1
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Verheul LM, Hoeksema WF, Groeneveld SA, Mulder BA, Bootsma M, Alings M, Evertz R, Blank AC, Kammeraad JAE, Clur SAB, Yap SC, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry. Heart Rhythm 2024:S1547-5271(24)00276-5. [PMID: 38493994 DOI: 10.1016/j.hrthm.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. OBJECTIVE The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. METHODS The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. RESULTS In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2-12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16-18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. CONCLUSION IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.
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Affiliation(s)
- Lisa M Verheul
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | | | - Bart A Mulder
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Reinder Evertz
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janneke A E Kammeraad
- Erasmus MC-Sophia Children's Hospital, Cardiovascular Institute, Department of Pediatric Cardiology, Rotterdam, The Netherlands
| | - Sally-Ann B Clur
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Sing-Chien Yap
- Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Paul G A Volders
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"; Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Utrecht, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
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2
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Verheul LM, Guglielmo M, Groeneveld SA, Kirkels FP, Scrocco C, Cramer MJ, Bootsma M, Kapel GFL, Alings M, Evertz R, Mulder BA, Prakken NHJ, Balt JC, Volders PGA, Hirsch A, Yap SC, Postema PG, Nijveldt R, Velthuis BK, Behr ER, Wilde AAM, Hassink RJ. Mitral Annular Disjunction in Idiopathic Ventricular Fibrillation Patients: Just a Bystander or a Potential Cause? Eur Heart J Cardiovasc Imaging 2024:jeae054. [PMID: 38412329 DOI: 10.1093/ehjci/jeae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
AIMS Previously, we demonstrated that inferolateral mitral annular disjunction (MAD) is more prevalent in patients with idiopathic ventricular fibrillation (IVF) than in healthy controls. In the present study, we advanced the insights into the prevalence and ventricular arrhythmogenicity by inferolateral MAD in an even larger IVF cohort. METHODS AND RESULTS This retrospective multicentre study included 185 IVF patients (median age 39 [27, 52] years, 40% female). Cardiac magnetic resonance images were analysed for mitral valve and annular abnormalities and late gadolinium enhancement. Clinical characteristics were compared between patients with and without MAD. MAD in any of the 4 locations was present in 112 (61%) IVF patients and inferolateral MAD was identified in 24 (13%) IVF patients. Mitral valve prolapse (MVP) was found in 13 (7%) IVF patients. MVP was more prevalent in patients with inferolateral MAD compared with patients without inferolateral MAD(42% vs. 2%, p < 0.001). Proarrhythmic characteristics in terms of a high burden of premature ventricular complexes (PVC) and non-sustained ventricular tachycardia (VT) were more prevalent in patients with inferolateral MAD compared to patients without inferolateral MAD (67% vs. 23%, p < 0.001 and 63% vs 41%, p = 0.046, respectively). Appropriate implantable cardioverter defibrillator therapy during follow-up was comparable for IVF patients with or without inferolateral MAD (13% vs. 18%, p = 0.579). CONCLUSION A high prevalence of inferolateral MAD and MVP is a consistent finding in this large IVF cohort. The presence of inferolateral MAD is associated with a higher PVC burden and non-sustained VTs. Further research is needed to explain this potential interplay.
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Affiliation(s)
- L M Verheul
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Guglielmo
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A Groeneveld
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F P Kirkels
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - C Scrocco
- Cardiology Research Section, St. George University of London, Cranmer Terrace, London, SW17 0RE and St George's University Hospitals NHS Foundation Trust, London, SW17 0QT United Kingdom
| | - M J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Bootsma
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - G F L Kapel
- Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, The Netherlands
| | - M Alings
- Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - R Evertz
- Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen
| | - B A Mulder
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J C Balt
- St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - P G A Volders
- Maastricht University Medical Center+, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" (http://guardheart.ern-net.eu)
| | - A Hirsch
- Erasmus MC, Cardiovascular Institute, Thorax Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - S C Yap
- Erasmus MC, Cardiovascular Institute, Thorax Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - P G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
| | - R Nijveldt
- Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen
| | - B K Velthuis
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E R Behr
- Cardiology Research Section, St. George University of London, Cranmer Terrace, London, SW17 0RE and St George's University Hospitals NHS Foundation Trust, London, SW17 0QT United Kingdom
| | - A A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
| | - R J Hassink
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
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3
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Evertz R, van der Heijden T, Beukema R, Westra S, Meindersma E, van Deursen C, Vernooy K. Comparison and predictors of implantable cardioverter-defibrillator therapy for primary and secondary prevention. Neth Heart J 2023; 31:348-356. [PMID: 37326801 PMCID: PMC10444702 DOI: 10.1007/s12471-023-01785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are effective in detecting and treating ventricular arrhythmias. Studies on ICD therapy for different indications (primary and secondary prevention) and possible predictors of ICD therapy are limited. In this study, the incidence and type of ICD therapy were related to the indication and the underlying cardiac pathology. METHODS A single-centre, retrospective and observational study was performed of 482 patients who underwent ICD implantation for primary (53.3%) or secondary prevention (46.7%) between 2015 and 2020 at the Radboud University Medical Centre. RESULTS During a median follow-up of 2.4 years (interquartile range 0.2-3.9), the occurrence of appropriate ICD therapy for primary versus secondary prevention was 9.7% and 27.6%, respectively (p < 0.001). Time to appropriate ICD therapy was significantly shorter in the secondary prevention group (p < 0.001). No difference in ICD therapy was seen for different underlying aetiologies. In the majority of cases (70%) ICD therapy was given for ventricular tachycardia (VT). The occurrence of adverse events (16.3% vs 17.3%, p = 0.772), hospitalisation for cardiovascular reasons (29.2% vs 35.1%, p = 0.559) and all-cause mortality (12.5% vs 11.6%, p = 0.763) were similar in both groups. Male gender (3.53, 95% confidence interval (CI) (1.003, 12.403), p = 0.049) and secondary prevention indication (4.90, 95% CI (1.495, 16.066), p = 0.009) were predictors of appropriate ICD therapy. CONCLUSION The risk associated with appropriate ICD therapy is higher in secondary prevention patients, who have their first therapy within a shorter time frame after device implantation. Rates of complications, hospitalisation and all-cause mortality are comparable. Future treatment options should target the prevention of ICD therapy, mainly by preventing the recurrence of VT.
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Affiliation(s)
- Reinder Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Tessa van der Heijden
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rypko Beukema
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Esther Meindersma
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline van Deursen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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4
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Bos TA, Piers SRD, Wessels MW, Houweling AC, Bökenkamp R, Bootsma M, Bosman LP, Evertz R, Hellebrekers DMEI, Hoedemaekers YM, Knijnenburg J, Lekanne Deprez R, van Mil AM, Te Riele ASJM, van Slegtenhorst MA, Wilde AAM, Yap SC, Dooijes D, Koopmann TT, van Tintelen JP, Barge-Schaapveld DQCM. The arrhythmogenic cardiomyopathy phenotype associated with PKP2 c.1211dup variant. Neth Heart J 2023:10.1007/s12471-023-01791-2. [PMID: 37505369 PMCID: PMC10400759 DOI: 10.1007/s12471-023-01791-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The arrhythmogenic cardiomyopathy (ACM) phenotype, with life-threatening ventricular arrhythmias and heart failure, varies according to genetic aetiology. We aimed to characterise the phenotype associated with the variant c.1211dup (p.Val406Serfs*4) in the plakophilin‑2 gene (PKP2) and compare it with previously reported Dutch PKP2 founder variants. METHODS Clinical data were collected retrospectively from medical records of 106 PKP2 c.1211dup heterozygous carriers. Using data from the Netherlands ACM Registry, c.1211dup was compared with 3 other truncating PKP2 variants (c.235C > T (p.Arg79*), c.397C > T (p.Gln133*) and c.2489+1G > A (p.?)). RESULTS Of the 106 carriers, 47 (44%) were diagnosed with ACM, at a mean age of 41 years. By the end of follow-up, 29 (27%) had experienced sustained ventricular arrhythmias and 12 (11%) had developed heart failure, with male carriers showing significantly higher risks than females on these endpoints (p < 0.05). Based on available cardiac magnetic resonance imaging and echocardiographic data, 46% of the carriers showed either right ventricular dilatation and/or dysfunction, whereas a substantial minority (37%) had some form of left ventricular involvement. Both geographical distribution of carriers and haplotype analysis suggested PKP2 c.1211dup to be a founder variant originating from the South-Western coast of the Netherlands. Finally, a Cox proportional hazards model suggested significant differences in ventricular arrhythmia-free survival between 4 PKP2 founder variants, including c.1211dup. CONCLUSIONS The PKP2 c.1211dup variant is a Dutch founder variant associated with a typical right-dominant ACM phenotype, but also left ventricular involvement, and a possibly more severe phenotype than other Dutch PKP2 founder variants.
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Affiliation(s)
- Thomas A Bos
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sebastiaan R D Piers
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Arjan C Houweling
- Department of Human Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Regina Bökenkamp
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Debby M E I Hellebrekers
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yvonne M Hoedemaekers
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Knijnenburg
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronald Lekanne Deprez
- Department of Human Genetics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Anneke M van Mil
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anneline S J M Te Riele
- Netherlands ACM Registry, Utrecht, The Netherlands
- Department of Heart and Lungs, Division of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dennis Dooijes
- Department of Clinical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tamara T Koopmann
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Peter van Tintelen
- Netherlands ACM Registry, Utrecht, The Netherlands
- Department of Clinical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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5
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Joosten IBT, Horlings CGC, Vosse BAH, Wagner A, Bovenkerk DSH, Evertz R, Vernooy K, van Engelen BGM, Faber CG. Myotonic dystrophy type 1: A comparison between the adult- and late-onset subtype. Muscle Nerve 2023; 67:130-137. [PMID: 36484161 PMCID: PMC10107795 DOI: 10.1002/mus.27766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Although the extent of muscle weakness and organ complications has not been well studied in patients with late-onset myotonic dystrophy type 1 (DM1), adult-onset DM1 is associated with severe muscle involvement and possible life-threatening cardiac and respiratory complications. In this study we aimed to compare the clinical phenotype of adult-onset vs late-onset DM1, focusing on the prevalence of cardiac, respiratory, and muscular involvement. METHODS Data were prospectively collected in the Dutch DM1 registry. RESULTS Two hundred seventy-five adult-onset and 66 late-onset DM1 patients were included. Conduction delay on electrocardiogram was present in 123 of 275 (45%) adult-onset patients, compared with 24 of 66 (36%) late-onset patients (P = .218). DM1 subtype did not predict presence of conduction delay (odds ratio [OR] 0.706; confidence interval [CI] 0.405 to 1.230, P = .219). Subtype did predict indication for noninvasive ventilation (NIV) (late onset vs adult onset: OR, 0.254; CI, 0.104 to 0.617; P = .002) and 17% of late-onset patients required NIV compared with 40% of adult-onset patients. Muscular Impairment Rating Scale (MIRS) scores were significantly different between subtypes (MIRS 1 to 3 in 66% of adult onset vs 100% of late onset [P < .001]), as were DM1-activC scores (67 ± 21 in adult onset vs 87 ± 15 in late onset; P < .001). DISCUSSION Although muscular phenotype was milder in late-onset compared with adult-onset DM1, the prevalence of conduction delay was comparable. Moreover, subtype was unable to predict the presence of cardiac conduction delay. Although adult-onset patients had an increased risk of having an NIV indication, 17% of late-onset patients required NIV. Despite different muscular phenotypes, screening for multiorgan involvement should be equally thorough in late-onset as in adult-onset DM1.
