevation in at least 2 contiguous leads, excluding the anterior precordial leads. The ECG with the most prominent ER was used for analysis. Major ER was defined as >= 2-mm 3-point elevation. Symptoms of LOTS included cardiac syncope, documented polymorphic ventricular tachycardia (VT), and resuscitated cardiac arrest. RESULTS One hundred thirteen patients (mean age 41 +/- 19 years; 63 female) were reviewed, among whom 414 (mean 3.7 +/- 1.5) ECGs were analyzed. Of these, 30 patients (27%) with a history of symptoms. Fifty patients (44%) had ER, and 19 patients (17%) had major ER. Patients with major ER were not different from patients without major ER with respect to age, sex, long QT type, longest QTc recorded, number of patients with QTc >500 ms, or use of betablockade. Univariate and independent predictors of symptom status included the presence of major ER, longest QTc recorded >500 ms, and female sex. CONCLUSION ER > 2 mm was the strongest independent predictor of symptom status related to LOTS, along with female sex and QTc >500 ms.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; 11(9). DOI:10.1016/j.hrthm.2014.05.027 · 4.92 Impact Factor
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    ABSTRACT: BACKGROUND The integrated diagnostics (ID) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm, heart rate, intrathoracic fluid status, and activity, producing a risk score that correlates with 30-day risk of heart failure (HF) hospitalization. OBJECTIVE We sought to validate the ID algorithm using the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. METHODS Diagnostic measures of the algorithm include OptiVol fluid index, nighttime heart rate, minutes of patient activity, heart rate variability, and combined measure of cardiac rhythm and biventricular pacing. Monthly evaluations of ID parameters were assessed for the development of HF symptoms and hospitalization for HF. RESULTS A total of 1224 patients were included: 741 (61%) with cardiac resynchronization therapy with defibrillator devices and 483 (39%) with implanted cardioverter-defibrillator only. The mean age was 66 9 years, and 1013 (83%) were men. A total of 37,861 months of follow-up data were available, with 258 HF hospitalizations vent rate 0.68% per month). There were 33 HF hospitalizations during low-risk months (0.21% per month), 123 during medium-risk months (0.66% per month), and 102 during high-risk months (2.61% per month). Compared with Low-risk months, and 95 % confidence intervals) of HF hospitalizations during medium-risk months was 2.9 (2.0-4.4) and during high-risk months was 10.7 (6.9-16.6). Multi-variable analysis demonstrated that each ID variable had independent association with HF hospitalization. CONCLUSION The risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF signs and symptoms among patients in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial. This may present a useful adjunct to detect early signs of HF and adjust therapy to reduce morbidity and costs involved with hospital admission.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; 11(9). DOI:10.1016/j.hrthm.2014.05.015 · 4.92 Impact Factor
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    ABSTRACT: Beta-blockers are the standard of care for the treatment of long QT syndrome (LQTS), and have been shown to reduce recurrent syncope and mortality in patients with type 1 LQTS (LQT1). Although beta-blockers have minimal effect on the resting corrected QT interval, their effect on the dynamics of the non-corrected QT interval is unknown, and may provide insight into their protective effects. Twenty-three patients from eight families with genetically distinct mutations for LQT1 performed exercise stress testing before and after beta-blockade. One hundred and fifty-two QT, QTc, and Tpeak-Tend intervals were measured before starting beta-blockers and compared with those at matched identical cycle lengths following beta-blockade. Beta-blockers demonstrated heart-rate-dependent effects on the QT and QTc intervals. In the slowest heart rate tertile (<90 b.p.m.), beta-blockade increased the QT and QTc intervals (QT: 405 vs. 409 ms; P = 0.06; QTc: 459 vs. 464 ms; P = 0.06). In the fastest heart rate tertile (>100 b.p.m.), the use of beta-blocker was associated with a reduction in both the QT and QTc intervals (QT: 367 vs. 358 ms; P < 0.0001; QTc: 500 vs. 486 ms; P < 0.0001). The Tpeak-Tend interval showed minimal change at slower heart rates (<90 b.p.m.) (93 vs. 87 ms; P = 0.09) and at faster heart rates (>100 b.p.m.) (87 vs. 84 ms; P = NS) following beta-blockade. Beta-blockers have heart-rate-dependent effects on the QT and QTc intervals in LQTS. They appear to increase the QT and QTc intervals at slower heart rates and shorten them at faster heart rates during exercise.
