In addition to his continuing involvement in the study of cardiac disorders for the treatment of cardiac arrhythmais and the prevention of sudden cardiac death as well as the diagnosis and treatment of some forms of Cardiomyopathies Guy Fontaine was also interested in painting with the following goals in mind:

"Bringing to the People of this World..." described in the Gallery (1964)

• Bringing happiness for those who are sensitive to his kind of Calligraphic painting.
• To target a particular sense of estheticism independent to any kind of other preoccupation.
• To develop a particular style of Calligraphic painting which has been considered by Doris Dillon “unique” in her knowledge of international art when they meet at Oxford University in July 2006.

The interesting aspect of GF painting career is to start again to work in this direction after 40 years of silence due to his medical studies and the time necessary to reach the International level quoted above.

The original paintings performed between 1962 to 1965 were stored in a cellar during 40 years have been exhumed recently. It was amazing to see that the same style of calligraphy was perfectly preserved in his mind and can be started again after the passage of time with the same style.

Guy Fontaine Career Overview
(update August 2007)

Guy Fontaine was born in 1936 in the city of Corbeil Essonnes in France. He attended primary school in a Loyola institution and received secondary school education at the Lycée Montesquieu in Bordeaux prior to moving to Paris.

For the last 40 years he has been in the frontier of electrocardiography and clinical electrophysiology. His training in electrical engineering, together with his medical degree was an excellent background to enable him to contribute to this field. When he first started his career in the 1960s, this was a time of rapid development in medical electronics. In the late 1960s he built and designed different electronic devices for the treatment of patients with cardiac electrical disorders, including a device to synchronise DC shocks on the QRS complexes for the treatment of atrial fibrillation. Some of this equipment is now in the Museum of the Assistance Publique in Paris.

Later, he used his knowledge of electrical phenomena to make significant advances in pacemaker technology in rapid development at that time. One device presented in his medical thesis was used for studying the cardiac pacing threshold of patients waiting for pacemaker implantation. In 1966, he received his doctoral degree with ‘high distinction’ for his work entitled “Contributions to Electrical Stimulation of the Human Heart”. This led him to propose new ideas which have been incorporated by the pacemaker industry in their equipment. These include a design to test the cardiac stimulation threshold and later a system to evaluate the cardiac pacing threshold automatically and continuously.

In 1967, Dr Fontaine was the first physician in Paris to implant permanent pacemakers using intracardiac leads. Because of his expertise in this area he was referred patients with difficult arrhythmia problems from Europe and abroad. In 1968, he joined the cardiology staff at the Hôpital de la Salpêtrière in Paris in the department of Professor Jean Facquet.

In the following years he declined several offers of academic positions in order to devote his efforts to clinical research in cardiac pacing. This attitude was based on the fact that under the supervision of his first master and mentor, Pr J J Welti, he was absolutely convinced after multiple autopsies showing ‘hearts too good to die’ that the eradication of sudden death due to atrioventricular conduction disturbances was possible by solving technical and biotechnical problems. In those early days of pacemaker technology, it was a challenge to implant endocardial leads that would remain in a stable position providing a low pacing threshold after the initial normal rise of this parameter. Patients considered for implantation were the most severe cases. Therefore pacing failure was frequently followed by tragic events. He worked with computer programs to develop the software to study the histograms of 2,400 threshold measurements. Each patient had right ventricular leads connected to an external pacemaker. When the threshold stabilised at an acceptable level, the pacemaker was implanted, if not the endocardial lead was repositioned. He took personal meticulous care of the dressing when the leads emerged from the skin to prevent infection. This complication never occurred.

In 1975, he became interested in tachycardias and their treatment by pacemakers. He observed that many episodes of chronic ventricular tachycardia were preceded by extrasystoles. They were inducing their own repetition following the ‘rule of bigeminy’. He therefore used a properly timed stimulation of the ventricle to shorten the recovery pause after the extrasystole preventing ventricular tachycardia. This concept was later applied to obtain the same result by stimulating the atrium instead of the ventricle. This was achieved for permanent pacing by incorporating a resistor in the ventricular lead and connecting this lead with a regular atrial lead to the output of the first single chamber digital pacemaker (Vitatron DPG-1). This design based on an in-depth knowledge of electricity and biophysic parameters was recognised as an intellectual tour de force.

In 1976, he published the book “The Essentials of Cardiac Pacing”, co-authored with his mentors and colleagues, Professor Y Grosgogeat and J J Welti. This work was translated from French into English, German and Spanish. At that time he worked simultaneously at la Salpêtrière and implanted pacemakers in a private hospital in the centre of Paris. He participated in the training of many colleagues in this field and personally financed his own research.

