Biography

Philippe Coumel died in Paris on March 18, 2004 after a protracted battle with an illness that annihilated his muscle strength but left his brilliance and contributions intact. Modern electrophysiology was orphaned of one of its greats. Philippe went through all the stages of a professional and academic carrier in one hospital: the hospital Lariboisiere in Paris. Philippe and I met during our military service in Paris, some 45 years ago. We were in an active nephrology service, treating acute renal insufficiency with the old artificial kidney of Kolf. This was the beginning of a long-lasting personal and intellectual friendship. My uncanny interest in cardiac arrhythmias allowed me to share this passion with the benefit of the best mentor and teacher in town. This shared passion was to impact on our life in many ways, although Philippe went through immune to turmoil with his charm, natural elegance and distinction in thought and manner. Friendship and admiration were the reasons why a surgeon volunteered to team with a cardiologist to pay tribute to Philippe Coumel: a gifted scientist and discoverer, a doctor’s doctor and an exquisite mentor and teacher who could decipher, explain and make his arcane domain attractive.

To present Philippe’s contribution in a capsule is an impossible task. In the late 1960's and early 1970's Philippe pioneered the technique of programmed electrical stimulation to study the mechanism of arrhythmias in the clinical laboratory based on methods used in the experimental laboratory. He was the first to use pacemaker implantation to treat a tachycardia. This seminal work was done concomitantly but independently from Durrer and colleagues in Amsterdam.

Philippe first noted the effects of bundle branch block on orthodromic tachycardia in the Wolff-Parkinson-White syndrome and their implication for localization of accessory pathways.

Coumel observed incessant supraventricular tachycardia related to retrograde conduction with long conduction times and described permanent junctional reciprocating tachycardia (PJRT), a term that he coined.

He quickly appreciated the limitations of programmed electrical stimulation in investigating the factors modulating cardiac arrhythmias. He turned to Holter recording as a tool to dissect the modifiers of the substrate, especially the autonomic nervous system.

Philippe introduced the concept of the “triangle” of arrhythmogenesis with three main factors interacting to produce arrhythmia: the arrhythmogenic substrate, the triggering factors and modulating factors, the dominant one being the autonomic nervous system.

Philippe described vagally-induced atrial fibrillation as well as less common adrenergic atrial fibrillation. He understood the concept of combined increased vagal and adrenergic tone. He understood that the best time to study the triggering mechanisms was during spontaneous occurrence recorded on the Holter monitor.

Along with Michel Mirowski, Philippe implanted the first Cardioverter defibrillator in Europe but maintained a selective attitude for its use, endeavoring to identify patients who will benefit most from this device. Electrophysiologists are grappling with this issue to this day.

Philippe first described catecholaminergic polymorphic ventricular tachycardia, as well as a form of Torsades de Pointes triggered by short-coupled ventricular extra systoles in patients with a normal QT interval.

Ventricular depolarization and repolarization and their role in arrhythmogenesis continued to interest Philippe for the remainder of his career.

This capsule of 400 papers and book chapters is a pale representation of Philippe’s papers where he expressed not only science but himself as the man. Philippe was a discoverer who uncovered, observed, experimented and understood new facts where there were only shadows of doubt and ignorance for many. With humility, he was the most severe critique of his observations or experiments, using the scientific method. When a new field was uncovered and its mechanism and tenets well established, Philippe would turn his vision to new horizons and left his colleagues to cultivate the field that was just fertilized. This attitude was baffling but was the logical consequence of Philippe’s quest to study and understand the whole in its demanding complexity: that passion to understand cardiac arrhythmias with their so unpredictable, chaotic, stochastic or misleading features. But Philippe could hear a message when most of us could only perceive noise. This quest to encompass the whole explains the dramatic turn in his carrier when he reinvented himself from an agent provocateur triggering arrhythmias in the EP lab into a scientific sleuth out to uncovered the myriad of agent provocateurs of arrhythmias with the autonomic nervous system as the prime suspect. Philippe envisioned that the substrate, albeit the necessary condition and an easy target, was not necessary the most critical condition.

Member of many international scientific societies, Philippe was the recipient of the “Pioneer in Electrophysiology Award” of NASPE in 1997.Despite the praise and recognition of the world of electrophysiology, Philippe was a modest private man. He loved returning to his roots, family, friends, and hospital where his real life was. Philippe always considered publications, invitations, lectures, recognition, honors and awards as an obligation that he must return to the community. Everywhere Philippe went, he expressed his humanity in science and his science in humanity. He understood humanity with compassion. He could not help enjoying and observing the ironic similarities between the characteristics of human behavior and cardiac arrhythmias. Love and friendship were at the very heart of his practice. He knew and practiced one basic tenet: Science without friendship is hollow.

- Gerard Guiraudon, MD

Interview Excerpt

Influences on arrhythmias by the autonomic nervous system (4:21 sec.; Windows Media Audio)

Excerpted from this interview:
Interviewer: Jerry Griffin, MD
Date: June 28, 1999
Place: Berlin, Germany