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Affiliation(s)
- Isis B T Joosten
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Corinne G C Horlings
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Bettine A H Vosse
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anouk Wagner
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - David S H Bovenkerk
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Catharina G Faber
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Centre+, Maastricht, The Netherlands
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6
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Kharbanda RK, Moore JP, Lloyd MS, Galotti R, Bogers AJJC, Taverne YJHJ, Madhavan M, McLeod CJ, Dubin AM, Mah DY, Chang PM, Kamp AN, Nielsen JC, Aydin A, Tanel RE, Shah MJ, Pilcher T, Evertz R, Khairy P, Tan RB, Czosek RJ, Shivkumar K, de Groot NMS. Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study. J Am Heart Assoc 2022; 11:e025121. [DOI: 10.1161/jaha.121.025121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality.
Methods and Results
This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18–77) years at initiation of CRT. Median follow‐up time was 4.1 (25th–75th percentile, 1.3–8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro‐transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th–75th percentile, II–III; after CRT: II, 25th–75th percentile, II–III;
P
=0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds;
P
=0.003) in patients with pre‐CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long‐term follow‐up with a marginal but significant increase in SRV function (before CRT; 30%, 25th–75th percentile, 25–35; after CRT: 31%, 25th–75th percentile, 21–38;
P
=0.049). In contrast, no beneficial change in the above‐mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow‐up, and mortality at latest follow‐up was 21.3%.
Conclusions
This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing‐induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.
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Affiliation(s)
- Rohit K. Kharbanda
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Jeremy P. Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Michael S. Lloyd
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA
| | - Robert Galotti
- Ahmanson/UCLA Adult Congenital Heart Disease Center Los Angeles CA
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Yannick J. H. J. Taverne
- Department of Cardiothoracic Surgery Erasmus MC, University Medical Center Rotterdam The Netherlands
| | - Malini Madhavan
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Anne M. Dubin
- Division of Pediatric Cardiology, Department of Pediatrics Stanford University School of Medicine Stanford CA
| | - Douglas Y. Mah
- Department of Cardiology Boston Children’s Hospital and Harvard Medical School Boston MA
| | - Philip M. Chang
- Congenital Heart Center University of Florida Health Gainesville FL
| | - Anna N. Kamp
- The Heart Center Nationwide Children’s Hospital Colombus OH
| | - Jens C. Nielsen
- Department of Clinical Medicine, Aarhus University and Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Alper Aydin
- Division of Cardiology University of Ottawa Heart Institute Ottawa Canada
| | - Ronn E. Tanel
- Division of Pediatric Cardiology, UCSF Benioff Children’s Hospital University of California San Francisco CA
| | - Maully J. Shah
- Division of Cardiology Children’s Hospital of Philadelphia PA
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine University of Utah Salt Lake City UT
| | - Reinder Evertz
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute Université de Montréal Montreal Quebec Canada
| | - Reina B. Tan
- Division of Pediatric Cardiology New York University Langone Medical Center New York NY
| | - Richard J. Czosek
- Division of Pediatric Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati OH
| | | | - Natasja M. S. de Groot
- Department of Cardiology Erasmus MC, University Medical Center Rotterdam The Netherlands
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7
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Moore JP, de Groot NMS, O'Connor M, Cortez D, Su J, Burrows A, Shannon KM, O'Leary ET, Shah M, Khairy P, Atallah J, Wong T, Lloyd MS, Taverne YJHJ, Dubin AM, Nielsen JC, Evertz R, Czosek RJ, Madhavan M, Chang PM, Aydin A, Cano Ó. Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease. JACC Clin Electrophysiol 2022; 9:385-393. [PMID: 36752449 DOI: 10.1016/j.jacep.2022.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Dyssynchrony-associated left ventricular systolic dysfunction is a major contributor to heart failure in congenital heart disease (CHD). Although conventional cardiac resynchronization therapy (CRT) has shown benefit, the comparative efficacy of cardiac conduction system pacing (CSP) is unknown. OBJECTIVES To compare the clinical outcomes of CSP vs conventional CRT in CHD with biventricular, systemic left ventricular anatomy. METHODS Retrospective CSP data from 7 centers were compared with propensity score-matched conventional CRT control subjects. Outcomes were lead performance, change in left ventricular ejection fraction (LVEF), and QRS duration at 12 months. RESULTS A total of 65 CSP cases were identified (mean age 37 ± 21 years, 46% men). The most common CHDs were tetralogy of Fallot (n = 12 [19%]) and ventricular septal defect (n = 12 [19%]). CSP was achieved after a mean of 2.5 ± 1.6 attempts per procedure (38 patients with left bundle branch pacing, 17 with HBP, 10 with left ventricular septal myocardial). Left bundle branch area pacing [LBBAP] vs HBP was associated with a smaller increase in pacing threshold (Δ pacing threshold 0.2 V vs 0.8 V; P = 0.05) and similar sensing parameters at follow-up. For 25 CSP cases and control subjects with baseline left ventricular systolic dysfunction, improvement in LVEF was non-inferior (Δ LVEF 9.0% vs 6.0%; P = 0.3; 95% confidence limits: -2.9% to 10.0%) and narrowing of QRS duration was more pronounced for CSP (Δ QRS duration 35 ms vs 14 ms; P = 0.04). Complications were similar (3 [12%] CSP, 4 [16%] conventional CRT; P = 1.00). CONCLUSIONS CSP can be reliably achieved in biventricular, systemic left ventricular CHD patients with similar improvement in LVEF and greater QRS narrowing for CSP vs conventional CRT at 1 year. Among CSP patients, pacing electrical parameters were superior for LBBAP vs HBP.
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Affiliation(s)
- Jeremy P Moore
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA; Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA.
| | | | - Matthew O'Connor
- Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Daniel Cortez
- Adult Congenital Cardiology and Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA; Adult Congenital Cardiology and Pediatric Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Jonathan Su
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA
| | - Austin Burrows
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Kevin M Shannon
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA; Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maully Shah
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Atallah
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Tom Wong
- Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael S Lloyd
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jens C Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard J Czosek
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip M Chang
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Óscar Cano
- Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares, Valencia, Spain
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8
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Backhaus SJ, Uzun H, Roesel SF, Schulz A, Lange T, Evertz R, Kutty S, Hasenfus G, Schuster A. Unmasking systolic impairment in HFpEF by cardiovascular magnetic resonance derived hemodynamic force assessment: insights from the HFpEF stress trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Exercise-stress testing is recommended in case of uncertainty; however, this approach is time-consuming and costly. Since preserved EF does not represent normal systolic function, we evaluated cardiovascular magnetic resonance (CMR) comprehensive cardiac hemodynamic forces (HDF) analyses for an in-depth characterisation of cardiac function at rest.
Methods
The HFpEF Stress Trial (DZHK-17) prospectively recruited 75 patients with exertional dyspnea, preserved EF (≥50%) and signs of diastolic dysfunction (E/e' ≥8) on echocardiography. Patients underwent right heart catheterisation, echocardiography and CMR. 68 patients entered the final study cohort (HFpEF n=34 and non-cardiac dyspnea n=34 according to pulmonary capillary wedge pressure (PCWP)). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, E-wave deceleration as well as A-wave acceleration forces. Two patients were lost to 24 months follow-up evaluating cardiovascular mortality and hospitalisation (CVH).
Results
HDF assessment revealed impairment of LV longitudinal force in HFpEF (15.8 vs. 18.3, p=0.035) attributable to impairment of systolic peak (38.6 vs 51.6, p=0.003) and impulse (20.8 vs. 24.5, p=0.009) forces as well as late diastolic filling (−3.8 vs −5.4, p=0.029). Impairment of early diastolic filling could be observed in HFpEF patients identified at rest only but not stress (7.7 vs. 9.9, p=0.004). Impaired systolic peak was associated to CVH (HR 0.95, p=0.016) and superior for CVH prediction compared to LV global longitudinal strain (AUC 0.76 vs. 0.61, p=0.048).
Conclusions
Assessment of HDF reveals impairment of LV systolic and diastolic function in HFpEF. The value of systolic HDF assessment exceeded that of conventional deformation imaging for CVH prediction.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research
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Affiliation(s)
- S J Backhaus
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - H Uzun
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - S F Roesel
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - A Schulz
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - T Lange
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - R Evertz
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Taussig Heart Center , Baltimore , United States of America
| | - G Hasenfus
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
| | - A Schuster
- Georg-August University, Department of Cardiology and Pneumology , Göttingen , Germany
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De Riva Silva M, Evertz R, Lukac P, Dekker L, Ouss A, Blauw Y, Mulder B, Ter Bekke R, Vernooy K, Wijnmaalen AP, Kimura Y, Zeppenfeld K. Post-infarct VT substrate ablation based on evoked delayed potential elimination as well-defined target: results from a prospective multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with VT after myocardial infarction (MI), substrate-based ablation is superior to approaches that target clinical and tolerated VTs only. Different substrate modification strategies have been reported. However, proposed ablation targets are prone to operator interpretation (e.g. abnormal electrograms). Accordingly, ablation results can also be operator dependent. Evoked delayed potentials (EDP) are a well-defined target. Elimination of EDP has been effective to prevent VT recurrence in a retrospective, single center cohort.
Aim
(1)To evaluate the outcome of EDP ablation in a prospective cohort of patients included on an intention-to-treat principle and (2)to assess the outcome of EDP ablation following one uniform protocol when performed in centers without prior experience with this strategy.
Methods
Consecutive patients referred for post-MI VT ablation were prospectively enrolled in one center with extensive experience in EDP ablation and 5 centers with no prior experience. Substrate mapping focused on EDP identification followed a uniform protocol across all centers. In brief, all electrograms located within the infarct area were analyzed during sinus rhythm, RV pacing at a fixed rate and during the application of one short-coupled RV extra-stimulus (S2). Sites showing low-voltage, nearfield electrograms with >10ms delay or block in response to S2 were categorized as EDP and targeted for ablation. After ablation, re-mapping to confirm EDP elimination and a complete stimulation protocol (up to 4 extra's from RV and LV) were performed. Patients were followed for VT recurrence and mortality.
Results
130 patients (69±10 years, 87% men, 42% anterior MI, LVEF 34% (IQR 24–43), 71% NYHA II–III, 42% on amiodarone, 52% ≥1 ICD shock, 22% with electrical storm or incessant VT) were included. The extra-stimulation protocol was systematically conducted in 127 (98%) patients and in 121 (93%), EDPs were identified. EDPs were successfully eliminated in 117/121 (97%) patients. After 23 (IQR 14–35) min of RF, 102 (78%) patients were rendered non-inducible. Median procedural duration was 212 (IQR 179–262) min. During follow-up of 14 (IQR 8–18) months, 36 (28%) patients had VT recurrence and 13 (10%) died or received a LVAD. VT-free survival was 79% (95% CI: 72–86) and 72% (95% CI: 63–80) at 6 and 12 months follow-up. Of note, VT-free survival at 12 month was not significantly different between patients undergoing the procedure in centers with and without prior experience in EDP ablation (76% (95% CI: 61–90) vs. 70% (95% CI: 59–81); P=0.269).
