Michel Haïssaguerre

Université Bordeaux Montaigne, Pessac, Aquitaine, France

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Publications (661)3490.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: -Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias (VA). This study describes VA characteristics and ablation in patients implanted with a Heart Mate 2 (HM2) device. -All patients with a HM2 device who underwent VA catheter ablation at 9 tertiary centers were included. Thirty-four patients (30 male, age 58 ± 10 years) underwent 39 ablation procedures. The underlying cardiomyopathy etiology was ischemic in 21 and non-ischemic in 13 patients with a mean left ventricular ejection fraction of 17±5% before LVAD implantation. One hundred and ten ventricular tachycardias (VTs) (cycle lengths: 230-740ms, arrhythmic storm n=28) and 2 ventricular fibrillation triggers were targeted (25 transseptal, 14 retrograde aortic approaches). Nine patients required VT ablation <1 month after LVAD implantation due to intractable VT. Only 10/110 (9%) of the targeted VTs were related to the HM2 cannula. During follow-up, 7 patients were transplanted and 10 died. Of the remaining 17 patients, 13 were arrhythmia-free at 25 ± 15 months. In 1 patient with VT recurrence, change of turbine speed from 9400 to 9000 rpm extinguished VT. -Catheter ablation of VT among LVAD recipients is feasible and reasonably safe even soon after LVAD implantation. Intrinsic myocardial scar, rather than the apical cannula, appears to be the dominant substrate.
    Circulation Arrhythmia and Electrophysiology 04/2015; DOI:10.1161/CIRCEP.114.002394 · 5.42 Impact Factor
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    ABSTRACT: Ventricular tachycardia (VT) ablation for ventricular arrhythmias is a validated approach, typically performed endocardially, or combined with an epicardial approach if endocardial ablation failed or in case of non-ischaemic cardiomyopathy. We report our experience with epicardial only procedure in a subset of patients with incessant VT or VT storm. This was a single centre retrospective study. Between 2011 and 2014, all patients referred for VT ablation were reviewed at CHU Bordeaux. All patients with an epicardial only (anterior percutaneous approach) mapping and ablation procedure were included. In total, 296 patients underwent a VT ablation and 4 (all male, 70 ± 7 years, 27 ± 11% left ventricular ejection fraction) of them underwent an epicardial only procedure: two ischaemic patients had an endocardial left ventricular thrombus and incessant VT. One patient post-myocarditis had a failed a previous endocardial procedure without local abnormal ventricular activity (LAVA). The fourth patient had a dilated cardiomyopathy and a complicated epicardial puncture followed by mild continuous bleeding (200 mL) precluding anticoagulation associated with left ventricular endocardial access. Local abnormal ventricular activity elimination was verified only epicardially in all and obtained in two patients and non-inducibility was tested and achieved in the two patients without thrombus. No further complications occurred. After a mean follow-up of 21 ± 12 months, one patient (25%) had recurrence of VT and no patient death was observed. Epicardial only ablation seems feasible and effective and useful in a limited subset of patients with incessant VT. However, endpoints are more difficult to evaluate and long-term follow-up is needed. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Europace 04/2015; DOI:10.1093/europace/euv072 · 3.05 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 04/2015; 7(2):162. DOI:10.1016/S1878-6480(15)30085-9
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    ABSTRACT: nMARQ is a multipolar catheter designed to simultaneously ablate at multiple sites around the pulmonary vein (PV) circumference with a single radiofrequency application. We sought to define the safety and efficacy of atrial fibrillation (AF) ablation with the nMARQ catheter. In a multicenter study, patients with drug-refractory AF were included. Procedural outcomes were documented at one-year. 374 patients underwent PV isolation using nMARQ (age 60±10 years, 264 male). 263 patients had paroxysmal AF (PAF), while 111 patients had persistent AF. 1468 out of 1474 veins (99.6%) were isolated with the nMARQ catheter alone. 