Dr Fontaine was fascinated by the first surgical attempts to ablate the accessory bypass tract in the WPW syndrome first performed successfully in 1968 at Duke University (USA). After six months of work in the experimental surgical laboratory of Christian Cabrol in Paris, he developed with Dr Guiraudon the technique of epicardial mapping in 1971.

They performed the first European successful surgical ablation of an accessory pathway in WPW syndrome. He refined the technique of mapping by designing amplifiers with summation, rectification and filtering properties to simultaneously record signals from three electrodes located at the distal end of a specially built curved probe. This was designed to record potentials originating on the diaphragmatic ventricular surface without the need to lift the beating heart at the time of surgery. A grid based on anatomical landmarks independent of the size of the heart was designed and was later used worldwide by researchers in this field.

In 1977 the first representation of isochrones of epicardial activation drawn by a computer program was developed. He designed a method to reliably measure ventricular activation times despite the irregular rhythm produced by atrial fibrillation with the use of a tape recorder combined with an oscilloscope.

Dr Fontaine and his associate, Dr Robert Frank, then perfected the technique of epicardial recording which permitted them to obtain the first recordings of epicardial late potentials in humans confirmed six months later by endocardial recording.

Using the same hand held probe that was previously used for mapping the accessory bypass tract, Drs Fontaine, Frank and Guiraudon began to map the reentrant circuits in patients with ventricular tachycardias during surgery. They demonstrated for the first time the interruption of the reentrant pathway and prevention of recurrent ventricular tachycardia with a ‘simple ventriculotomy’. This approach documented that reentry was the mechanism of most chronic forms of ventricular tachycardia, a concept that was controversial at that time.

Another interesting contribution of Dr Fontaine and his group was to demonstrate the delayed activation of normal myocardium after a period of about 100 milliseconds after pacing in a zone where late epicardial potentials were recorded.

This again reinforced the concept of a reentrant phenomenon in heart muscle and definitely excluded the mechanism of triggered activity, another challenging mechanism extensively studied in the laboratories of experimental electrophysiology. From this observation and following the remarkable work on ‘entrainement’ in atrial flutter made by Dr Albert Waldo who trained in Columbia University in New York (NY) where they first met, Dr Fontaine was able, after three days of intensive work with only pen and paper, to propose a new technique of identifying the critical zone of slow conduction in ventricular tachycardia (concealed entrainement). That was his second intellectual tour de force! This zone is the most appropriate for ablation of a circus movement tachycardia. This approach was later extended by others for the same purpose to other forms of reentrant arrhythmias. It is now a commonly used method in the electrophysiological laboratory.

Dr Fontaine relocated in 1979 to the Hospital Jean Rostand continuing the care of referred patients with supraventricular and ventricular tachycardias who were unresponsive or intolerant of antiarrhythmic drugs.

It was just before this phase of his work that Dr Fontaine suggested the term of “Arrhythmogenic Right Ventricular Dysplasia” (ARVD) to describe a new clinical entity found in young patients with ventricular tachycardia originating in the right ventricle showing replacement of myocardial tissue by fat and fibrosis (1977). In these patients the left ventricle was apparently normal. This work led to the publication of a clinical profile of this condition in collaboration with Pr Frank Marcus from Tucson Arizona (USA) who spent a sabbatical year at Jean Rostand hospital in 1979. Dr Fontaine continued to contribute to our understanding of this condition by many observations including the discovery of late potentials on the surface electrocardiogram (Epsilon wave) and its effect on the understanding of the electrical field of the heart.

He developed several software programs to permit the first recording of late potentials on the thorax by the summation averaging technique, the creation of a program simulating the genesis of potentials recorded by a unipolar versus a bipolar electrode system. This facilitated understanding of late and fragmented potentials. He developed other computer programs for the automatic exploration of the atrioventricular conduction properties of the heart in which the computer was used for stimulation of the heart, analysis of data as well as the automatic drawing of curves expressing the results.

Subsequently, several of these concepts such as epicardial maps, summation averaging, automatic programs to facilitate electrophysiologic testing were developed in the United States.

Recently, Dr Fontaine made the important observation that patients with right ventricular dysplasia have a parietal block which results in a QRS complex that has a longer duration in lead V1, V2 or V3 compared with that in V6.

This, in combination with computer processing should be of clinical value for screening or for assisting in verification of this condition. He recently introduced new terms in the classification of bundle branch blocks: the ‘more than complete’ and ‘more than incomplete’ bundle branch blocks. These terms express the prolongation of QRS complexes recorded in the right precordial leads of the ECG as compared to all the other leads. They suggest a trouble in conduction restricted to the right ventricular myocardium in addition to the classical ECG patterns of complete or incomplete right bundle branch block.