Conclusion
In a large prospective cohort of patients with post-MI VT, substrate ablation based on EDP elimination resulted in excellent long-term outcome. Of importance, procedural outcomes were similar in centers with or without experience in EDP ablation, indicating that this approach can be easily reproduced by operators previously not familiar with the technique.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - R Evertz
- Radboud University Medical Center , Nijmegen , The Netherlands
| | - P Lukac
- Aarhus University Hospital, Cardiology , Aarhus , Denmark
| | - L Dekker
- Catharina Hospital , Eindhoven , The Netherlands
| | - A Ouss
- Catharina Hospital , Eindhoven , The Netherlands
| | - Y Blauw
- University Medical Centre Groningen , Groningen , The Netherlands
| | - B Mulder
- University Medical Centre Groningen , Groningen , The Netherlands
| | - R Ter Bekke
- Maastricht University Medical Centre (MUMC) , Maastricht , The Netherlands
| | - K Vernooy
- Maastricht University Medical Centre (MUMC) , Maastricht , The Netherlands
| | - A P Wijnmaalen
- Leiden University Medical Center , Leiden , The Netherlands
| | - Y Kimura
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Zeppenfeld
- Leiden University Medical Center , Leiden , The Netherlands
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10
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Groeneveld SA, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Wilde AAM, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation. J Am Heart Assoc 2022; 11:e025364. [PMID: 35929463 PMCID: PMC9496286 DOI: 10.1161/jaha.121.025364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls. Methods and Results In this retrospective, multicenter cohort study, cardiac magnetic resonance images from patients with IVF (ie, negative for ischemia, cardiomyopathy, and channelopathies) and age‐ and sex‐matched control subjects were analyzed for the presence of MAD (≥2 mm) and MVP (>2 mm). In total, 72 patients (mean age 39±14 years, 42% women) and 72 control subjects (mean age 41±11 years, 42% women) were included. MAD in the inferolateral wall was more prevalent in patients with IVF versus healthy controls (7 [11%] versus 1 [1%], P=0.024). MVP was only seen in patients with IVF and not in controls (5 [7%] versus 0 [0%], P=0.016). MAD was observed in both patients with (n=4) and without (n=3) MVP. Conclusions Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Feddo P Kirkels
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Maarten J Cramer
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Kristina H Haugaa
- ProCardio Center for Innovation Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway.,University of Oslo Oslo Norway
| | - Pieter G Postema
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Niek H J Prakken
- Department of Radiology University Medical Center Groningen Groningen the Netherlands
| | - Arco J Teske
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Birgitta K Velthuis
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Rutger J Hassink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
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11
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Joosten IBT, Janssen CEW, Horlings CGC, den Uijl D, Evertz R, van Engelen BGM, Faber CG, Vernooy K. An evaluation of 24 h Holter monitoring in patients with myotonic dystrophy type 1. Europace 2022; 25:156-163. [PMID: 35851806 PMCID: PMC9907751 DOI: 10.1093/europace/euac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate the clinical effectiveness of routine 24 h Holter monitoring to screen for conduction disturbances and arrhythmias in patients with myotonic dystrophy type 1 (DM1). METHODS AND RESULTS A retrospective two-centre study was conducted including DM1-affected individuals undergoing routine cardiac screening with at least one 24 h Holter monitoring between January 2010 and December 2020. For each individual, the following data were collected: Holter results, results of electrocardiograms (ECGs) performed at the same year as Holter monitoring, presence of cardiac complaints, and neuromuscular status. Holter findings were compared with the results of cardiac screening (ECG + history taking) performed at the same year. Cardiac conduction abnormalities and/or arrhythmias that would have remained undiagnosed based on history taking and ECG alone were considered de novo findings. A total 235 genetically confirmed DM1 patients were included. Abnormal Holter results were discovered in 126 (54%) patients after a mean follow-up of 64 ± 28 months in which an average of 3 ± 1 Holter recordings per patient was performed. Abnormalities upon Holter mainly consisted of conduction disorders (70%) such as atrioventricular (AV) block. Out of 126 patients with abnormal Holter findings, 74 (59%) patients had de novo Holter findings including second-degree AV block, atrial fibrillation/flutter and non-sustained ventricular tachycardia. Patient characteristics were unable to predict the occurrence of de novo Holter findings. In 39 out of 133 (29%) patients with normal ECGs upon yearly cardiac screening, abnormalities were found on Holter monitoring during follow-up. CONCLUSION Twenty-four hour Holter monitoring is of added value to routine cardiac screening for all DM1 patients.
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Affiliation(s)
- Isis B T Joosten
- Corresponding author. Tel: +31 43 3877059; fax: +31 43 3877055. E-mail address:
| | - Cheyenne E W Janssen
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Corinne G C Horlings
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, The Netherlands,Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Dennis den Uijl
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Catharina G Faber
- Department of Neurology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre+, Maastricht, The Netherlands
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12
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Evertz R, Hub S, Kowallick J, Seidler T, Danner B, Hasenfuß G, Toischer K, Schuster A. 482 How Much Experience Is Required For Aortic Valve Morphology Assessment And Valve Size Selection In Tavr Patients? J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Verhaert DVM, Linz D, Chaldoupi SM, Westra SW, den Uijl DW, Philippens S, Kerperien M, Habibi Z, Vorstermans B, ter Bekke RMA, Beukema RJ, Evertz R, Hemels MEW, Luermans JGLM, Manusama R, Lankveld TAR, van der Heijden CAJ, Bidar E, Hermans BJM, Zeemering S, Bijvoet GP, Habets J, Holtackers RJ, Mihl C, Nijveldt R, van Empel VPM, Knackstedt C, Simons SO, Buhre WFFA, Tijssen JGP, Isaacs A, Crijns HJGM, Maesen B, Vernooy K, Schotten U. Rationale and Design of the ISOLATION Study: A Multicenter Prospective Cohort Study Identifying Predictors for Successful Atrial Fibrillation Ablation in an Integrated Clinical Care and Research Pathway. Front Cardiovasc Med 2022; 9:879139. [PMID: 35879962 PMCID: PMC9307503 DOI: 10.3389/fcvm.2022.879139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Continuous progress in atrial fibrillation (AF) ablation techniques has led to an increasing number of procedures with improved outcome. However, about 30-50% of patients still experience recurrences within 1 year after their ablation. Comprehensive translational research approaches integrated in clinical care pathways may improve our understanding of the complex pathophysiology of AF and improve patient selection for AF ablation. Objectives Within the "IntenSive mOlecular and eLectropathological chAracterization of patienTs undergoIng atrial fibrillatiOn ablatioN" (ISOLATION) study, we aim to identify predictors of successful AF ablation in the following domains: (1) clinical factors, (2) AF patterns, (3) anatomical characteristics, (4) electrophysiological characteristics, (5) circulating biomarkers, and (6) genetic background. Herein, the design of the ISOLATION study and the integration of all study procedures into a standardized pathway for patients undergoing AF ablation are described. Methods ISOLATION (NCT04342312) is a two-center prospective cohort study including 650 patients undergoing AF ablation. Clinical characteristics and routine clinical test results will be collected, as well as results from the following additional diagnostics: determination of body composition, pre-procedural rhythm monitoring, extended surface electrocardiogram, biomarker testing, genetic analysis, and questionnaires. A multimodality model including a combination of established predictors and novel techniques will be developed to predict ablation success. Discussion In this study, several domains will be examined to identify predictors of successful AF ablation. The results may be used to improve patient selection for invasive AF management and to tailor treatment decisions to individual patients.
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Affiliation(s)
- Dominique V. M. Verhaert
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Dominik Linz
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sevasti Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sjoerd W. Westra
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Dennis W. den Uijl
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mijke Kerperien
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Zarina Habibi
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bianca Vorstermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Rachel M. A. ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Rypko J. Beukema
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Martin E. W. Hemels
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Justin G. L. M. Luermans
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Randolph Manusama
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Theo A. R. Lankveld
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Claudia A. J. van der Heijden
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ben J. M. Hermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Geertruida P. Bijvoet
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jesse Habets
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robert J. Holtackers
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Vanessa P. M. van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sami O. Simons
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Jan G. P. Tijssen
- Department of Cardiology, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Aaron Isaacs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Harry J. G. M. Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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14
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Evertz R, De Riva Silva M, Lukac P, Dekker L, Ouss A, Blauw Y, Mulder BA, Ter Bekke R, Vernooy K, Wijnmaalen AP, Kimura Y, Zeppenfeld K. Post-infarct VT substrate ablation based on evoked delayed potential elimination as well-defined target : results from a prospective multicenter study. Europace 2022. [DOI: 10.1093/europace/euac053.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Substrate ablation is superior to approaches that target clinical and tolerated VTs in patients with post-myocardial infarction (MI) VT. Different substrate modification strategies have been reported. However, proposed ablation targets are prone to operator interpretation (e.g. abnormal electrograms). Accordingly, ablation results can also be operator dependent. Evoked delayed potentials (EDP) are a well-defined target. Elimination of EDP has been effective to prevent VT recurrence in a retrospective, single center cohort.
Aim
(1)To evaluate the outcome of EDP ablation in a prospective cohort of patients included on an intention-to-treat principle and (2)to assess the outcome of EDP ablation following one uniform protocol when performed in centers without prior experience with this strategy.
Methods
Consecutive patients referred for post-MI VT ablation were prospectively enrolled in one center with extensive experience in EDP ablation and 5 centers with no prior experience. Substrate mapping focused on EDP identification followed a uniform protocol across all centers. In brief, all electrograms located within the infarct area were analyzed during sinus rhythm, RV pacing at a fixed rate and during the application of one short-coupled RV extra (S2). Sites showing low-voltage, nearfield electrograms with >10ms delay or block in response to S2 were categorized as EDP and targeted for ablation. After ablation, re-mapping to confirm EDP elimination and a complete stimulation protocol (up to 4 extra’s from RV and LV) were performed.
Results
131 patients (69±10 years, 87% men, 42% anterior MI, LVEF 33±11%, 70% NYHA II-III, 43% on amiodarone, 52% ≥1 ICD shock, 34% with electrical storm or incessant VT) were included. Multipolar catheters or catheters with micro-electrodes in the tip were used in 53%. The extra-stimulation protocol was systematically conducted in 127 (97% ) patients and in 121 (92%), EDPs were identified. EDPs were successfully eliminated in 117/121 (97%) patients. After 23 (IQR 14-35) min of RF, 101 (77%) patients were rendered non-inducible. Median procedural duration was 213 (IQR 180-267) min. During follow-up of 14 (IQR 8-19) months, 36 (27%) patients had VT recurrence and 14 (11%) died or received a LVAD. VT-free survival was 78% (CI95% 71-85) and 71% (CI95% 63-80) at 6 and 12 months follow-up. Of note, VT-free survival at 12 month was not significantly different between patients undergoing the procedure in centers with and without prior experience in EDP ablation (76% (CI95% 62-90) vs. 69% (CI95% 59-80); P=0.269).
Conclusion
In a large prospective cohort of patients with post-MI VT, substrate ablation based on EDP elimination resulted in excellent long-term outcome. Of importance, procedural outcomes were similar in centers with or without experience in EDP ablation, indicating that this approach can be easily reproduced by operators previously not familiar with the technique.