35 (13%) PAF patients and 30 (27%) persistent AF patients underwent additional ablation at non-PV sites (2.4 ± 1.4 non-PV sites). Procedure time for PV isolation only was 1.9 ± 0.7 hours (fluoroscopy 24 ± 14 minutes). Procedure time for PV isolation and non-PV ablation was 2.4 ± 1.0 hours (fluoroscopy 30 ± 23 minutes). Major adverse events occurred in 2 patients (0.5%); one esophago-pericardial fistula and another mortality due to sepsis of unknown cause. One-year follow-up data was available in 65 (25%) PAF and 20 (18%) persistent AF patients. 42 (65%) PAF and 13 (65%) persistent AF patients were free of arrhythmia at one year. In patients undergoing repeat procedures (n = 17) the most frequent points of PV reconnection were: anterior RSPV, inferior RIPV, and superior LSPV. AF ablation with nMARQ is associated with short procedure times and high acute success rates. Further research is necessary to more clearly define long-term outcome. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 04/2015; DOI:10.1111/jce.12698 · 2.88 Impact Factor
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    ABSTRACT: A non-invasive 3D mapping technique (ECVUE™, CardioInsight Inc., Cleveland) maps the origin and mechanisms of various arrhythmias without catheterizing the heart. Thirty-three patients (3 centers, mean 45.0±14.6y,) with symptomatic premature ventricular complexes (24PVCs), focal atrial tachycardias (2ATs) and manifest accessory pathways (7WPW syndromes) were prospectively explored using 3D, non-invasive bedside electrocardiomapping. The location of origin of the focal arrhythmia was first determined using non-invasive mapping. Subsequently, a stimulus artifact was delivered at this site to confirm and evaluate the precise location of the mapped focal origin. The procedural parameters and clinical efficacy were studied. Ablation was successful in 32/33 (97%) patients (PVCs:13 right, 10 left, 1 septal; WPW:3 left, 3 right; ATs:2 left) without complications. The time from catheterization to permanent arrhythmia elimination/termination, RF duration, skin-to-skin procedural duration and fluoroscopic exposure were median 16min, 3.98min, 71min and 11.9min (for n = 29) respectively. At mean 24.7 ± 3.7months of follow-up, 31 patients remain arrhythmia-free after a single procedure. One patient (right WPW syndrome) required repeat ablation 1month later. One patient had recurrence of PVCs and is now deceased. The cumulative radiation (CT scan and fluoroscopy) exposure was median 7.57mSv. ECVUE(TM) is a -non-invasive tool allowing rapid pre-procedural localization of focal arrhythmia and enables the electrophysiologist with highly specific information to direct RF delivery at the source of the arrhythmia with minimal intracardiac mapping. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 04/2015; DOI:10.1111/jce.12700 · 2.88 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 04/2015; 7(2):167. DOI:10.1016/S1878-6480(15)30098-7
  • Ashok J. Shah, Michel Haissaguerre, Meleze Hocini
    Cardiac electrophysiology clinics 03/2015; 7(1). DOI:10.1016/S1877-9182(15)00004-0
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    ABSTRACT: -Brugada syndrome (BrS) is a highly arrhythmogenic cardiac disorder, associated with an increased incidence of sudden death. Its arrhythmogenic substrate in the intact human heart remains ill-defined. -Using noninvasive ECG imaging (ECGI), we studied 25 BrS patients to characterize the electrophysiologic substrate, and 6 patients with right bundle branch block (RBBB) for comparison. Seven normal subjects provided control data. Abnormal substrate was observed exclusively in the right ventricular outflow tract (RVOT) with the following properties (compared to normal controls; p<0.005): (1)ST-segment elevation (STE) and inverted T-wave of unipolar electrograms (EGMs) (2.21±0.67 vs. 0 mV); (2)delayed RVOT activation (82±18 vs. 37±11 ms); (3)low amplitude (0.47±0.16 vs. 3.74±1.60 mV) and fractionated EGMs, suggesting slow discontinuous conduction; (4)prolonged recovery time (RT; 381±30 vs. 311±34 ms) and activation-recovery intervals (ARIs; 318±32 vs. 241±27 ms), indicating delayed repolarization; (5)steep repolarization gradients (ΔRT/Δx= 96±28 vs. 7±6 ms/cm, ΔARI/Δx= 105±24 vs. 7±5 ms/cm) at RVOT borders. With increased heart rate in 6 BrS patients, reduced STE and increased fractionation were observed. Unlike BrS, RBBB had delayed activation in the entire RV, without STE, fractionation, or repolarization abnormalities on EGMs. -The results indicate that both, slow discontinuous conduction and steep dispersion of repolarization are present in the RVOT of BrS patients. ECGI could differentiate between BrS and RBBB.
