Michel Haïssaguerre

Université Victor Segalen Bordeaux 2, Burdeos, Aquitaine, France

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Publications (627)3428.92 Total impact

  • Ashok J. Shah, Michel Haissaguerre, Meleze Hocini
    Cardiac electrophysiology clinics 03/2015;
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    ABSTRACT: Patients with ventricular tachycardia (VT) and ventricular fibrillation (VF) and no reversible cause are difficult to treat. While implantable defibrillators prolong survival, many patients remain symptomatic due to device shocks and syncope. To address this, there have been recent advances in the catheter ablation of VT and VF. For example, non-invasive imaging has improved arrhythmia substrate characterisation, 3D catheter navigation tools have facilitated mapping of arrhythmia and substrate and ablation catheters have advanced in their ability to deliver effective lesions. However, the long-term success rates of ablation for VT and VF remain modest, with nearly half of treated patients developing recurrence within 2-3 years, and this drives the ongoing innovation in the field. This review focuses on the challenges particular to ablation of life-threatening ventricular arrhythmia, and the strategies that have been recently developed to improve procedural efficacy. Patient sub-groups that illustrate the use of new strategies are described.
    Expert Review of Cardiovascular Therapy 02/2015;
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    ABSTRACT: The Brugada syndrome (BrS) is a rare heritable cardiac arrhythmia disorder associated with ventricular fibrillation and sudden cardiac death. Mutations in the SCN5A gene have been causally related to BrS in 20-30% of cases. Twenty other genes have been described as involved in BrS, but their overall contribution to disease prevalence is still unclear. This study aims to estimate the burden of rare coding variation in arrhythmia-susceptibility genes among a large group of patients with BrS. We have developed a custom kit to capture and sequence the coding regions of 45 previously reported arrhythmia-susceptibility genes and applied this kit to 167 index cases presenting with a Brugada pattern on the electrocardiogram as well as 167 individuals aged over 65 year-old and showing no history of cardiac arrhythmia. By applying burden tests, a significant enrichment in rare coding variation (with a minor allele frequency below 0.1%) was observed only for SCN5A, with rare coding variants carried by 20.4% of cases with BrS versus 2.4% of control individuals (p=1.4 x 10(-7)). No significant enrichment was observed for any other arrhythmia-susceptibility gene, including SCN10A and CACNA1C. These results indicate that, except for SCN5A, rare coding variation in previously reported arrhythmia-susceptibility genes do not contribute significantly to the occurrence of BrS in a population with European ancestry. Extreme caution should thus be taken when interpreting genetic variation in molecular diagnostic setting, since rare coding variants were observed in a similar extent among cases versus controls, for most previously reported BrS-susceptibility genes. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Human Molecular Genetics 02/2015; · 6.68 Impact Factor
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    ABSTRACT: The early repolarization (ER) pattern is associated with an increased risk of arrhythmogenic sudden death. However, strategies for risk stratification of patients with the ER pattern are not fully defined. This study sought to determine the role of electrophysiology studies (EPS) in risk stratification of patients with ER syndrome. In a multicenter study, 81 patients with ER syndrome (age 36 ± 13 years, 60 males) and aborted sudden death due to ventricular fibrillation (VF) were included. EPS were performed following the index VF episode using a standard protocol. Inducibility was defined by the provocation of sustained VF. Patients were followed up by serial implantable cardioverter-defibrillator interrogations. Despite a recent history of aborted sudden death, VF was inducible in only 18 of 81 (22%) patients. During follow-up of 7.0 ± 4.9 years, 6 of 18 (33%) patients with inducible VF during EPS experienced VF recurrences, whereas 21 of 63 (33%) patients who were noninducible experienced recurrent VF (p = 0.93). VF storm occurred in 3 patients from the inducible VF group and in 4 patients in the noninducible group. VF inducibility was not associated with maximum J-wave amplitude (VF inducible vs. VF noninducible; 0.23 ± 0.11 mV vs. 0.21 ± 0.11 mV; p = 0.42) or J-wave distribution (inferior, odds ratio [OR]: 0.96 [95% confidence interval (CI): 0.33 to 2.81]; p = 0.95; lateral, OR: 1.57 [95% CI: 0.35 to 7.04]; p = 0.56; inferior and lateral, OR: 0.83 [95% CI: 0.27 to 2.55]; p = 0.74), which have previously been demonstrated to predict outcome in patients with an ER pattern. Our findings indicate that current programmed stimulation protocols do not enhance risk stratification in ER syndrome. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 01/2015; 65(2):151-9. · 15.34 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) is an electrical treatment of heart failure with reduced ejection fraction and wide QRS. It aims to correct the electrical dyssynchrony present in 30-50% of patients in this population. Dyssynchrony results in widening of the QRS complex on the electrocardiogram (ECG). CRT was initially developed to treat patients who had left bundle branch block (LBBB) and delayed activation of the lateral left ventricular wall. However, a large proportion of heart failure patients present with a widened QRS that is neither a LBBB nor a right BBB: nonspecific intraventricular conduction delay (NICD). Less studied than RBBB or LBBB, its pathophysiology is both complex and varied yet still reflects intramyocardial conduction delay. NICD is most often associated with cardiomyopathy: e.g. ischemic or hypertensive. Conduction pathways can be either healthy or affected. Results from CRT therapy are contradictory in this patient group, despite a seemingly neutral trend. Unfortunately, prospective studies are lacking. Guidelines recommending implantation of CRT in this group are solely based on analyses of subgroups with small sample size. A dedicated prospective study is therefore warranted in order for this question to be properly answered. The detailed study of the ECG as well as non-invasive study of ventricular electrical activation may enable clinicians to better identify patients with NICD who will respond to CRT. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2015; · 4.56 Impact Factor
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    ABSTRACT: Purpose To evaluate an automated method for the quantification of fat in the right ventricular (RV) free wall on multidetector computed tomography (CT) images and assess its diagnostic value in arrhythmogenic RV cardiomyopathy (ARVC). Materials and Methods This study was approved by the institutional review board, and all patients gave informed consent. Thirty-six patients with ARVC (mean age ± standard deviation, 46 years ± 15; seven women) were compared with 36 age- and sex-matched subjects with no structural heart disease (control group), as well as 36 patients with ischemic cardiomyopathy (ischemic group). Patients underwent contrast material-enhanced electrocardiography-gated cardiac multidetector CT. A 2-mm-thick RV free wall layer was automatically segmented and myocardial fat, expressed as percentage of RV free wall, was quantified as pixels with attenuation less than -10 HU. Patient-specific segmentations were registered to a template to study fat distribution. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of fat quantification by using task force criteria as a reference. Results Fat extent was 16.5% ± 6.1 in ARVC and 4.6% ± 2.7 in non-ARVC (P < .0001). No significant difference was observed between control and ischemic groups (P = .23). A fat extent threshold of 8.5% of RV free wall was used to diagnose ARVC with 94% sensitivity (95% confidence interval [CI]: 82%, 98%) and 92% specificity (95% CI: 83%, 96%). This diagnostic performance was higher than the one for RV volume (mean area under the ROC curve, 0.96 ± 0.02 vs 0.88 ± 0.04; P = .009). In patients with ARVC, fat correlated to RV volume (R = 0.63, P < .0001), RV function (R = -0.67, P = .001), epsilon waves (R = 0.39, P = .02), inverted T waves in V1-V3 (R = 0.38, P = .02), and presence of PKP2 mutations (R = 0.59, P = .02). Fat distribution differed between patients with ARVC and those without, with posterolateral RV wall being the most ARVC-specific area. Conclusion Automated quantification of RV myocardial fat on multidetector CT images is feasible and performs better than RV volume in the diagnosis of ARVC. © RSNA, 2015 Online supplemental material is available for this article.
    Radiology 01/2015; · 6.21 Impact Factor
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    ABSTRACT: The more recent studies of human pathologies have essentially revealed the complexity of the interactions involved at the different levels of integration in organ physiology. Integrated organ thus reveals functional properties not predictable by underlying molecular events. It is therefore obvious that current fine molecular analyses of pathologies should be fruitfully combined with integrative approaches of whole organ function. It follows an important issue in the comprehension of the link between molecular events in pathologies, and whole organ function/dysfunction is the development of new experimental strategies aimed at the study of the integrated organ physiology. Cardiovascular diseases are a good example as heart submitted to ischemic conditions has to cope both with a decreased supply of nutrients and oxygen, and the necessary increased activity required to sustain whole body-including the heart itself-oxygenation.By combining the principles of control analysis with noninvasive (31)P NMR measurement of the energetic intermediates and simultaneous measurement of heart contractile activity, we developed MoCA (for Modular Control and Regulation Analysis), an integrative approach designed to study in situ control and regulation of cardiac energetics during contraction in intact beating perfused isolated heart (Diolez et al., Am J Physiol Regul Integr Comp Physiol 293(1):R13-R19, 2007). Because it gives real access to integrated organ function, MoCA brings out a new type of information-the "elasticities," referring to internal responses to metabolic changes-that may be a key to the understanding of the processes involved in pathologies. MoCA can potentially be used not only to detect the origin of the defects associated with the pathology, but also to provide the quantitative description of the routes by which these defects-or also drugs-modulate global heart function, therefore opening therapeutic perspectives. This review presents selected examples of the applications to isolated intact beating heart and a wider application to cardiac energetics under clinical conditions with the direct study of heart pathologies.