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Affiliation(s)
- R Evertz
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - M De Riva Silva
- Leiden University Medical Center, cardiology, Leiden, Netherlands (The)
| | - P Lukac
- Aarhus University Hospital, cardiology, Aarhus, Denmark
| | - L Dekker
- Catharina Hospital, cardiology, Eindhoven, Netherlands (The)
| | - A Ouss
- Catharina Hospital, cardiology, Eindhoven, Netherlands (The)
| | - Y Blauw
- University Medical Center Groningen, cardiology, Groningen, Netherlands (The)
| | - BA Mulder
- University Medical Center Groningen, cardiology, Groningen, Netherlands (The)
| | - R Ter Bekke
- Maastricht University Medical Centre (MUMC), cardiology, Maastricht, Netherlands (The)
| | - K Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), cardiology, Maastricht, Netherlands (The)
| | - AP Wijnmaalen
- Leiden University Medical Center, cardiology, Leiden, Netherlands (The)
| | - Y Kimura
- Leiden University Medical Center, cardiology, Leiden, Netherlands (The)
| | - K Zeppenfeld
- Leiden University Medical Center, cardiology, Leiden, Netherlands (The)
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15
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Evertz R, Hub S, Backhaus S, Lange T, Toischer K, Kowallick J, Hasenfuss G, Schuster A. Comparison of different sowtware solutions for AVC quantification using contrast enhanced MDCT. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
Estimating aortic valve calcification (AVC) derived from multi detector computed tomography (MDCT) scans in aortic stenosis (AS) patients has gained increasing interest for diagnostic and prognostic reasons. Little is known about the interchangeability of AVC obtained from different software solutions which, was systematically determined in consecutive patients undergoing contrast enhanced MDCT before TAVR.
Methods and results
50 randomly selected patients who underwent contrast enhanced MDCT for TAVR planning were included in the analysis. All MDCT data sets were analysed using three different software vendors (3 Mensio, CVI 42, Snygo.Via). AVC score was expressed as mm³. For analysing intra- and inter-observer variability a subset of 10 patients were analysed twice with at least 2 weeks in between the measurements. Intra- and inter-observer variability was quantified using the ICC reliability method, Bland-Altman analysis and coefficients of variation.
AVC scores were successfully obtained using all software solutions (3 Mensio 941 ± 623, CVI42 941 ± 637, Syngo.Via 948 mm³ ± 655) without significant differences (p = 0.455). There was excellent intra- (3 Mensio: ICC 0.999 [0.995 – 1.000], COV 3.86 %, mean difference -19.28 [± 45.07]; CVI 42: ICC 1.000 [0.999 – 1.000], COV 1.6 %, mean difference -10.28 [± 18.6]; Syngo.Via: ICC 0.998 [0.993 – 1.000], COV 4.13 %, mean difference -24.81 [± 48.52]) and inter-observer variability (3 Mensio: ICC 1.000 [0.999 – 1.000], COV 1.38 %, mean difference -7.14 [± 16.20]; CVI 42: ICC 1.000 [1.000 – 1.000], COV 1.01 %, mean difference -1.74 [± 11.83]; Syngo.Via: ICC 0.996 [0.985 – 0.999], COV 6.68 %, mean difference -0.65 [± 79.43]) for all software types. Best inter-vendor agreement was found between CVI 42 and Syngo.Via (ICC 0.997 [CI 0.995-0.998], COV 7.26 %, mean difference -7 [± 68.60]) followed by 3 Mensio / CVI 42 (ICC 0,996 [CI 0,922-0,998], COV 8.95 %, mean difference -0.06 [± 84.16]) and 3 Mensio / Syngo.Via (ICC 0,992 [CI 0,986-0,995], COV 12.19%, mean difference -7.06 [± 115.07]).
Conclusion
Contrast enhanced MDCT derived AVC scores are interchangeable between and reproducible within different commercially available software solutions. This is important since sufficient reproducibility, inter-changeability and valid results represent prerequisites for accurate TAVR planning and wide spread clinical use.
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Affiliation(s)
- R Evertz
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - S Hub
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - S Backhaus
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - T Lange
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - K Toischer
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - J Kowallick
- University Medical Center of Gottingen (UMG), Department of Diagnostic& Interventional Radiology, Goettingen, Germany
| | - G Hasenfuss
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - A Schuster
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
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16
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Evertz R, Hub S, Beuthner B, Backhaus S, Lange T, Topci R, Toischer K, Kowallick J, Puls M, Zeisberg E, Hasenfuss G, Schuster A. Aortic valve calcification and endomyocardial fibrosis determine adverse outcomes following transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
There is evidence to suggest that subtype of aortic stenosis (AS), degree of myocardial fibrosis (MF) and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Since little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as association with adverse cardiac events.
Methods
100 consecutive patients with severe AS and indication for transfemoral transcatheter aortic valve replacement (TAVR) were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multi detector computed tomography (MDCT) and left ventricular endomyocardial biopsy at the time of TAVR.
Results
The final study cohort consisted of 92 patients with completed study protocol comprising of 39 (42.4 %) normal ejection fraction high gradient (NEFHG), 13 (14.1 %) low EF high gradient (LEFHG), 25 (27.2 %) low EF (flow) low gradient (LEFLG) and 15 (16.3 %) paradoxical low flow low gradient (PLFLG) AS. The high gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421; 813 ± 281 mm³ respectively) as compared to the low gradient phenotypes (LEFLG and PLFLG; 503 ± 326; 555 ± 594 mm³ respectively, p < 0.05). Conversely, MF was most prevalent in low output phenotypes (LEFLG > LEFHG > PLFLG > HEFHG, p < 0.05). This was paralleled by larger cardiovascular mortality within 600 days post TAVR (LEFLG n = 7 > PLFLG n = 4 > LEFHG n = 2 > NEFHG n = 1). In Patients with high MF burden a higher AVC was associated with a lower mortality (p = 0.045, HR = 0.261, 95%CI 0.07-0.97). Within LEFLG AS, patients with larger AVC (>476.8 mm³) had larger MF (40.2%) and higher cardiovascular mortality (n = 5) as compared to patients with lower AVC (£476.8 mm³, 17.1% MF, p = 0.027, cardiovascular mortality n = 2).
Conclusion
MF is associated with adverse cardiovascular outcome following TAVR which is most prevalent in low ejection fraction situations. In the presence of large MF burden patients with large AVC have better outcome following TAVR. Conversely worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy while better survival rates in large AVC patients may indicate severe AS associated pressure overload relief and subsequently improved survival following TAVR.
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Affiliation(s)
- R Evertz
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - S Hub
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - B Beuthner
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - S Backhaus
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - T Lange
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - R Topci
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - K Toischer
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - J Kowallick
- University Medical Center of Gottingen (UMG), Department of Diagnostic& Interventional Radiology, Goettingen, Germany
| | - M Puls
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - E Zeisberg
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - G Hasenfuss
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
| | - A Schuster
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology , Goettingen, Germany
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17
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Joosten IBT, van Lohuizen R, den Uijl DW, Evertz R, de Greef BTA, van Engelen BGM, Faber CG, Vernooy K. Electrocardiographic predictors of infrahissian conduction disturbances in myotonic dystrophy type 1. Europace 2021; 23:298-304. [PMID: 33150426 PMCID: PMC7868883 DOI: 10.1093/europace/euaa256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022] Open
Abstract
Aims The aim of this study was to determine electrocardiographic (ECG) criteria predicting abnormal infrahissian conduction in patients with myotonic dystrophy type 1 (DM1), as these criteria could be used to identify the need for an electrophysiological study (EPS). Methods and results A retrospective multicentre study was conducted including DM1-affected individuals who underwent EPS between 2007 and 2018. For each individual, EPS indication, His-ventricle (HV) interval, resting ECG parameters prior to EPS, left ventricular ejection fraction (LVEF), neurological status, and DM1 DNA analysis results were collected. Electrocardiographic parameters of patients with a normal HV interval were compared with ECG parameters of patients with a prolonged HV interval. Logistic regression was performed to determine predictors for a prolonged HV interval of ≥70 ms on EPS and diagnostic accuracy of ECG parameters was ascertained. Among 100 DM1-affected individuals undergoing EPS, 47 had a prolonged HV interval. The sole presence of a PR interval >200 ms [odds ratio (OR) 8.45, confidence interval (CI) 2.64–27.04] or a QRS complex >120 ms (OR 9.91, CI 3.53–27.80) on ECG were independent predictors of a prolonged HV interval. The combination of both parameters had a positive predictive value of 78% for delayed infrahissian conduction on EPS. His-ventricle interval was independent of DM1 genetic mutation size, neuromuscular status, and LVEF. Conclusion The combination of a prolonged PR interval and widened QRS complex on ECG accurately predicts abnormal infrahissian conduction on EPS in patients with DM1. These ECG parameters could be used as a screening tool to determine the need for referral to a specialized multidisciplinary neuromuscular team with EPS capacity.
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Affiliation(s)
- Isis B T Joosten
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Romy van Lohuizen
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bianca T A de Greef
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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18
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Groeneveld S, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of mitral annulus disjunction and mitral valve prolapse in a multicenter cohort of idiopathic ventricular fibrillation patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation
Background
Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP) and ventricular arrhythmias[1,2]. The prevalence of MAD and MVP in IVF patients in this regard, is not well established.
Purpose
To explore prevalence of MAD and MVP in IVF patients.
Methods
In this retrospective multicenter cohort study, Cardiac Magnetic Resonance images from IVF patients (i.e., negative for ischemia, cardiomyopathy and channelopathies) and matched control subjects were analyzed for MAD (≥2mm) and MVP (>2mm).
Results
In total, 71 IVF patients (mean age 39, 59% male) and 71 controls (mean age 41, 58% male) were included. MAD in the inferolateral wall was more prevalent in IVF patients versus healthy controls (6 [10%] vs. 1 [1%], p = 0.035). MVP was only seen in IVF patients and not in controls (4 [7%] vs. 0 [0%], p = 0.037). MVP was observed both in IVF patients with (n = 3) and without (n = 1) MAD. Patients with MAD did not show papillary muscle fibrosis. Four (67%) patients with MAD showed frequent ventricular ectopy from the basal myocardial region.
Conclusion
Inferolateral MAD and MVP were significantly more prevalent in IVF patients compared to healthy controls (figure). This is in line with previous studies suggesting a correlation between mitral valve disease and IVF. Our findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
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Affiliation(s)
- S Groeneveld
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - FP Kirkels
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - MJ Cramer
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - R Evertz
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - KH Haugaa
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - PG Postema
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - NHJ Prakken
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - AJ Teske
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - BK Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - R Nijveldt
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - RJ Hassink
- University Medical Center Utrecht, Utrecht, Netherlands (The)
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19
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Evertz R, Reinders M, Houck C, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy. Open Heart 2020; 7:openhrt-2020-001298. [PMID: 32817255 PMCID: PMC7437693 DOI: 10.1136/openhrt-2020-001298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Currently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies. Methods A single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied. Results Almost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF. Conclusion No clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.