    Europace 05/2014; 16(12). DOI:10.1093/europace/euu086 · 3.05 Impact Factor
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    Jeffrey I Weitz · Jeffrey S Healey · Allan C Skanes · Atul Verma
    Circulation 04/2014; 129(16):1688-94. DOI:10.1161/CIRCULATIONAHA.113.005376 · 14.95 Impact Factor
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    ABSTRACT: Interventional cardiac electrophysiology (EP) has experienced a significant growth in Canada. Our aim is to establish a periodic registry as a nationwide initiative. The registry is designed to collect information regarding EP laboratory infrastructure, human resources, and the spectrum and volumes of EP procedures. Respective administrative staff were contacted electronically. Out of 25 identified Canadian EP centers, 19 centers (76 %) have participated in the registry. Responding centers have access on average to 5.3 lab days per week to perform EP studies/ablations; average lab time per full- and part-time (prorated to 0.5) EP physician is 0.8 day per week. Diagnostic EP studies and radio-frequency ablations are performed in all (19) centers; cryoablation is available in 83 % of centers. Two centers have remote magnetic navigation systems. EnSite NavX is the most widely available 3D mapping system utilized in 15 (83 %) centers, followed by CARTO and intracardiac echo which are each available in 14 (78 %) centers; LocaLisa is actively used in one center. The number of full-time physicians ranges between 0 and 7, with a mean of 3.5 full-time physicians per center. The ratio of staff to trainees is 1.6:1. A total of 8,041 EP procedures are performed in the 19 centers per annum. On an annual average, 104 procedures per one operator and 159 procedures per trainee are performed. This registry provides contemporary information on invasive EP lab resources and procedures in Canada. It also demonstrates that Canadian EP procedural intensities of practice and training are comparable to international standards.
    Journal of Interventional Cardiac Electrophysiology 04/2014; 40(1). DOI:10.1007/s10840-014-9899-6 · 1.55 Impact Factor
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    ABSTRACT: Provocative testing with sodium channel blockers is advocated for the evaluation of unexplained cardiac arrest (UCA) with the primary purpose of unmasking the typical ECG features of Brugada syndrome. The CASPER registry systematically assesses subjects with UCA or a family history of sudden death (FHSD). To determine the clinical yield of procainamide infusion in a national registry of subjects with either UCA or a FHSD. Subjects with either UCA or a FHSD without evidence of a Brugada pattern at baseline underwent procainamide testing (15 mg/kg to a maximum of 1 g at 50 mg/min). A test was considered positive for Brugada pattern if there was an increase in ST elevation >1 mm or if there was >1 mm of new ST elevation in leads V1 and/or V2. Genetic testing was performed on the basis of phenotype detection. Procainamide testing was performed in 174 subjects (age 46.8±15.4 years; 47% female). Testing provoked a Brugada pattern in 12 subjects (6.9%), 5 of whom had no ST abnormalities at baseline. No subjects with a negative procainamide challenge were subsequently diagnosed with Brugada syndrome. Genetic testing was conducted in 10 of the 12 subjects with a provoked Brugada pattern, and was positive for a mutation in the SCN5A gene in 1. Irrespective of the baseline ECG, procainamide testing provoked a Brugada pattern in a significant proportion of subjects with UCA or a FHSD, thereby facilitating a diagnosis of Brugada syndrome, and is recommended in the workup of UCA.
    Heart rhythm: the official journal of the Heart Rhythm Society 03/2014; 11(6). DOI:10.1016/j.hrthm.2014.03.022 · 4.92 Impact Factor
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    ABSTRACT: INTRODUCTION: For radiofrequency (RF) catheter ablation of the left atrium, safe and effective dosing of RF energy requires transmural left atrium ablation without injury to extra-cardiac structures. The thickness of the left atrial wall may be a key parameter in determining the appropriate amount of energy to deliver. While left atrial wall-thickness is known to exhibit inter- and intra-patient variation, this is not taken into account in the current clinical workflow. Our goal is to develop a tool for presenting patient-specific left atrial thickness information to the clinician in order to assist in the determination of the proper RF energy dose. METHODS: We use an interactive segmentation method with manual correction to segment the left atrial blood pool and heart wall from contrast-enhanced cardiac CT images. We then create a mesh from the segmented blood pool and determine the wall thickness, on a per–vertex basis, orthogonal to the mesh surface. The thickness measurement is visualized by assigning colors to the vertices of the blood pool mesh. We applied our method to 5 contrast-enhanced cardiac CT images. RESULTS: Left atrial wall-thickness measurements were generally consistent with published thickness ranges. Variations were found to exist between patients, and between regions within each patient. CONCLUSION: It is possible to visually determine areas of thick vs. thin heart wall with high resolution in a patient-specific manner.