    Methods in molecular biology (Clifton, N.J.) 01/2015; 1264:289-303. · 1.29 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):99-100.
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    ABSTRACT: Biventricular pacing (BVP) may not achieve complete electrical resynchronization. To assess whether the resynchronizing effect of BVP varies among patients depending on the underlying electrical substrate. High resolution electrocardiographic mapping with invasive measurement of Left Ventricular (LV) dP/dtmax were performed during baseline activation and during BVP in 61 heart failure patients with various conduction delays: 13 narrow QRS (<120ms), 22 nonspecific intraventricular conduction disturbance and 26 left bundle branch block. Electrical dyssynchrony, both during baseline and BVP, was quantified by total and LV activation times (TAT and LVTAT) and by ventricular electrical uncoupling (VEU = mean LV - mean RV activation time). Response to BVP was defined as a ≥10% LVdP/dtmax increase. The electrical activation pattern during BVP was similar for all patient groups and, hence, not dependent on the baseline conduction disturbance. During BVP, TAT, LVTAT and VEU were similar for all groups and correlated not/weakly with the change in LVdP/dtmax. In contrast, the changes in electrical dyssynchrony correlated significantly with the change in LVdP/dtmax: r=0.71, 0.69, and 0.69 for ∆TAT, ∆LVTAT and ∆VEU, respectively (all p<0.001). Responders showed higher baseline dyssynchrony levels and BVP-induced dyssynchrony reduction than nonresponders (all p<0.001); in nonresponders BVP worsened activation times compared to baseline. BVP does not eliminate electrical dyssynchrony but rather brings it to a common level independent of the patient's underlying electrical substrate. Therefore, BVP is of benefit to dyssynchronous patients but not to patients with insufficient electrical dyssynchrony in whom it induces an iatrogenic electropathy. Copyright © 2014. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 12/2014; · 4.56 Impact Factor
  • Cardiac electrophysiology clinics 12/2014;
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    ABSTRACT: -This study aimed to determine five-year efficacy of catheter ablation for persistent atrial fibrillation (PsAF) using AF termination as a procedural endpoint. -150 patients (57±10 years) underwent PsAF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided and linear ablation) with the desired procedural endpoint being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia (AT). AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3±3.9%, 28.0±3.7%, and 16.8±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7±2.5%, 79.8±3.4%, and 62.9±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (IQR 43-73) months following the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs (AADs). Another 14 (9.3%) patients maintained sinus rhythm after re-initiation of AADs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (HR 3.831; 95%CI: 2.070-7.143; p<0.001), left atrial diameter ≥50mm (HR 2.083; 95%CI: 1.078-4.016; p=0.03), continuous AF duration ≥18 months (HR 1.984; 95%CI: 1.024-3.846; p<0.04) and structural heart disease (HR 1.874; 95% CI: 1.037-3.388; p=0.04) predicted arrhythmia recurrence. -In patients with PsAF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow up period.Procedural AF non-termination and specific baseline factors predict long-term outcome after ablation.
    Circulation Arrhythmia and Electrophysiology 12/2014; · 5.42 Impact Factor
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    ABSTRACT: Little is presently known about the outcome of atrial lesions performed with high-intensity focused ultrasound (HIFU) for atrial fibrillation ablation. We aimed to assess endocardial atrial lesions 6 months after epicardial HIFU ablation (Epicor(™)) and to evaluate the benefit of a combined ablation approach.