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Affiliation(s)
- Reinder Evertz
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon Reinders
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charlotte Houck
- Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Tim Ten Cate
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rypko Beukema
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoerd Westra
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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20
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Roudijk RW, Evertz R, Teske AJ, Marcelis C, Bosboom D, Velthuis BK, Udink Ten Cate FEA, Te Riele ASJM. Arrhythmogenic Right Ventricular Cardiomyopathy in a Pediatric Patient. JACC Case Rep 2020; 2:919-924. [PMID: 34317382 PMCID: PMC8302029 DOI: 10.1016/j.jaccas.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/29/2019] [Accepted: 01/06/2020] [Indexed: 01/27/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is rarely diagnosed in childhood. We describe the case of a 9-year-old girl with genetically confirmed ARVC who presented with syncope, ventricular arrhythmia, and biventricular myocardial dysfunction. This case highlights the need for development of pediatric ARVC diagnosis criteria specific for pediatric patients and discusses potential diagnostic improvement using echocardiographic deformation imaging. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Rob W Roudijk
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arco J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carlo Marcelis
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dennis Bosboom
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris E A Udink Ten Cate
- Department of Pediatric Cardiology, Academic Center for Congenital Heart Disease, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anneline S J M Te Riele
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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21
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Evertz R, Houck CA, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Concomitant pulmonary vein isolation and percutaneous closure of atrial septal defects: A pilot project. CONGENIT HEART DIS 2019; 14:1123-1129. [PMID: 31692272 PMCID: PMC7003759 DOI: 10.1111/chd.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Abstract
Background Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures. Purpose This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF. Methods In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5‐day‐holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF. Results The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12‐month follow‐up, three patients were free of AF recurrence (60%). Conclusion This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
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Affiliation(s)
- Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rypko Beukema
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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22
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Van Vugt SPG, Volleberg RHJA, Westra SW, Thannhauser J, Evertz R, Hemels MEW, Beukema RJ, De Asmundis C, Chierchia GB, Brouwer MA. P2834Diagnostic yield of holter recording after atrial fibrillation ablation - detection of asymptomatic recurrences during a one-year follow-up period. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Strategies to detect recurrences after atrial fibrillation (AF) catheter ablation vary widely. Whereas a symptom-based approach may overestimate procedural success due to asymptomatic recurrences, continuous invasive monitoring with implantable devices may be refused by patients and is not routinely recommended. In trial settings, Holter monitoring is recommended at one year after ablation, though more frequent and intensive follow-up is encouraged for more accurate detection of arrhythmia recurrences.
Purpose
To study the diagnostic yield of Holter monitoring in the detection of asymptomatic recurrent arrhythmias after cryoballoon catheter ablation for AF.
Methods
Prospective registry on AF patients who underwent cryoballoon ablation with subsequent follow-up in our centre. Follow-up comprised routine (i.e. at 3, 6, and 12 months) and symptom-driven electrocardiographic (ECG) registrations after a three-month blanking period. In addition, patients were scheduled for six-day Holter monitoring shortly after the blanking period, at six months and at the end of the one-year follow-up period. For the current analysis, we studied the Holter recordings of the patients without previously detected arrhythmia recurrence and determined the proportion of asymptomatic recurrences at each respective monitoring period.
Results
We studied 364 patients with a median age of 60 years (IQR 54–66) and a median CHA2DS2-VASc score of 1 (IQR 1–2). One-year recurrences were documented in 119 (32.7%) patients, of which 90 were initially detected on Holter recording and 39 on ECG registrations (Table). A total of 34 patients did not report symptoms during the documentation of recurrent arrhythmia and comprised 28.6% (34/119) of all recurrences and 37.8% (34/90) of the Holter-detected recurrences. At the three-month Holter registration, 33.3% of the patients with recurrences did not report symptoms, which was 29.4% and 62.5% at the six- and twelve-month registrations, respectively (Figure).
Timing and detection of recurrences Time after ablation 3 months 3–6 months 6 months 6–12 months 12 months Patients with Holter-detected recurrences 57/119 (47.9%) 17/119 (14.3%) 16/119 (13.4%) Patients with ECG-documented recurrences 18/119 (15.1%) 11/119 (9.2%)
Proportions of asymptomatic recurrences
Conclusions
In this cohort of AF patients with serial six-day Holter monitoring after cryoballoon ablation, up to one-third of the patients had asymptomatic recurrences. Whereas Holter monitoring shortly after the blanking period detected nearly half of all one-year recurrences, the proportion of asymptomatic detected recurrences was higher in recordings at one year and seems therefore important in the detection of asymptomatic recurrences after catheter ablation.
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Affiliation(s)
- S P G Van Vugt
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - R H J A Volleberg
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - S W Westra
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - J Thannhauser
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - R Evertz
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - M E W Hemels
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - R J Beukema
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | | | | | - M A Brouwer
- Heart Rhythm Management Centre, Brussels, Belgium
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23
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Ebner N, Dinopoulos G, Evertz R, Garfias Macedo T, Godoy B, Springer J, Von Haehling S. P6323Exercise capacity as predictor for anaemia or iron deficiency in patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anaemia and iron deficiency (ID) are important factors for muscle function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined.
Methods
A total of 280 out-patients with stable chronic HF were enrolled with mean age of 67.0±10.7 years, 21%female, mean left ventricular ejection fraction (LVEF) was 38.9±13.4%, mean Body Mass Index (BMI) 29.3±5.5 kg/m2]. Anaemia was defined according to World Health Organization criteria [Haemoglobin (Hb) <13 g/dL in men and <12 g/dL in women]. ID was defined as ferritin <100 μg/L or ferritin <100 <300 μg/L than with transferrin saturation (TSAT) <20%. Exercise capacity was assessed by spiroergometry (peakVO2), 6 minute walk test (6MWT), short physical performance battery test (SPPB), hang grip strength (HGS) and leg force (LF). All patients were followed up for a mean of 8 month.
Results
A total of 89 (32%) chronic HF patients had anaemia and 142 (51%) had iron deficiency at baseline. Patients with anaemia showed significant lower exercise capacity compared to patients without anaemia (peak VO2: 15.3±4.6 vs. 18.5±4.8 kg/min p<0.0001, 6MWT: 365.2±135.5 vs. 461.6±127.4 m p<0.0001, SPPB: 9.4±2.3 vs. 11.0±1.6 total points p<0.0001, HGS: 32.5±10.0 vs. 38.8±12.4 kg p<0.0001, LF: 31.4±11.0 vs. 41.3±21.6 kg p<0.0001). The same we found in patients with ID compared to patients without ID (peak VO2: 16.3±5.1 vs. 18.6±4.5 kg/min p=0.001, 6MWT: 400.0±140.8 vs. 458.8±128.4 m p=0.0008, SPPB: 10.0±2.1 vs. 10.9±1.7 total points p=0.0003, HGS: 34.5±11.9 vs. 39.3±11.7 kg p=0.001, LF: 35.7±23.4 vs. 40.5±13.6 kg p=0.04). After a Follow up of mean 8 month 53 patients develop a new onset of either anaemia (n=24) or ID (n=29). Logistic regression analysis showed that gender, 6 minute walk distance, SPPB, HGS and presence of diabetes mellitus at baseline are significantly associated with the development of anaemia or ID (all p<0.05). The strongest predictor was lower SPPB (p=0.0008). Interestingly known determinates lower peak VO2, higher age, higher NYHA class, Creatinine, and hsCRP were not predictive in our cohort to develop anaemia or ID after 8 month (all p>0.05).
Conclusion
Both anaemia and ID are strongly associated with reduced exercise capacity in patients with HF. The effect of anaemia and iron deficiency together is stronger than that of anemia and ID alone. Reduced SPPB, 6MWT, and HGS are important risk factors for the development of anaemia or ID.
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Affiliation(s)
- N Ebner
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - G Dinopoulos
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - R Evertz
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - T Garfias Macedo
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - B Godoy
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - J Springer
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - S Von Haehling
- University Medical Center of Gottingen (UMG), Gottingen, Germany
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24
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van den Broek LM, Westra SW, Evertz R, Boulaksil M. Lead detour. Neth Heart J 2019; 28:51. [PMID: 31407146 PMCID: PMC6940403 DOI: 10.1007/s12471-019-01320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- L M van den Broek
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Boulaksil
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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25
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van den Broek LM, Westra SW, Evertz R, Boulaksil M. Lead detour. Neth Heart J 2019; 28:56. [PMID: 31407147 PMCID: PMC6940402 DOI: 10.1007/s12471-019-01321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- L M van den Broek
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Evertz
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Boulaksil
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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26
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Van Vugt S, Westra S, Volleberg R, Focks JJ, Evertz R, Hemels M, Beukema R, de Asmundis C, Brouwer M, Chierchia JB. TIMING OF HOLTER DETECTED RECURRENCES DURING FOLLOW-UP AFTER CRYOBALLOON ABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: IN SEARCH OF THE OPTIMAL FOLLOW-UP TIMEPOINT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Houck CA, Evertz R, Teuwen CP, Roos-Hesselink JW, Kammeraad JAE, Duijnhouwer AL, de Groot NMS, Bogers AJJC. Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood. CONGENIT HEART DIS 2018; 14:280-287. [PMID: 30485659 PMCID: PMC7379716 DOI: 10.1111/chd.12724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/25/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
Objective Outcomes after surgical repair of complete atrioventricular septal defect (cAVSD) have improved. With advancing age, the risk of development of dysrhythmias may increase. The aims of this study were to (1) examine development of sinus node dysfunction (SND), atrial and ventricular tachyarrhythmias, and (2) study progression of atrioventricular conduction abnormalities in young adult patients with repaired cAVSD. Study design In this retrospective multicenter study, 74 patients (68% female) with a cAVSD repaired in childhood were included. Patients’ medical files were evaluated for occurrence of SND, atrioventricular conduction block (AVB), atrial and ventricular tachyarrhythmias. Results Median age at repair was 6 months (interquartile range 3‐10) and median age at last follow‐up was 24 years (interquartile range 21‐28). SND occurred after a median of 17 years (interquartile range 11‐19) after repair in 23% of patients, requiring pacemaker implantation in two patients (12%). Regular supraventricular tachycardia was observed in three patients (4%). Atrial fibrillation and ventricular tachyarrhythmias were not observed. Twenty‐seven patients (36%) had first‐degree AVB, which was self‐limiting in 16 (59%) and persistent in 10 (37%) patients. One patient developed third‐degree AVB 7 days after left atrioventricular valve replacement. Spontaneous type II second‐degree AVB occurred in a 28‐year‐old patient. Both patients underwent pacemaker implantation. Conclusions Clinically significant dysrhythmias were uncommon in young adult patients after cAVSD repair. However, three patients required pacemaker implantation for either progression of SND or spontaneous type II second‐degree AVB. Longer follow‐up should point out whether dysrhythmias will progress or become more prevalent with increasing age.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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28
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Acosta J, Fernández-Armenta J, Borràs R, Anguera I, Bisbal F, Martí-Almor J, Tolosana JM, Penela D, Andreu D, Soto-Iglesias D, Evertz R, Matiello M, Alonso C, Villuendas R, de Caralt TM, Perea RJ, Ortiz JT, Bosch X, Serra L, Planes X, Greiser A, Ekinci O, Lasalvia L, Mont L, Berruezo A. Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy. JACC Cardiovasc Imaging 2018; 11:561-572. [DOI: 10.1016/j.jcmg.2017.04.021] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 01/03/2023]
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29