This work has been recently extended in collaboration with the French Atomic Energy Commission by the creation of a numeric model of electrical activation of the heart. This work was started in 2002 in collaboration with Dr Aadrian van Oosterom from the University of Nimegue (Holland).

Together with Dr Fontaliran it was found that patients with ARVD appear to be prone to an inflammatory process of unknown etiology involving the right as well as the left ventricular myocardium superimposed on the genetic background of ARVD. This mechanism which may also be genetically determined, has been recently extended to all forms of cardiomyopathies. It has important prognostic implications.

Dr Fontaine made an important contribution regarding the pathology of ARVD. He was consulted as to the cause of death of a 17 year old woman who died suddenly. The histological section from the left ventricle showed an area of fat and fibrosis. Since even small areas of fat in the left ventricle appear to be specific for ARVD, it was suggested that the patient may have had ARVD. Subsequent examination of the right ventricle confirmed the diagnosis of dysplasia. This was the first case in whom the disease was identified from the study of the left ventricle.

An exciting discovery by Dr Fontaine in conjunction with Dr Mallat, Dr Fontaliran and other colleagues is that there is evidence of apoptosis in right ventricular dysplasia that may provide insight into the pathogenesis of this inherited condition. In the normal heart apoptosis is an important mechanism in cardiac embryogenesis by suppression of excessive tissue without necrosis. This process, genetically determined, was identified for the first time in human myocardium in ARVD in 1996.

This disease and its variants is being more frequently recognised, it is a rare but important cause of sudden cardiac death during sports. It is now included in the latest classification of cardiomyopathies proposed by the World Health Organisation in 1996 under the more general term of ‘Arrhythmogenic Right Ventricular Cardiomyopathy’.

Dr Fontaine was instrumental in organising and was President of the First International Symposium devoted to Right Ventricular Dysplasia held in Paris in 1996. Since it is known that this disease is genetic, a challenging problem is now to define the risk of sudden death or identification of this condition in family members. This and other considerations have led Dr Fontaine to initiate the French registry of right ventricular dysplasia in 1999 and to participate in the European Registry co-ordinated by Dr Gaetano Thiene in Padua. Other investigators include Drs McKenna in London, Wichter in Germany, Wlodarska in Poland, Protonotarios in Greece as well as other members of Padua University. This registry is collaborating with the North American Interdisciplinary Study of ARVD under the direction of Dr Marcus.

Dr Fontaine also did extensive research to help understand ablation using direct current energy. This culminated in further research leading to a doctoral thesis in sciences awarded with ‘high distinction’ from the University of Orsay in 1991. The title of this thesis was “Physical, Biophysical and Electrophysical Effects of Fulguration: Application to the Treatment of Cardiac Arrhythmias”.

He is frequently sought for his expertise in catheter ablation of cardiac arrhythmias, especially for ventricular tachycardia, and has participated as a consultant on this procedure in a number of laboratories in the United States. He also performed the first Kent bundle ablation in Shanghai in 1990 where 4 patients were treated successfully by fulguration in 3 days, the first successful radiofrequency ablation of the His bundle in Portugal in 1991, in St Petersburg in 1992, and in Warsaw and Sofia in 1993.

Dr Fontaine is considered as the epitome of the international scientist. He is invited to lecture in Europe, South America, the USA, Japan and China. Notable lectures include one at the American Heart Association in the Main Arena in 1978 (Dallas), The Texas Heart Institute (Houston) in 1981, the Schiaparelli lecture in Venice in 1985, the Mikamo lecture in Osaka in 1986, the Murray Kornfeld Memorial lecture in Boston in 1989 and the Great Wall Cardiologic Conference in Beijing in 2003. Johns Hopkins “Patients conference” in Baltimore, Stanford University and NELCEP New Orleans in 2005. Salt lake City LDS hospital and University of Utah 2005. He is an active participant in the major international congresses. He was co-director of the University Department of Cardiovascular Electrophysiology at Jean Rostand hospital in Ivry/Seine, a suburb of Paris, until 2001.

Dr Fontaine has always stressed international co-operation in medicine. He realised that the traditional French policy of insisting that international congresses in France have to be conducted in French impeded this goal.

In 1985, he organised an International Symposium in Paris on the subject of Fulguration and Lasers in cardiac arrhythmias. This was the first scientific event in cardiology held in Paris and conducted entirely in English – a revolutionary development at that time.

The world of micro-computer technology has not left Dr Fontaine behind. He learned the dBase programing language to evaluate his series of patients treated by high energy DC ablation. The same computer skills are used for the statistical analysis of the data from a population of ARVD patients as compared to a control group.

Dr Fontaine is currently working together with Pr Jean-Philippe Metzger, Daniel Thomas and Iraj Gandjbakhch (Cardiac Surgery) heads of the new “Institut de Cardiologie” in the Hôpital de la Salpêtrière, where ARVD was first identified.