    Circulation 03/2015; DOI:10.1161/CIRCULATIONAHA.114.013698 · 14.95 Impact Factor
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    ABSTRACT: Mitral isthmus (MI) ablation is an effective option in patients undergoing ablation for persistent atrial fibrillation (AF). Achieving bidirectional conduction block across the MI is challenging, and predictors of MI ablation success remain incompletely understood. We sought to determine the impact of anatomical location of the ablation line on the efficacy of MI ablation. A total of 40 consecutive patients (87% Male; 54 ± 10 years) undergoing stepwise AF ablation were included. MI ablation was performed in sinus rhythm. MI ablation was performed from the left inferior PV to either the posterior (Group 1) or the anterolateral (Group 2) mitral annulus depending on randomization. The length of the MI line (measured with the 3D mapping system) and the amplitude of the EGMs at 3 positions on the MI were measured in each patient. MI block was achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in group 2 (p = NS). Total MI radiofrequency time (18 ± 7 min vs. 17 ± 8 min; p = NS) was similar between groups. Patients with incomplete MI block had a longer MI length (34 ± 6 mm vs. 24 ± 5 mm; p < 0.001), a higher bipolar voltage along the MI (1.75 ± 0.74 mV vs. 1.05 ± 0.69mV; p < 0.01), and a longer history of continuous AF (19 ± 17 months vs. 10 ± 10 months; p < 0.05). In multivariate analysis, decreased length of the MI was an independent predictor of successful MI block (OR 1.5; 95% CI 1.1-2.1; p < 0.05). Increased length but not anatomical location of the MI predicts failure to achieve bidirectional MI block during ablation of persistent AF. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 03/2015; DOI:10.1111/jce.12667 · 2.88 Impact Factor
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    ABSTRACT: Catheter ablation has emerged as an effective treatment strategy for atrial fibrillation (AF) in recent years. During AF, complex fractionated atrial electrograms (CFAE) can be recorded and are known to be a potential target for ablation. Automatic algorithms have been developed to simplify CFAE detection, but they are often based on a single descriptor or a set of descriptors in combination with sharp decision classifiers. However, these methods do not reflect the progressive transition between CFAE classes. The aim of this study was to develop an automatic classification algorithm, which combines the information of a complete set of descriptors and allows for progressive and transparent decisions. We designed a method to automatically analyze CFAE based on a set of descriptors representing various aspects, such as shape, amplitude and temporal characteristics. A fuzzy decision tree (FDT) was trained and evaluated on 429 predefined electrograms. CFAE were classified into four subgroups with a correct rate of 81±3%. Electrograms with continuous activity were detected with a correct rate of 100%. In addition, a percentage of certainty is given for each electrogram to enable a comprehensive and transparent decision. The proposed FDT is able to classify CFAE with respect to their progressive transition and may allow objective and reproducible CFAE interpretation for clinical use.
    Biomedizinische Technik/Biomedical Engineering 03/2015; DOI:10.1515/bmt-2014-0110 · 2.43 Impact Factor
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    ABSTRACT: Noninvasive mapping overcomes previous barriers to provide panoramic beat-to-beat mapping during atrial fibrillation (AF). This article demonstrates the utility of noninvasive mapping in identifying localized driving sources in persistent AF. Reentrant driver activity detected by noninvasive mapping from specific regions correlated with distinct f-wave morphologies. Ablation targeting these drivers resulted in progressive AF cycle length prolongation and termination of the arrhythmia. Copyright © 2015 Elsevier Inc. All rights reserved.
    Cardiac electrophysiology clinics 03/2015; 7(1):153-155. DOI:10.1016/j.ccep.2014.11.008
  • 03/2015; 1(2):64-67. DOI:10.1016/j.hrcr.2015.01.008
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    ABSTRACT: We studied the extent and distribution of left atrial (LA) fibrosis on delayed-enhanced (DE) MRI in a general cardiology population. 190 consecutive patients referred for cardiac MRI underwent DE imaging using a free breathing method. The population comprised 60 AF patients and 130 patients without AF, including 75 with structural heart disease (SHD). DE was quantified using histogram thresholding, expressed in% of the wall. Regression analysis was performed to identify predictors of DE. Additionally, DE was registered on a template to study its distribution in subpopulations. In the total population, age, AF and SHD were independently associated with DE. DE was increasingly observed from 11.1 ± 4.7% in patients with no SHD nor AF, 18.8 ± 7.8% in SHD and no AF history, 22.9 ± 7.8% in paroxysmal AF, to 27.8 ± 7.7% in persistent AF. Among non-AF patients, age and SHD were independently associated with DE. Among AF patients, female gender and AF persistence were independently associated with DE. DE was variably distributed but more frequently detected in the posterior wall. Age, history of AF and SHD are the most powerful predictors of atrial fibrosis, as detected by MRI, in a general cardiology population. Atrial fibrosis predominates in the posterior LA wall. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 02/2015; 26(5). DOI:10.1111/jce.12651 · 2.88 Impact Factor
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    ABSTRACT: -Therapy strategies for atrial fibrillation based on electrical characterization are becoming viable personalized medicine approaches to treat a notoriously difficult disease. In light of these approaches that rely on high-density surface mapping, this study aims to evaluate the presence of three-dimensional electrical substrate variations within the transmural wall during acute episodes of atrial fibrillation. -Optical signals were simultaneously acquired from the epicardial and endocardial tissue during acute fibrillation in ovine isolated left atria. Dominant frequency, regularity index, propagation angles and phase dynamics were assessed and correlated across imaging planes to gauge the synchrony of the activation patterns compared to paced rhythms. Static frequency parameters were well correlated spatially between the endocardium and the epicardium (dominant frequency, 0.79±0.06 and regularity index, 0.93±0.009). However, dynamic tracking of propagation vectors and phase singularity trajectories revealed discordant activity across the transmural wall. The absolute value of the difference in the number, spatial stability, and temporal stability of phase singularities between the epicardial and endocardial planes was significantly greater than 0 with a median difference of 1.0, 9.27%, and 19.75%, respectively. The number of wavefronts with respect to time was significantly less correlated and the difference in propagation angle was significantly larger in fibrillation compared to paced rhythms. -Atrial fibrillation substrates are dynamic three-dimensional structures with a range of discordance between the epicardial and endocardial tissue. The results of this study suggest that transmural propagation may play a role in AF maintenance mechanisms.