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Houck CA, Evertz R, Teuwen CP, Roos-Hesselink JW, Duijnhouwer T, Bogers AJJC, de Groot NMS. Time course and interrelationship of dysrhythmias in patients with surgically repaired atrial septal defect. Heart Rhythm 2017; 15:341-347. [PMID: 29038089 DOI: 10.1016/j.hrthm.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) and other supraventricular tachycardias (SVTs) are known complications after surgical repair of atrial septal defect (ASD), but sinus node dysfunction (SND) and complete atrioventricular conduction block (cAVB) may also occur. OBJECTIVE The aim of this study was to examine time course and interrelationship of various dysrhythmias in patients with ASD. METHODS Adult patients (N = 95) with surgically repaired secundum ASD (n = 40), partial atrioventricular septal defect (n = 37) or sinus venosus defect (n = 18), and documented SND, cAVB, AF, and/or other SVT were included. The median age at repair was 13 years (interquartile range [IQR] 6-45 years), and patients were followed for 26 years (IQR 15-37 years) after ASD repair. RESULTS SND was observed in 34 patients (36%), cAVB in 14 (14%), AF in 48 (49%), and SVT in 44 (45%); 37 patients (39%) had ≥2 dysrhythmias. All dysrhythmias presented most often after ASD repair (P < .01), with a median duration of 12 years (IQR 17 days - 32 years) to 16 years (IQR 4 - 28 years) between repair and onset. Development of SND and cAVB late after ASD repair was not related to a redo procedure in 100% and 60% of patients, respectively. SND preceded atrial tachyarrhythmias in 50% (P = .31) and SVT preceded AF in 68% (P = .09) of patients with both dysrhythmias. CONCLUSION A substantial number of dysrhythmias presented (very) late after ASD repair. In most patients, development of late SND and cAVB was not related to redo procedures. In patients with multiple dysrhythmias, a specific order of appearance was not observed.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Toon Duijnhouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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30
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Duijnhouwer A, Van Kimmenade R, Van Dijk A, Evertz R, Timmermans J, Roos-Hesselink J, De Boer M. P6315Outcome in Turner patients with aortic dilation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Boulaksil M, Meuwese CL, Evertz R, Kolff-Kamphuis MGM. Broad complex rhythm with a salty taste. Neth Heart J 2017; 25:350-351. [PMID: 28108935 PMCID: PMC5405025 DOI: 10.1007/s12471-017-0951-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- M Boulaksil
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - C L Meuwese
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G M Kolff-Kamphuis
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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32
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Vogels RJ, Teuwen CP, Ramdjan TTTK, Evertz R, Knops P, Witsenburg M, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Usefulness of Fragmented QRS Complexes in Patients With Congenital Heart Disease to Predict Ventricular Tachyarrhythmias. Am J Cardiol 2017; 119:126-131. [PMID: 27780553 DOI: 10.1016/j.amjcard.2016.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
Fragmented QRS complexes (fQRS) on 12-lead electrocardiogram are known predictors of ventricular tachyarrhythmia (VTA) in patients with coronary artery disease. There is limited knowledge of the clinical implications of fQRS in patients with congenital heart defects (CHD). Aims of this study were to examine (1) the occurrence of fQRS in patients with various types of CHD and (2) whether fQRS is associated with development of VTA. This study was designed as retrospective case-control study. Patients with CHD with VTA were included and matched with control patients of the same age, gender, and CHD type. Clinical data and fQRS were analyzed and compared. The initial VTA episode developed in 139 patients with CHD at a mean age of 39 ± 14 years. Compared with controls (n = 219, age 38 ± 13 years), QRS duration was longer in patients with VTA (110 vs 100 ms; p <0.01). Furthermore, fQRS was more frequently observed in patients with VTA in the last electrocardiogram before VTA (n = 73 [53%] vs n = 67 [31%]; p <0.001), especially in patients with sustained VTA (64%). Multiple conditional logistic regression demonstrated more fQRS (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5 to 5.8; p = 0.002), nonsystemic ventricular dysfunction (OR 5.1, 95% CI 2.1 to 12.4; p <0.001), and more prolonged QRS complexes (OR 2.8, 95% CI 1.3 to 6.2; p = 0.011) in patients with VTA. Therefore, the presence of fQRS on electrocardiogram may be a useful tool in daily clinical practice to identify patients at risk for developing VTA in patients with CHD, in addition to known predictors of VTA.
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Affiliation(s)
- Rogier J Vogels
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tanwier T T K Ramdjan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Teuwen CP, Korevaar TIM, Coolen RL, van der Wel T, Houck CA, Evertz R, Yaksh A, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects. Europace 2016; 20:25-32. [DOI: 10.1093/europace/euw300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/24/2016] [Indexed: 12/12/2022] Open
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34
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Fernandez-Armenta J, Penela D, Acosta J, Andreu D, Evertz R, Cabrera M, Korshunov V, Vassanelli F, Martínez M, Tolosana Jose M, Mont L, Berruezo A. 218-04: Substrate Ablation Before or After Ventricular Tachycardia Induction and Ablation. A Randomized Study. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i186b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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35
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Teuwen CP, Ramdjan TT, Götte M, Brundel BJ, Evertz R, Vriend JW, Molhoek SG, Reinhart Dorman H, van Opstal JM, Konings TC, van der Voort P, Delacretaz E, Wolfhagen NJ, van Gastel V, de Klerk P, Theuns DA, Witsenburg M, Roos-Hesselink JW, Triedman JK, Bogers AJ, de Groot NM. Non-sustained ventricular tachycardia in patients with congenital heart disease: An important sign? Int J Cardiol 2016; 206:158-63. [DOI: 10.1016/j.ijcard.2016.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/20/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
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36
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Teuwen CP, Taverne YJHJ, Houck C, Götte M, Brundel BJJM, Evertz R, Witsenburg M, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Tachyarrhythmia in patients with congenital heart disease: inevitable destiny? Neth Heart J 2016; 24:161-70. [PMID: 26728051 PMCID: PMC4771626 DOI: 10.1007/s12471-015-0797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The prevalence of patients with congenital heart disease (CHD) has increased over the last century. As a result, the number of CHD patients presenting with late, postoperative tachyarrhythmias has increased as well. The aim of this review is to discuss the present knowledge on the mechanisms underlying both atrial and ventricular tachyarrhythmia in patients with CHD and the advantages and disadvantages of the currently available invasive treatment modalities.
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Affiliation(s)
- C P Teuwen
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Y J H J Taverne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Houck
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - M Götte
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - B J J M Brundel
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Physiology, Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Evertz
- Department of Cardiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - M Witsenburg
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - A J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N M S de Groot
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Teuwen CP, Ramdjan TT, Götte M, Brundel BJ, Evertz R, Vriend JW, Molhoek SG, Dorman HG, van Opstal JM, Konings TC, van der Voort P, Delacretaz E, Houck C, Yaksh A, Jansz LJ, Witsenburg M, Roos-Hesselink JW, Triedman JK, Bogers AJ, de Groot NM. Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects. Circ Arrhythm Electrophysiol 2015; 8:1065-72. [DOI: 10.1161/circep.115.003272] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/24/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Christophe P. Teuwen
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Tanwier T.T.K. Ramdjan
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Marco Götte
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Bianca J.J.M. Brundel
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Reinder Evertz
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Joris W.J. Vriend
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Sander G. Molhoek
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Henderikus G.R. Dorman
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Jurren M. van Opstal
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Thelma C. Konings
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Pepijn van der Voort
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Etienne Delacretaz
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Charlotte Houck
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Ameeta Yaksh
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Luca. J. Jansz
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Maarten Witsenburg
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Jolien W. Roos-Hesselink
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - John K. Triedman
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Ad J.J.C. Bogers
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
| | - Natasja M.S. de Groot
- From the Department of Cardiology (C.P.T., T.T.T.K.R., C.H., A.Y., L.J.J., M.W., J.W.R.-H., N.M.S.d.G.) and Department of Cardio-Thoracic Surgery (A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Haga Hospital, The Hague, The Netherlands (M.G., J.W.J.V.); Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands (B.J.J.M.B.); Department of Cardiology, VU University Medical Center, Amsterdam,
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Berruezo A, Fernández-Armenta J, Andreu D, Penela D, Herczku C, Evertz R, Cipolletta L, Acosta J, Borràs R, Arbelo E, Tolosana JM, Brugada J, Mont L. Scar Dechanneling. Circ Arrhythm Electrophysiol 2015; 8:326-36. [DOI: 10.1161/circep.114.002386] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/23/2014] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed.
Methods and Results—
The study included 101 consecutive patients with left ventricular scar–related VT (75 ischemic patients; left ventricular ejection fraction, 36±13%). Procedural end point was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance followed by abolition of residual inducible VTs. By itself, scar dechanneling rendered noninducibility in 54.5% of patients; ablation of residual inducible VT increased noninducibility to 78.2%. Patients needing only scar dechanneling had a shorter procedure (213±64 versus 244±71 minutes;
P
=0.027), fewer radiofrequency applications (19±11% versus 27±18%;
P
=0.01), and external cardioversion/defibrillation shocks (20% versus 65.2%;
P
<0.001). At 2 years, patients needing scar dechanneling alone had better event-free survival (80% versus 62%) and lower mortality (5% versus 11%). Incomplete CC-electrogram elimination was the only independent predictor (hazard ratio, 2.54 [1.06–6.10]) for the primary end point. Higher end point-free survival rates were observed in patients noninducible after scar dechanneling (log-rank
P
=0.013) and those with complete CC-electrogram elimination (log-rank
P
=0.013). The complications rate was 6.9%, with no deaths.
Conclusions—
Scar dechanneling alone results in low recurrence and mortality rates in more than half of patients despite the limited ablation extent required. Residual inducible VT ablation improves acute results, but patients who require it have worse outcomes. Recurrences are mainly related to incomplete CC-electrogram elimination.
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Affiliation(s)
- Antonio Berruezo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Fernández-Armenta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Csaba Herczku
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Reinder Evertz
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Laura Cipolletta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Roger Borràs
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Elena Arbelo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Jose María Tolosana
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Josep Brugada
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Lluis Mont
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
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Berruezo A, Penela D, Burgos F, Evertz R, Fernández-Armenta J, Roca J, Doltra A, Acosta J, Francino A, Sitges M, Alsina X, Ordoñez A, Villuendas R, Brugada R, Mont L, Brugada J. Optimized pacing mode for hypertrophic cardiomyopathy: Impact of ECG fusion during pacing. Heart Rhythm 2015; 12:909-16. [PMID: 25623178 DOI: 10.1016/j.hrthm.2015.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) fusion with intrinsic QRS could reduce the benefit of atrial synchronous biventricular pacing (AS-BiVP) in patients with hypertrophic obstructive cardiomyopathy (HOCM). OBJECTIVES The purpose of this study was to assess the benefit of AS-BiVP and the influence of ECG fusion for reduction of left ventricular outflow tract gradient (LVOTG) in these patients. METHODS Twenty-one symptomatic HOCM patients with severe LVOTG were included. Twelve patients were evaluated retrospectively for the prevalence of fusion and its influence on outcomes after AS-BiVP. Eleven patients (2 of the first population were also evaluated retrospectively) were prospectively included to evaluate the benefit of performing atrioventricular node ablation (AVNA) to achieve full ventricular capture if fusion was present during AS-BiVP. RESULTS Seven of the first 12 patients (58%) had ECG fusion. After 54 ± 24 months of AS-BiVP, the presence of fusion was associated with lower values for reduction of resting, dynamic LVOTG and New York Heart Association (NYHA) class. In the prospectively evaluated patients, after 12 months of follow-up, resting LVOTG decreased from 98 ± 39 to 39 ± 24 mm Hg (P = .008); dynamic LVOTG decreased from 112 ± 38 to 60 ± 24 mm Hg (P = .013); NYHA class decreased from 2.8 ± 0.4 to 1.7 ± 0.6 (P = .014); endurance time during constant work rate cycling exercise (80% of peak oxygen consumption) increased from 399 ± 148 to 691 ± 249 seconds (P = .046); quality of life improved from 46 ± 22 to 22 ± 20 points (P = .02); and brain natriuretic peptide levels decreased from 318 ± 238 to 152 ± 118 pg/mL (P = .09). Eight of the 11 prospectively evaluated patients (73%) needed AVNA, which further decreased LVOTG from 108 ± 40 mm Hg at baseline to 89 ± 29 mm Hg after BiVP to 54 ± 22 mm Hg after AVNA (P = .003). CONCLUSION As-BiVP that ensures no ECG fusion, by means of AVNA when needed, appears to be the optimal pacing mode in HOCM patients.
