Guy Hugues Fontaine (1936 – 2018) was a French cardiologist and electrophysiolgist.
Fontaine was a pioneer in modern electrophysiology and arrhythmia therapy. Worked to map the reentrant circuits in patients with ventricular tachycardia during surgery with the aim of interrupting the reentrant arrhythmia by ventriculotomy.
During this time described and defined arrhythmogenic right ventricular dysplasia; coin the term ‘epsilon wave‘ for the late QRS ‘wiggle’ seen in 30% of patients; and describe bipolar lead placements to best visualise the characteristic waves (Fontaine leads; F-ECG)
- Born 24 December 1936 Corbeil-Essonne, France
- Trained in electrical engineering and medicine
- 1966 – PhD on Contributions of Electrical Stimulation to the Human Heart
- Died 7 March 2018 Saint Mandé, France
Fontaine leads: Fontaine bipolar precordial leads (F-ECG) are used to increase the sensitivity of epsilon wave detection. Leads are placed as shown with the Right Arm (RA) over the manubrium; Left Arm (LA) over the xiphoid process and Left Leg (LL) in the standard V4 position (5th ICS MCL). Instead of regular leads I, II, and III there are now three bipolar chest leads that are termed FI, FII, and FIII which record the potentials developed in the right ventricle, from the infundibulum to the diaphragm.
The vertical bipolar lead FI, (similar to aVF) magnifies the atrial potentials and can be used to record epsilon waves; search for AV dissociation in ventricular tachycardia; and to study abnormal atrial rhythms when the P waves are too small on regular leads.
Key Medical Attributions
Epsilon wave. Fontaine coined the term epsilon wave – small positive deflection (‘blip’ or ‘wiggle’) buried in the end of the QRS complex. It is the characteristic finding in arrhythmogenic right ventricular dysplasia (ARVD/C).
The term “epsilon” was nice, because it occurs in the Greek alphabet after delta; thus, delta represents the pre-excitation and epsilon the post-excitation phenomenon. In addition, epsilon is also used in mathematics to express a very small phenomenon…Fontaine 1997
- Fontaine G, Frank R et al. Significance of intraventricular conduction disorders observed in arrhythmogenic right ventricular dysplasia. Arch Mal Coeur Vaiss. 1984;77:872–9
- Fontaine G. Arrhythmogenic right ventricular dysplasia. Current Opinion in Cardiology, 1995; 10(1): 16-20. [PMID 7787258]
- Fontaine G, Fontaltaliran F. About the histology of arrhythmogenic right ventricular dysplasia. Circulation. 1997 Sep 16;96(6):2089-90. [PMID 9323112]
- Fontaine GH. The multiple facets of right ventricular cardiomyopathies. Eur Heart J. 2011 May;32(9):1049-51 [PMID 21460364]
- Fontaine G, Chen HS. Arrhythmogenic Right Ventricular Dysplasia Back in Force. Am J Cardiol. 2014 May 15;113(10):1735-9 [PMC4119941]
- Hurst JW. Naming of the waves in the ECG, with a brief account of their genesis. Circulation. 1998 Nov 3;98(18):1937-42.
- Berry D. Guy Fontaine and arrhythmogenic right ventricular dysplasia. Eur Heart J. 2011 May;32(9):1042-3
- Li G. Guy Fontaine, a personal tribute. European Heart Journal. 2018; 39(24): 2228–2229
- Frank R. Guy Fontaine MD PhD HDR. European Heart Journal. 2018; 39(24): 2226–2227
- Marcus FI. Guy Fontaine: a pioneer in electrophysiology. Clin Cardiol. 1998 Feb;21(2):145-6.
- Cadogan M. History of the Electrocardiogram. LITFL
- Cadogan M. ECG Lead positioning. LITFL
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