    SPIE Medical Imaging; 03/2014
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    ABSTRACT: Background Early repolarization (ER) is associated with an increased risk of death from cardiac causes. Recent evidence supports ER’s role as a modifier and/or predictor of risk in many cardiac conditions. Objectives Determine the prevalence of ER amongst genotype positive patient with Long QT syndrome (LQTS) and evaluate its utility in predicting risk of symptoms. Methods ER was defined as QRS slurring and/or notching associated with ≥1 mV QRS-ST junction (J-point) elevation in at least 2 contiguous leads, excluding the anterior precordial leads. The ECG with the most prominent ER was used for analysis. Major ER was defined as ≥ 2 mm J point elevation. Symptoms of LQTS included cardiac syncope, documented polymorphic ventricular tachycardia (VT) and resuscitated cardiac arrest. Results One hundred and thirteen patients (mean age 41 ± 19, 63 female) were reviewed in whom 414 (mean 3.7 ± 1.5) ECGs were analyzed. Of these, there were 30 patients (27%) with a history of symptoms. Fifty patients (44%) had ER, and 19 patients (17%) had major ER. Patients with major ER were not different than patients without major ER with respect to age, sex, LQT type, longest QTc recorded, number of patients with QTc> 500 msec, or use of beta blockade. Univariate and independent predictors of symptom status included the presence of major ER, longest QTc recorded > 500 msec, and female sex. Conclusion ER ≥ 2 mm was the strongest independent predictor of symptom status related to LQTS, along with female sex and QTc > 500 msec.
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    ABSTRACT: Background The Integrated Diagnostics (ID) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm, heart rate, intrathoracic fluid status, and activity, producing a risk score that correlates with 30-day risk of heart failure (HF) hospitalization. Objective We sought to validate the ID algorithm using the RAFT trial. Methods Diagnostic measures of the algorithm include OptiVol fluid index, night-time heart rate, minutes of patient activity, heart rate variability, and combined measure of cardiac rhythm and biventricular pacing. Monthly evaluations of ID parameters were assessed for development of heart failure symptoms, and hospitalization for heart failure. Results 1,224 patients were included, 741 with CRT-D devices and 483 ICD only. Average age was 66±9 years and 83% were male. 37,861 months of follow-up data were available, with 258 HF hospitalizations (event rate 0.68% per month). There were 33 HF hospitalizations during low-risk months (0.21% per month), 123 during medium risk months (0.66% per month), and 102 during high-risk months (2.61% per month). Compared to low-risk months, the relative risk of HF hospitalizations during medium-risk months was 2.9 [2.0-4.4] and during high-risk months was 10.7 [6.9-16.6]. Multivariable analysis demonstrated that each ID variable had independent association with HF hospitalization. Conclusions Risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF symptoms and signs among patients in the RAFT trial. This may present a useful adjunct to detect early signs of heart failure and adjust therapy to reduce morbidity and costs involved with hospital admission.

Publication Stats

7k Citations
1,399.24 Total Impact Points

Institutions

  • 2000–2015
    • The University of Western Ontario
      • • Division of Cardiology
      • • Department of Medicine
      London, Ontario, Canada
    • Syracuse University
      Syracuse, New York, United States
    • University of Alabama at Birmingham
      • Department of Biomedical Engineering
      Birmingham, Alabama, United States
  • 2012–2014
    • Western University
      London, Ontario, Canada
  • 2000–2013
    • London Health Sciences Centre
      • Division of Cardiology
      London, Ontario, Canada
  • 2011
    • CHU de Québec
      Quebec City, Quebec, Canada
    • Robarts Research Institute
      • Imaging Research Laboratories
      London, Ontario, Canada
    • St. Vincent's Hospital Sydney
      • Department of Cardiology
      Sydney, New South Wales, Australia
  • 2008
    • Centro Universitario de Ciencias de la Salud
      Guadalajara, Jalisco, Mexico
  • 2005
    • Lawson Health Research Institute
      London, Ontario, Canada
    • Université de Montréal
      Montréal, Quebec, Canada
  • 1997–1998
    • University of Ottawa
      • Department of Medicine
      Ottawa, Ontario, Canada
    • Ottawa University
      اوتاوا، کانزاس, Kansas, United States