    Journal of Interventional Cardiac Electrophysiology 11/2014; · 1.55 Impact Factor
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    ABSTRACT: Purpose: Radio frequency catheter ablation (RFCA) is a well-established clinical procedure for the treatment of atrial fibrillation (AF) but suffers from a low single-procedure success rate. Recurrence of AF is most likely attributable to discontinuous or nontransmural ablation lesions. Yet, despite this urgent clinical need, there is no clinically available imaging modality that can reliably map the lesion transmural extent in real time. In this study, the authors demonstrated the feasibility of shear-wave elastography (SWE) to map quantitatively the stiffness of RFCA-induced thermal lesions in cardiac tissues in vitro and in vivo using an intracardiac transducer array. Methods: SWE was first validated in ex vivo porcine ventricular samples (N = 5). Both B-mode imaging and SWE were performed on normal cardiac tissue before and after RFCA. Areas of the lesions were determined by tissue color change with gross pathology and compared against the SWE stiffness maps. SWE was then performed in vivo in three sheep (N = 3). First, the stiffness of normal atrial tissues was assessed quantitatively as well as its variation during the cardiac cycle. SWE was then performed in atrial tissue after RFCA. Results: A large increase in stiffness was observed in ablated ex vivo regions (average shear modulus across samples in normal tissue: 22 ± 5 kPa, average shear-wave speed (ct ): 4.5 ± 0.4 m s−1 and in determined ablated zones: 99 ± 17 kPa, average ct : 9.0 ± 0.5 m s−1 for a mean shear modulus increase ratio of 4.5 ± 0.9). In vivo, a threefold increase of the shear modulus was measured in the ablated regions, and the lesion extension was clearly visible on the stiffness maps. Conclusions: By its quantitative and real-time capabilities, Intracardiac SWE is a promising intraoperative imaging technique for the evaluation of thermal ablation during RFCA.
    Medical Physics 10/2014; 41(11):2901. · 3.01 Impact Factor
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    ABSTRACT: -Congenital Long QT syndrome (LQTS) is an arrhythmogenic disorder that causes syncope and sudden death. While its genetic basis has become well-understood, the mechanisms whereby mutations translate to arrhythmia susceptibility in the in situ human heart have not been fully defined. We used noninvasive ECG imaging (ECGI) to map the cardiac electrophysiologic substrate and examine whether LQTS patients display regional heterogeneities in repolarization, a substrate which promotes arrhythmogenesis.
    Circulation 10/2014; · 14.95 Impact Factor
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    ABSTRACT: Background Left Bundle Branch Block (LBBB) leads to prolonged left ventricular (LV) total activation time (TAT) and ventricular electrical uncoupling (VEU: mean LV activation time minus mean right ventricular (RV) activation time); both have been shown to be preferential targets for cardiac resynchronization therapy (CRT). Whether RV apical pacing (RVAP) produces similar ventricular activation patterns has not been well studied. Objective To compare electrical ventricular activation patterns during RVAP and LBBB. Methods We performed electrocardiographic mapping (ECM) during sinus rhythm, RVAP and CRT in 24 patients with LBBB. Results We observed differences in the electrical activation pattern with RVAP compared to LBBB. During LBBB, RV activation occurred rapidly; in contrast RV activation was prolonged during RVAP (46±21 vs. 69±17 ms, p<0.001). There was no significant difference in LVTAT, however, differences in conduction pattern were observed. During LBBB LV activation was circumferential whereas with RVAP it proceeded from apex-to-base. Differences in the number, size and orientation of lines of slow conduction were also observed. With LBBB, VEU was nearly twice as long as during RVAP (73±12 vs. 38±21ms, p<0.001). CRT resulted in a greater reduction in VEU relative to LBBB activation (p<0.001). Conclusion RVAP produces significant differences in ventricular activation characteristics compared to LBBB. Significantly less VEU occurs with RVAP and as a result CRT produces a smaller relative reduction in VEU. This may explain the finding that CRT appears to be more effective in patients with LBBB than in patients upgraded because of high percentages of RV pacing.