    Circulation Arrhythmia and Electrophysiology 02/2015; 8(2). DOI:10.1161/CIRCEP.114.002545 · 5.42 Impact Factor
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    ABSTRACT: -Epicardial ventricular tachycardia (VT) ablation is associated with risks of coronary artery (CA) and phrenic nerve (PN) injury. We investigated the role of multidetector CT (MDCT) in visualizing CA and PN during VT ablation. -Ninety-five consecutive patients (86 males, age 57±15) with VT underwent cardiac MDCT. The PN detection rate and anatomical variability were analyzed. In 49 patients undergoing epicardial mapping, real-time MDCT integration was used to display CAs/PN locations in 3D mapping systems. Elimination of local abnormal ventricular activities (LAVA) was used as ablation endpoint. The distribution of CAs/PN with respect to LAVA was analyzed and compared between VT etiologies. MDCT detected PN in 81 patients (85%). Epicardial LAVAs were observed in 44/49 patients (15 ICM, 15 NICM, 14 ARVC) with a mean of 35±37 LAVA points/patient. LAVAs were located within 1cm from CAs and PN in 35(80%) and 18(37%) patients, respectively. The prevalence of LAVA adjacent to CAs was higher in NICM and ARVC than in ICM (100% vs. 86% vs. 53%, P<0.01). The prevalence of LAVAs adjacent to PN was higher in NICM than in ICM (93% vs. 27%, P<0.001). Epicardial ablation was performed in 37 patients (76%). Epicardial LAVAs could not be eliminated due to the proximity to CAs or PN in 8 patients (18%). -The epicardial electrophysiological VT substrate is often close to CAs and PN in patients with NICM. High-resolution image integration is potentially useful to minimize risks of PN and CA injury during epicardial VT ablation.
    Circulation Arrhythmia and Electrophysiology 02/2015; 8(2). DOI:10.1161/CIRCEP.114.002420 · 5.42 Impact Factor
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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; 13(3):1-14. DOI:10.1586/14779072.2015.1009039
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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; 24(10). DOI:10.1093/hmg/ddv036 · 6.68 Impact Factor
  • 02/2015; DOI:10.1016/j.hrcr.2015.01.019
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):99-100. DOI:10.1016/S1878-6480(15)71774-X
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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. DOI:10.1016/j.jacc.2014.10.043 · 15.34 Impact Factor

Publication Stats

26k Citations
3,490.65 Total Impact Points

Institutions

  • 2014–2015
    • Université Bordeaux Montaigne
      Pessac, Aquitaine, France
  • 2001–2015
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 1988–2015
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Maastricht University
      Maestricht, Limburg, Netherlands
  • 2010
    • University of California, San Diego
      San Diego, California, United States
    • Lund University
      • Department of Electroscience
      Lund, Skåne, Sweden
  • 1994–2010
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 2008
    • University of Texas at Austin
      Austin, Texas, United States
    • Isala Klinieken
      • Department of Cardiology
      Zwolle, Overijssel, Netherlands
  • 2007
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
    • University of Barcelona
      Barcino, Catalonia, Spain
  • 2002
    • University of Geneva
      • Division of Cardiology
      Genève, GE, Switzerland
  • 2000
    • The University of Fort Lauderdale
      Fort Lauderdale, Florida, United States