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MESH Headings
- Ablation Techniques/adverse effects
- Ablation Techniques/methods
- Adult
- Aged
- Atrioventricular Node/physiopathology
- Atrioventricular Node/surgery
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathy, Hypertrophic, Familial/complications
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Cardiomyopathy, Hypertrophic, Familial/surgery
- Echocardiography, Doppler, Color/methods
- Electrocardiography/methods
- Female
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Severity of Illness Index
- Spain
- Treatment Outcome
- Ventricular Outflow Obstruction/diagnosis
- Ventricular Outflow Obstruction/etiology
- Ventricular Outflow Obstruction/surgery
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Affiliation(s)
- Antonio Berruezo
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain.
| | - Diego Penela
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Felip Burgos
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain
| | - Reinder Evertz
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Juan Fernández-Armenta
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Josep Roca
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain
| | - Ada Doltra
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Juan Acosta
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Antonio Francino
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Marta Sitges
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Xavi Alsina
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Augusto Ordoñez
- Cardiology Department, Hospital Sant Pau I Santa Tecla, Tarragona, Catalonia, Spain
| | - Roger Villuendas
- Arrhythmia Section, Cardiology Department, Hospital Germans Trias i Pujol de Badalona, Catalonia, Spain
| | - Ramón Brugada
- Department of Medical Sciences, University of Girona, Catalonia, Spain and Cardiology Service, Hospital Josep Trueta, Girona, Catalonia, Spain
| | - Lluis Mont
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
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Duchateau N, Giraldeau G, Gabrielli L, Fernández-Armenta J, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Sitges M, Bijnens BH. Quantification of local changes in myocardial motion by diffeomorphic registration via currents: Application to paced hypertrophic obstructive cardiomyopathy in 2D echocardiographic sequences. Med Image Anal 2015; 19:203-19. [DOI: 10.1016/j.media.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Faita F, Di Lascio N, Bruno R, Bianchini E, Ghiadoni L, Sicari R, Gemignani V, Angelis A, Ageli K, Ioakimidis N, Chrysohoou C, Agelakas A, Felekos I, Vaina S, Aznaourides K, Vlachopoulos C, Stefanadis C, Nemes A, Szolnoky G, Gavaller H, Gonczy A, Kemeny L, Forster T, Ramalho A, Placido R, Marta L, Menezes M, Magalhaes A, Cortez Dias N, Martins S, Almeida A, Pinto F, Nunes Diogo A, Botezatu CD, Enache R, Popescu B, Nastase O, Coman M, Ghiorghiu I, Calin A, Rosca M, Beladan C, Ginghina C, Grapsa J, Cabrita I, Durighel G, O'regan D, Dawson D, Nihoyannopoulos P, Pellicori P, Kallvikbacka-Bennett A, Zhang J, Lukaschuk E, Joseph A, Bourantas C, Loh H, Bragadeesh T, Clark A, Cleland J, Kallvikbacka-Bennett A, Pellicori P, Lomax S, Putzu P, Diercx R, Parsons S, Dicken B, Zhang J, Clark A, Cleland J, Vered Z, Adirevitz L, Dragu R, Blatt A, Karev E, Malca Y, Roytvarf A, Marek D, Sovova E, Berkova M, Cihalik C, Taborsky M, Lindqvist P, Tossavainen E, Soderberg S, Gonzales M, Gustavsson S, Henein M, Sonne C, Bott-Fluegel L, Hauck S, Lesevic H, Hadamitzky M, Wolf P, Kolb C, Bandera F, Pellegrino M, Generati G, Donghi V, Alfonzetti E, Castelvecchio S, Menicanti L, Guazzi M, Buchyte S, Rinkuniene D, Jurkevicius R, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Santoro A, Federico Alvino F, Giovanni Antonelli G, Roberta Molle R, Matteo Bertini M, Stefano Lunghetti S, Sergio Mondillo S, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Szulik M, Stabryla-Deska J, Kalinowski M, Sliwinska A, Szymala M, Lenarczyk R, Kalarus Z, Kukulski T, Yiangou K, Azina C, Yiangou A, Ioannides M, Chimonides S, Baysal S, Pirat B, Okyay K, Bal U, Muderrisoglu H, Popovic D, Ostojic M, Petrovic M, Vujisic-Tesic B, Arandjelovic A, Petrovic I, Banovic M, Popovic B, Vukcevic V, Damjanovic S, Velasco Del Castillo S, Onaindia Gandarias J, Arana Achaga X, Laraudogoitia Zaldumbide E, Rodriguez Sanchez I, Cacicedo De Bobadilla A, Romero Pereiro A, Aguirre Larracoechea U, Salinas T, Subinas A, Elzbieciak M, Wita K, Grabka M, Chmurawa J, Doruchowska A, Turski M, Filipecki A, Wybraniec M, Mizia-Stec K, Varho V, Karjalainen P, Lehtinen T, Airaksinen J, Ylitalo A, Kiviniemi T, Gargiulo P, Galderisi M, D' Amore C, Lo Iudice F, Savarese G, Casaretti L, Pellegrino A, Fabiani I, La Mura L, Perrone Filardi P, Kim JY, Chung W, Yu J, Choi Y, Park C, Youn H, Lee M, Nagy A, Manouras A, Gunyeli E, Gustafsson U, Shahgaldi K, Winter R, Johnsson J, Zagatina A, Krylova L, Zhuravskaya N, Vareldzyan Y, Tyurina T, Clitsenko O, Khalifa EA, Ashour Z, Elnagar W, Jung I, Seo H, Lee S, Lim D, Mizariene V, Verseckaite R, Janenaite J, Jonkaitiene R, Jurkevicius R, Sanchez Espino A, Bonaque Gonzalez J, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinones J, Gomez Recio M, Silva Fazendas Adame PR, Caldeira D, Stuart B, Almeida S, Cruz I, Ferreira A, Freire G, Lopes L, Cotrim C, Pereira H, Mediratta A, Addetia K, Moss J, Nayak H, Yamat M, Weinert L, Mor-Avi V, Lang R, Al Amri I, Debonnaire P, Van Der Kley F, Schalij M, Bax J, Ajmone Marsan N, Delgado V, Schmidt FP, Gniewosz T, Jabs A, Munzel T, Jansen T, Kaempfner D, Hink U, Von Bardeleben R, Jose J, George O, Joseph G, Jose J, Adawi S, Najjar R, Ahronson D, Shiran A, Van Riel A, Boerlage - Van Dijk K, De Bruin - Bon H, Araki M, Meregalli P, Koch K, Vis M, Mulder B, Baan J, Bouma B, Marciniak A, Elton D, Glover K, Campbell I, Sharma R, Batalha S, Lourenco C, Oliveira Da Silva C, Manouras A, Shahgaldi K, Caballero L, Garcia-Lara J, Gonzalez-Carrillo J, Oliva M, Saura D, Garcia-Navarro M, Espinosa M, Pinar E, Valdes M, De La Morena G, Barreiro Perez M, Lopez Perez M, Roy D, Brecker S, Sharma R, Venkateshvaran A, Dash PK, Sola S, Barooah B, Govind SC, Winter R, Shahgaldi K, Brodin LA, Manouras A, Saura Espin D, Caballero Jimenez L, Gonzalez Carrillo J, Oliva Sandoval M, Lopez Ruiz M, Garcia Navarro M, Espinosa Garcia M, Valdes Chavarri M, De La Morena Valenzuela G, Gatti G, Dell'angela L, Pinamonti B, Benussi B, Sinagra G, Pappalardo A, Hernandez V, Saavedra J, Gonzalez A, Iglesias P, Civantos S, Guijarro G, Monereo S, Ikeda M, Toh N, Oe H, Tanabe Y, Watanabe N, Ito H, Ciampi Q, Cortigiani L, Pratali L, Rigo F, Villari B, Picano E, Sicari R, Yoon J, Sohn J, Kim Y, Chang H, Hong G, Kim T, Ha J, Choi B, Rim S, Choi E, Tibazarwa K, Sliwa K, Wonkam A, Mayosi B, Oryshchyn N, Ivaniv Y, Pavlyk S, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Sunbul M, Tigen K, Karaahmet T, Dundar C, Ozben B, Guler A, Cincin A, Bulut M, Sari I, Basaran Y, Baydar O, Kadriye Kilickesmez K, Ugur Coskun U, Polat Canbolat P, Veysel Oktay V, Umit Yasar Sinan U, Okay Abaci O, Cuneyt Kocas C, Sinan Uner S, Serdar Kucukoglu S, Zaroui A, Mourali M, Ben Said R, Asmi M, Aloui H, Kaabachi N, Mechmeche R, Saberniak J, Hasselberg N, Borgquist R, Platonov P, Holst A, Edvardsen T, Haugaa K, Lourenco MR, Azevedo O, Nogueira I, Moutinho J, Fernandes M, Pereira V, Quelhas I, Lourenco A, Eran A, Yueksel D, Er F, Gassanov N, Rosenkranz S, Baldus S, Guedelhoefer H, Faust M, Caglayan E, Matveeva N, Nartsissova G, Chernjavskij A, Ippolito R, De Palma D, Muscariello R, Santoro C, Raia R, Schiano-Lomoriello V, Gargiulo F, Galderisi M, Lipari P, Bonapace S, Zenari L, Valbusa F, Rossi A, Lanzoni L, Canali G, Molon G, Campopiano E, Barbieri E, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Sunbul M, Tigen K, Ozen G, Durmus E, Kivrak T, Cincin A, Ozben B, Atas H, Direskeneli H, Basaran Y, Stevanovic A, Dekleva M, Trajic S, Paunovic N, Simic A, Khan S, Mushemi-Blake S, Jouhra F, Dennes W, Monaghan M, Melikian N, Shah A, Maceira Gonzalez AM, Lopez-Lereu M, Monmeneu J, Igual B, Estornell J, Boraita A, Kosmala W, Rojek A, Bialy D, Mysiak A, Przewlocka-Kosmala M, Popescu I, Mancas S, Mornos C, Serbescu I, Ionescu G, Ionac A, Gaudron P, Niemann M, Herrmann S, Hu K, Liu D, Wojciech K, Frantz S, Bijnens B, Ertl G, Weidemann F, Maceira Gonzalez AM, Cosin-Sales J, Ruvira J, Diago J, Aguilar J, Igual B, Lopez-Lereu M, Monmeneu J, Estornell J, Cruz C, Pinho T, Madureira A, Lebreiro A, Dias C, Ramos I, Silva Cardoso J, Julia Maciel M, De Meester P, Van De Bruaene A, Herijgers P, Voigt JU, Budts W, Franzoso F, Voser E, Wohlmut C, Kellenberger C, Valsangiacomo Buechel E, Carrero C, Benger J, Parcerisa M, Falconi M, Oberti P, Granja M, Cagide A, Del Pasqua A, Secinaro A, Antonelli G, Iacomino M, Toscano A, Chinali M, Esposito C, Carotti A, Pongiglione G, Rinelli G, Youssef Moustafa A, Al Murayeh M, Al Masswary A, Al Sheikh K, Moselhy M, Dardir M, Deising J, Butz T, Suermeci G, Liebeton J, Wennemann R, Tzikas S, Van Bracht M, Prull M, Trappe HJ, Martin Hidalgo M, Delgado Ortega M, Ruiz Ortiz M, Mesa Rubio D, Carrasco Avalos F, Seoane Garcia T, Pan Alvarez-Ossorio M, Lopez Aguilera J, Puentes Chiachio M, Suarez