He is continuing to study ARVD in seven French departments/laboratories in Assistance Publique des Hôpitaux de Paris and the French medical research institution INSERM (5 Units).

He was instrumental in convincing Dr William McKenna (London, UK) and his group to identify the gene of Naxos disease (a variant of ARVD) and Dr Jeff Saffitz, an expert in confocal microscopy, from Washington University in St Louis, Missouri (USA) to explain abnormal electrical conduction properties in the myocardium of patients with this condition. In the year 2005 the report of this work obtained the award of Best Scientific Paper published in the Heart Rhythm Society Journal since its inception.

Some recent contributions obtained by the analysis of ARVD patients from the French registry was to demonstrate that older patients with ARVD progress to congestive cardiac failure (2005). He also was the first to report at the American College of Cardiology meeting in 2001 that some of them can be treated by dynamic anterior cardiomyoplasty. This operation wraps the right ventricle with a skeletal muscle partially disconnected from the back of the body. This technique which may prevent heart transplantation was originally developed by Dr Juan Carlos Chachques, Alain Carpentier and Jean Noel Fabiani in Hôpital Broussais and Hôpital Européen Georges Pompidou in Paris.

Since 2003 he has been a consultant for the French department of the Schiller company for the study of light weight defibrillators designed for the treatment of out-of-hospital cardiac arrest.

He has been included in 2007 as “supervisor” in a 4 years research grant from the American Heart Association (AHA) with Dr Li Zhang (University of Utah), for the study of ECGs in children with possible diagnosis of Arrhythmogenic Right Ventricular Dysplasia.

He is the author of more than 840 scientific articles of which 430 are written in English. There are 216 book chapters of which 150 have been published in English. He is the author or editor of six books on different subjects of Electrocardiography or Electrophysiology.

He has received the Pr Pierre Rijlandt Prize of Electrophysiology in 1995 together with Dario di Francesco, Milano (Italy) and Allan Scher, Seattle (USA).

For all these contributions Dr Fontaine biography has been quoted in Who's Who in Medicine and International in 1999, Science in 2003. He is the only French investigator of the XXth Century included in the book “Profiles in Cardiology” edited by three famous American cardiologists : Dr Willis Hurst, Richard Conti and Bruce Fye in 2003. This book which includes 18 Frenchmen presents the biography of 216 individuals who have made a significant contribution to Cardiology and Cardiovascular disease since the XIVth Century. He received the prestigious award of “Pioneer in Cardiac Pacing and Electrophysiology” given by the Heart Rhythm Society in 2005.

Dr Fontaine has been one of the five awardees of the American Biographic Institute's "Legion of Honor" for the year 2005 (selection from 34,200 researchers mostly working in Universities around the World) and one of the 400 International Biographic Centre's "Order of Distinction" (Cambridge UK) also obtained in 2005.

Dr Fontaine has two hobbies. He likes classic music and to improvise on his grand piano in his house in St Mande. He is also interested in making genuine Calligraphic paintings. See his virtual gallery in the "Painting Gallery" section.

Dr Fontaine is fortunate to have a devoted wife. She is a psychiatrist and practices in Paris. They have four children who are accomplished in their own ways. His eldest daughter lives in London and has a degree in Business Management. His son is a computer expert and works in Woodland Hills in the NorthWest of Los Angeles, California, USA. His second daughter is an ophthalmologist at the University of Paris, whilst his youngest daughter is practising rehabilitation Medicine in the city of Grasse on the French Riviera.

Dr Fontaine is an accomplished scientist and an international scholar. He continues to contribute to our understanding of the basics of right ventricular cardiomyopathies their diagnosis, prognosis and treatment.

Biographical Books quoting the name of Guy Fontaine

(Update 26/10/2008)

1. Références des grandes étapes en Cardiologie et Chirurgie Cardiovasculaire
Robert Khoury, Pariente Pub 1993

2. Who’s Who in Medicine 1999

3. Who’s Who International 1999

4. History of Cardiology in China Book made of commented photos Chinese Society of Cardiology 1993

5. Profiles in Cardiology

Willis Hurst Richard Conti Bruce Fye 2003

6. Profiles in Cardiac Pacing Lüderitz B. 2005

7. 2000 Intellectuals of the XXI th Century

International Biographical Center Cambridge UK 2005

8. Great Minds of the XXI th Century

American Biographical Institute Raleigh USA 2005

9. One Hundred Lifetime of Achievement 2005

International Biographical Center Cambridge UK 2006

10. Who's Who in the World 2009 (in press)

11. 500 Greatest Geniuses of the XXI th Century
American Biographical Institute Raleigh USA 2009 (in press)

12. Who's Who en France 2009 (in press)

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