    Heart Rhythm 10/2014; · 4.92 Impact Factor
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    ABSTRACT: Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar related VT have been reported.Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high frequency sharp signals that represent near-field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far-field signals. Delayed enhancement on cardiac MRI and/or wall thinning on Multi-Detector Computed Tomography are also extremely helpful to identify the areas of interest during ablationA strategy aiming at careful LAVA mapping, ablation and elimination is feasible and can be achieved in about 70% of patients with scar related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered non-inducible.This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high definition imaging, mapping, and epicardial access.This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 10/2014; · 3.48 Impact Factor
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    ABSTRACT: Background Recurrent peri-mitral atrial tachycardia (AT) is a challenging arrhythmia, yet frequently encountered in the context of atrial fibrillation (AF) ablation. Objective We investigated the clinical characteristics, procedural and clinical outcomes in patients with recurrent peri-mitral AT (PMAT) after AF ablation. Methods Among 520 consecutive ablation procedures for recurrent AT/AF following AF ablation, 40 procedures (patients) were undertaken for clinically recurrent PMAT 12.1±13.6 months after the last procedure (total 2.2±1.3 procedures). Previously, mitral isthmus (MI) linear ablation was performed in 26/40 procedures including 13 procedures with complete block and 13 with 159.0±23.0 ms of conduction delay without block. As a reference group, conduction delay was evaluated in 55 patients with incomplete MI block and absence of spontaneous PMAT during follow-up period. Results Recurrent PMATs were terminated by MI linear ablation in 26/40 patients. Bidirectional block across MI and anterior line joining mitral annulus and left atrial roof was achieved in 33 (82.5%) and 2 (5%) patients, respectively. At mean follow-up of 26.7±14.5 months, 2 (5%) patients underwent reablation for spontaneously recurrent PMAT. At 12 months after the ablation procedure for PMAT, 73.5% of the patients were free from AT/AF. Conduction delay >149 ms predicted the occurrence of spontaneous PMAT with 80.0% sensitivity and 87.3% specificity. Conclusion PMAT can recur even after successful bidirectional MI linear block. Substantial conduction delay without block across the MI from previous procedure(s) could predispose to recurrent PMAT. While most of the clinical PMAT can be successfully treated by catheter ablation, very late recurrence is possible.
    Heart Rhythm 09/2014; · 4.92 Impact Factor
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    ABSTRACT: -The optimal contact force (CF) for ventricular mapping and ablation remains unvalidated. We assessed CF in different endocardial and epicardial regions during ventricular tachycardia (VT) substrate mapping using a CF-sensing catheter (Smartouch, Biosense-Webster) and compared the trans-septal (TS) versus retro-aortic approach (RAo).
    Circulation Arrhythmia and Electrophysiology 09/2014; · 5.95 Impact Factor
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    ABSTRACT: Nonischemic cardiomyopathy (NICM) is a heterogeneous condition providing a favorable substrate for VT.
    Journal of Cardiovascular Electrophysiology 09/2014; · 3.48 Impact Factor
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    ABSTRACT: The early repolarization (ER) pattern has historically been regarded as a benign ECG variant. However in recent years, this view has been challenged based on multiple reports linking the ER pattern with an increased risk of sudden cardiac death. The mechanistic basis of ventricular arrhythmogenesis in ER syndrome is presently incompletely understood. Furthermore, strategies for risk stratification and therapy for ER syndrome remain suboptimal. The recent emergence of novel mapping techniques for cardiac arrhythmia have ushered a new era of research into the mechanistic basis of ER syndrome. This review provides an overview of current evidence relating to ER and risk of ventricular arrhythmias and discusses potential future areas of research to elucidate the mechanisms of ventricular arrhythmogenesis.
    Heart rhythm: the official journal of the Heart Rhythm Society 09/2014; · 4.56 Impact Factor

Publication Stats

25k Citations
3,428.92 Total Impact Points

Institutions

  • 2001–2015
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 1988–2014
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 2013
    • Centre Hospitalier Universitaire de Nantes
      Naoned, Pays de la Loire, France
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2012
    • Maastricht University
      Maestricht, Limburg, Netherlands
    • Niigata University
      Niahi-niigata, Niigata, Japan
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
    • Masonic Medical Research Laboratory
      • Department of Molecular Genetics
      Utica, New York, United States
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 1994–2012
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 2011
    • Inselspital, Universitätsspital Bern
      Berna, Bern, Switzerland
  • 2010
    • University of California, San Diego
      San Diego, California, United States
    • Università degli Studi di Torino
      • Department of Medical Science
      Torino, Piedmont, Italy
    • Lund University
      • Department of Electroscience
      Lund, Skåne, Sweden
  • 2004–2010
    • Cardinal Wyszynski National Institute of Cardiology
      • Department of Heart Failure and Transplantology
      Warszawa, Masovian Voivodeship, Poland
  • 2009
    • The University of Calgary
      Calgary, Alberta, Canada
  • 2007
    • University of Barcelona
      Barcino, Catalonia, Spain
    • University of Hamburg
      Hamburg, Hamburg, Germany
  • 2002
    • University of Geneva
      • Division of Cardiology
      Genève, GE, Switzerland
  • 2000
    • The University of Fort Lauderdale
      Fort Lauderdale, Florida, United States