De Lezo Cruz Conde J, Petrovic MT, Giga V, Stepanovic J, Tesic M, Jovanovic I, Djordjevic-Dikic A, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Piatkowski R, Kochanowski J, Scislo P, Opolski G, Zagatina A, Zhuravskaya N, Krylova L, Vareldzhyan Y, Tyurina T, Clitsenko O, Bombardini T, Gherardi S, Leone O, Picano E, Michelotto E, Ciccarone A, Tarantino N, Ostuni V, Rubino M, Genco W, Santoro G, Carretta D, Romito R, Colonna P, Cameli M, Lunghetti S, Lisi M, Curci V, Cameli P, Focardi M, Favilli R, Galderisi M, Mondillo S, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Machida T, Izumo M, Suzuki K, Kaimijima R, Mizukoshi K, Manabe-Uematsu M, Takai M, Harada T, Akashi Y, Martin Garcia A, Arribas-Jimenez A, Cruz-Gonzalez I, Nieto F, Iscar A, Merchan S, Martin-Luengo C, Brecht A, Theres L, Spethmann S, Dreger H, Baumann G, Knebel F, Jasaityte R, Heyde B, Rademakers F, Claus P, D'hooge J, Lervik Nilsen LC, Lund J, Brekke B, Stoylen A, Giraldeau G, Duchateau N, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Kordybach M, Kowalski M, Hoffman P, Pilichowska E, Zaborska B, Baran J, Kulakowski P, Budaj A, Wahi S, Vollbon W, Leano R, Thomas A, Bricknell K, Holland D, Napier S, Stanton T, Teferici D, Qirko S, Petrela E, Dibra A, Bajraktari G, Bara P, Sanchis Ruiz L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, Bijnens B, Sitges M, Sulemane S, Panoulas V, Bratsas A, Tam F, Nihoyannopoulos P, Abduch M, Alencar A, Coracin F, Barban A, Saboya R, Dulley F, Mathias W, Vieira M, Buccheri S, Mangiafico S, Arcidiacono A, Bottari V, Leggio S, Tamburino C, Monte IP, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Spitzer E, Beitzke D, Kaneider A, Pavo N, Gottsauner-Wolf M, Wolf F, Loewe C, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Cortinovis S, Fiorentini C, Pepi M, Gustafsson M, Alehagen U, Dahlstrom U, Johansson P, Faden G, Faggiano P, Albertini L, Reverberi C, Gaibazzi N, Taylor RJ, Moody W, Umar F, Edwards N, Townend J, Steeds R, Leyva F, Mihaila S, Muraru D, Piasentini E, Peluso D, Casablanca S, Naso P, Puma L, Iliceto S, Vinereanu D, Badano L, Ciciarello FL, Agati L, Cimino S, De Luca L, Petronilli V, Fedele F, Tsverava M. Poster Session Saturday 14 December - AM: 14/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdovic E, Abdovic S, Hristova K, Hristova K, Katova T, Katova T, Gocheva N, Gocheva N, Pavlova M, Pavlova M, Gurzun MM, Ionescu A, Canpolat U, Yorgun H, Sunman H, Sahiner L, Kaya E, Ozer N, Tokgozoglu L, Kabakci G, Aytemir K, Oto A, Gonella A, D'ascenzo F, Casasso F, Conte E, Margaria F, Grosso Marra W, Frea S, Morello M, Bobbio M, Gaita F, Seo H, Lee S, Lee J, Yoon Y, Park E, Kim H, Park S, Lee H, Kim Y, Sohn D, Nemes A, Domsik P, Kalapos A, Orosz A, Lengyel C, Forster T, Enache R, Muraru D, Popescu B, Calin A, Nastase O, Botezatu D, Purcarea F, Rosca M, Beladan C, Ginghina C, Canpolat U, Aytemir K, Ozer N, Yorgun H, Sahiner L, Kaya E, Oto A, Muraru D, Piasentini E, Mihaila S, Padayattil Jose' S, Peluso D, Ucci L, Naso P, Puma L, Iliceto S, Badano L, Cikes M, Jakus N, Sutherland G, Haemers P, D'hooge J, Claus P, Yurdakul S, Oner F, Direskeneli H, Sahin T, Cengiz B, Ercan G, Bozkurt A, Aytekin S, Osa Saez AM, Rodriguez-Serrano M, Lopez-Vilella R, Buendia-Fuentes F, Domingo-Valero D, 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Giraldeau G, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K, Ruiz Ortiz M, Mesa D, Romo E, Delgado M, Seoane T, Martin M, Carrasco F, Lopez Granados A, Arizon J, Suarez De Lezo J, Magalhaes A, Cortez-Dias N, Silva D, Menezes M, Saraiva M, Santos L, Costa A, Costa L, Nunes Diogo A, Fiuza M, Ren B, De Groot-De Laat L, Mcghie J, Vletter W, Geleijnse M, Toda H, Oe H, Osawa K, Miyoshi T, Ugawa S, Toh N, Nakamura K, Kohno K, Morita H, Ito H, El Ghannudi S, Germain P, Samet H, Jeung M, Roy C, Gangi A, Orii M, Hirata K, Yamano T, Tanimoto T, Ino Y, Yamaguchi T, Kubo T, Imanishi T, Akasaka T, Sunbul M, Kivrak T, Oguz M, Ozguven S, Gungor S, Dede F, Turoglu H, Yildizeli B, Mutlu B, Mihaila S, Muraru D, Piasentini E, Peluso D, Cucchini U, Casablanca S, Naso P, Iliceto S, Vinereanu D, Badano L, Rodriguez Munoz D, Moya Mur J, Becker Filho D, Gonzalez A, Casas Rojo E, Garcia Martin A, Recio Vazquez M, Rincon L, Fernandez Golfin C, Zamorano Gomez J, Ledakowicz-Polak A, Polak L, Zielinska M, Kamiyama T, Nakade T, Nakamura Y, Ando T, Kirimura M, Inoue Y, Sasaki O, Nishioka T, Farouk H, Sakr B, Elchilali K, Said K, Sorour K, Salah H, Mahmoud G, Casanova Rodriguez C, Cano Carrizal R, Iglesias Del Valle D, Martin Penato Molina A, Garcia Garcia A, Prieto Moriche E, Alvarez Rubio J, De Juan Bagua J, Tejero Romero C, Plaza Perez I, Korlou P, Stefanidis A, Mpikakis N, Ikonomidis I, Anastasiadis S, Komninos K, Nikoloudi P, Margos P, Pentzeridis P. Poster session Thursday 12 December - AM: 12/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Andreu D, Ortiz-Perez JT, Fernandez-Armenta J, Evertz R, Penela D, Tolosana JM, Arbelo E, Mont L, Brugada J, Berruezo A. 3D delayed enhancement magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- R Evertz
- Cardiology Department - Arrhythmia Section, Thorax Institute - Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain,
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Evertz R, Mont L. Diagnóstico diferencial entre doble respuesta ventricular y extrasistolia hisiana bigeminada. Respuesta. Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2013.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Evertz R, Mont L. Differential diagnosis between dual ventricular response and bigeminy arising from the bundle of His. Response. Rev Esp Cardiol (Engl Ed) 2013; 66:515-516. [PMID: 24776067 DOI: 10.1016/j.rec.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Reinder Evertz
- Sección de Arritmias, Departamento de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain.
| | - Lluis Mont
- Sección de Arritmias, Departamento de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
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Fernández-Armenta J, Berruezo A, Andreu D, Camara O, Silva E, Serra L, Barbarito V, Carotenutto L, Evertz R, Ortiz-Pérez JT, De Caralt TM, Perea RJ, Sitges M, Mont L, Frangi A, Brugada J. Three-dimensional architecture of scar and conducting channels based on high resolution ce-CMR: insights for ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 2013; 6:528-37. [PMID: 23685537 DOI: 10.1161/circep.113.000264] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conducting channels are the target for ventricular tachycardia (VT) ablation. Conducting channels could be identified with contrast enhanced-cardiac magnetic resonance (ce-CMR) as border zone (BZ) corridors. A 3-dimensional (3D) reconstruction of the ce-CMR could allow visualization of the 3D structure of these BZ channels. METHODS AND RESULTS We included 21 patients with healed myocardial infarction and VT. A 3D high-resolution 3T ce-CMR was performed before CARTO-guided VT ablation. The left ventricular wall was segmented and characterized using a pixel signal intensity algorithm at 5 layers (endocardium, 25%, 50%, 75%, epicardium). A 3D color-coded shell map was obtained for each layer to depict the scar core and BZ distribution. The presence/characteristics of BZ channels were registered for each layer. Scar area decreased progressively from endocardium to epicardium (scar area/left ventricular area: 34.0±17.4% at endocardium, 24.1±14.7% at 25%, 16.3±12.1% at 50%, 13.1±10.4 at 75%, 12.1±9.3% at epicardium; P<0.01). Forty-five BZ channels (2.1±1.0 per patient, 23.7±12.0 mm length, mean minimum width 2.5±1.5 mm) were identified, 85% between the endocardium and 50% shell and 76% present in ≥1 layer. The ce-CMR-defined BZ channels identified 74% of the critical isthmus of clinical VTs and 50% of all the conducting channels identified in electroanatomic maps. CONCLUSIONS Scar area in patients with healed myocardial infarction decreases from the endocardium to the epicardium. BZ channels, more commonly seen in the endocardium, display a 3D structure within the myocardial wall that can be depicted with ce-CMR. The use of ce-CMR-derived maps to guide VT ablation warrants further investigation.
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Evertz R, Merschón F, Berruezo A, Mont L. Doble respuesta ventricular: otra vía a la taquicardia supraventricular en fisiología doble del nódulo. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vatasescu R, Evertz R, Mont L, Sitges M, Brugada J, Berruezo A. Biventricular / left ventricular pacing in hypertrophic obstructive cardiomyopathy: an overview. Indian Pacing Electrophysiol J 2012; 12:114-23. [PMID: 22665960 PMCID: PMC3356591 DOI: 10.1016/s0972-6292(16)30503-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.
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Affiliation(s)
- Radu Vatasescu
- Cardiology Department, Clinic Emergency Hospital, Bucharest, Romania
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Evertz R, van Bennekom S, Dirksen MT, Verheugt FW. Hotline sessions of the 31st European Congress of Cardiology. Eur Heart J 2009; 30:2562-5. [DOI: 10.1093/eurheartj/ehp432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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