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European Heart Journal 2004 25(12):1083-1084; doi:10.1016/j.ehj.2004.04.032
Copyright © 2004 by the European Society of Cardiology.
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Obituary

Obituary to: Philippe Coumel – A founding father of modern arrhythmology

Jerónimo Farréa,* and Hein J. Wellensb

a Department of Cardiology, Servicio de Cardiologia, Fundacion Jimenez Diaz, Madrid, Spain
b Maastricht, The Netherlands

accepted April 7, 2004 * Correspondence to: Jerónimo Farré, Department of Cardiology, Servicio de Cardiologia, Fundacion Jimenez Diaz, Avda Reyes Católicos 2, 28040 Madrid, Spain. Tel.: +34-91-544-1636; fax: +34-91-549-9402
E-mail address: jfarre{at}telefonica.net

On March 18 2004, Philippe Coumel passed away in Paris. At that time European cardiology lost one of its most creative sons. In the late 1960s and early 1970s Philippe Coumel not only introduced the technique of programmed electrical stimulation of the heart,1 simultaneously but independent from Durrer and co-workers in Amsterdam, but also described criteria to determine the mechanisms and pathways of A–V junctional reciprocating tachycardias.1–5 By reporting findings such as: (1) the paradoxical capture; (2) prolongation of tachycardia V–A conduction times during bundle branch block ipsilateral to the location of the accessory pathway; (3) and by showing pre-excitation of the atria by an appropriately timed ventricular premature extra stimulus during a supra ventricular tachycardia when the bundle of His is refractory, he clearly indicated how to identify the presence of an accessory AV pathway in the tachycardias circuit.

After having studied the substrate of tachycardia and some of its triggers, Coumel realised the limitations of programmed electrical stimulation in investigating all the factors in the development of cardiac arrhythmias. He then used the Holter recording to unravel the role of the autonomic nervous system.6–9 This resulted in the concept of Coumel's triangle of arrhythmogenesis: "there are always three main ingredients required for the production of a clinical arrhythmia, the arrhythmogenic substrate, the trigger factor and the modulation factors of which the most common is the autonomic nervous system. The role of the autonomic nervous system is best assessed by the data provided from Holter recordings, a true electrophysiological investigation, rather than a simple tool for picking up spontaneous arrhythmias."

While Philippe Coumel was one of the early persons to accept the implantable cardioverter defibrillator (ICD),10 he never lost sight of its limitations.11

In the field of ventricular arrhythmias he continued to describe new findings such as the polymorphic catecholaminergic ventricular tachycardias,12 as well as a form of Torsades des Pointes triggered by short-coupled ventricular extrasystoles in patients with a normal QT interval.13 The dynamic behaviour of the QT interval and its role in arrhythmogenesis have been more recent areas of interest for Coumel.14,15

Although Coumel authored almost 400 scientific papers and more than 200 book chapters, he will be remembered by his original concepts based on detailed analysis of an arrhythmia often in a single patient. He immediately recognised what was new an exciting and did not need a large series of patients to prove his theories. Philippe will be remembered by cardiologists from all over the world, not only because of his originality leading to important new findings, but also because of his support and friendship.

References

  1. Coumel P, Cabrol C, Fabiato A et al. Tachycardie permanente par rythme réciproque. Arch. Mal. Coeur. Vaiss. 1967;60:1830–1864.
  2. Coumel P, Attuel P. Reciprocating tachycardia in overt and latent preexcitation. Influence of functional bundle branch block on the rate of the tachycardia. Eur. J. Cardiol. 1974;1:423–436.[Medline]
  3. Coumel P, Attuel P, Motté G et al. Les tachycardies jonctionnelles paroxystiques. Evaluation du point de junction inferieur du cuicuit de réentrée. Demembrement des rythmes recyproques intranodeaux. Arch. Mal. Coeur. Vaiss. 1975;68:1255–1268.[Web of Science][Medline]
  4. Krikler D, Curry P, Attuel P et al. `Incessant' tachycardias in Wolff-Parkinson-White syndrome. I: Initiation without antecedent extrasystoles or PR lengthening, with reference to reciprocation after shortening of cycle length. Br. Heart J. 1976;38:885–896.[Abstract/Free Full Text]
  5. Coumel P, Attuel P, Slama R et al. `Incessant' tachycardias in Wolff-Parkinson-White syndrome. II: role of atypical cycle length dependency and nodal-his escape beats in initiating reciprocating tachycardias. Br. Heart J. 1976;38:897–905.[Abstract/Free Full Text]
  6. Coumel P, Attuel P, Lavallee J et al. The atrial arrhythmia syndrome of vagal origin. Arch. Mal. Coeur. Vaiss. 1978;71:645–656.[Web of Science][Medline]
  7. Coumel P, Friocourt P, Mugica J et al. Long-term prevention of vagal atrial arrhythmias by atrial pacing at 90/minute: experience with 6 cases. Pacing Clin. Electrophysiol. 1983;6:552–560.[CrossRef][Medline]
  8. Coumel P. Cardiac arrhythmias and the autonomic nervous system. J. Cardiovasc. Electrophysiol. 1993;4:338–355.[Web of Science][Medline]
  9. Coumel P, Leenhardt A. Mental activity, adrenergic modulation, and cardiac arrhythmias in patients with heart disease. Circulation. 1991;83(Suppl 4):II58–II70.
  10. Coumel P, Leclercq JF, Slama R. The potential role of the implantable defibrillator in malignant ventricular arrhythmias. Pacing Clin. Electrophysiol. 1984;7:1137–1139.[CrossRef][Medline]
  11. Coumel P, Wilde AA. Learning from mistakes: the case of clinical electrophysiology: a perspective on evidence-based rhythmology. Circulation. 2001;104:845–847.[Free Full Text]
  12. Leenhardt A, Lucet V, Denjoy I et al. Catecholaminergic polymorphic ventricular tachycardia in children. A 7-year follow-up of 21 patients. Circulation. 1995;91:1512–1519.[Abstract/Free Full Text]
  13. Leenhardt A, Glaser E, Burguera M et al. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation. 1994;89:206–215.[Abstract/Free Full Text]
  14. Maison-Blanche P, Coumel P. Changes in repolarization dynamicity and the assessment of the arrhythmic risk. Pacing Clin. Electrophysiol. 1997;20(10 Pt 2):2614–2624.[CrossRef][Medline]
  15. Coumel P, Maison-Blanche P, Badilini F. Dispersion of ventricular repolarization: reality? Illusion? Significance? Circulation. 1998;97:2491–2493.[Free Full Text]

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