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Tjong FV, Knops RE, Udo EO, Brouwer TF, Dukkipati SR, Koruth JS, Petru J, Sediva L, van Hemel NM, Neuzil P, Reddy VY. Leadless pacemaker versus transvenous single-chamber pacemaker therapy: A propensity score-matched analysis. Heart Rhythm 2018; 15:1387-1393. [DOI: 10.1016/j.hrthm.2018.04.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/28/2022]
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Udo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing. Int J Cardiol 2015; 185:95-100. [PMID: 25804349 DOI: 10.1016/j.ijcard.2015.03.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 04/25/2014] [Revised: 11/25/2014] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) is associated with an increased risk of heart failure (HF) events. However, the extent and shape of this association is hardly assessed. OBJECTIVE We quantified whether the undesired effects of RVP are confirmed in an unselected population of first bradycardia pacemaker recipients. Furthermore, we studied the shape of the association between RVP and HF death and cardiac death. METHODS Cumulative percentage RVP (%RVP) was measured in 1395 patients. Using multivariable Cox regression analysis with %RVP as time-dependant co-variate we evaluated the association between %RVP and HF- and cardiac death, both unadjusted and adjusted for confounders, including age, gender, pacemaker-indication, cardiac disease, HF at baseline, diabetes, hypertension, atrio-ventricular synchrony, usage of beta-blocking drugs, anti-arrhythmic medication, HF medication, and prior atrial fibrillation/flutter. Non-linear associations were evaluated with restricted cubic splines. RESULTS During a mean follow-up of 5.8 (SD 1.1) years 104 HF deaths and 144 cardiac deaths were observed. %RVP was significantly associated with HF- and cardiac death in both unadjusted (p<0.001 and p<0.001, respectively) and adjusted analyses (p=0.046 and p=0.009, respectively). Our results show a linear association between %RVP and HF- and cardiac death. We observed a constant increase of 8% risk of HF death per 10% increase in RVP. A model incorporating various non-linear transformations of %RVP using restrictive cubic splines showed no improved model fit over linear associations. CONCLUSION This long-term, prospective study observed a significant, though linear association between %RVP and risk of HF death and/or cardiac death in unselected bradycardia pacing recipients.
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Affiliation(s)
- Erik O Udo
- Department of Cardiology, UMC Utrecht, The Netherlands, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - Norbert M van Hemel
- Department of Cardiology, UMC Utrecht, The Netherlands, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, UMC Utrecht, The Netherlands, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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Udo EO, van Hemel NM, Zuithoff NPA, Doevendans PA, Moons KGM. Prognosis of the bradycardia pacemaker recipient assessed at first implantation: a nationwide cohort study. Heart 2013; 99:1573-8. [DOI: 10.1136/heartjnl-2013-304445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Udo EO, van Hemel NM, Zuithoff NPA, Barrett MJ, Ruiter JH, Doevendans PA, Moons KGM. Incidence and predictors of pacemaker reprogramming: potential consequences for remote follow-up. Europace 2013; 15:978-83. [PMID: 23419656 DOI: 10.1093/europace/eut002] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Remote follow-up (FU) enables to cope with the expanding number of pacemaker (PM) FU. Although remote FU offers comparable monitoring options to in-office FU, reprogramming of device settings is not available, thereby imposing a potentially important restriction to the applicability of remote FU. The aim of this study was to assess in a large cohort of bradycardia PM recipients, the incidence of PM reprogramming during long-term FU and its predictors, to judge the possibilities for remote FU. METHODS AND RESULTS Between 2003 and 2010 all in-office FU of 1517 bradycardia PM recipients included in the FOLLOWPACE study were recorded. Only 24.5% of all 13 258 recorded FU visits >3 months after implantation were visits-with-reprogramming (VWRs), occurring in 1158 patients (79%). Fifty percent of patients were free of reprogramming at 9 months, and 29% at 24 months. Using multivariable binary logistic regression analysis, the following patient characteristics were predictive for frequent PM reprogramming, defined as >3 VWRs during 3 year FU: age, a history of atrial arrhythmias, PM complication <3 months after implantation, congestive heart failure, PM indication, and lead fixation method. This model had a receiver operating characteristic area of 0.66 (95% confidence interval 0.61-0.71). CONCLUSION This study observed a low proportion of VWR (∼25%) during a mean FU of 5.3 years; however, those patients at high risk for PM reprogramming cannot easily be predicted. The vast majority of patients (>80%) do not need frequent reprogramming, suggesting a potential benefit of using remote FU to reduce the number of unnecessary in-office visits.
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Affiliation(s)
- Erik O Udo
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
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Geuzebroek GSC, van Amersfoorth SCM, Hoogendijk MG, Kelder JC, van Hemel NM, de Bakker JMT, Coronel R. Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease. J Thorac Cardiovasc Surg 2011; 144:327-33. [PMID: 22014714 DOI: 10.1016/j.jtcvs.2011.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 05/12/2011] [Revised: 08/10/2011] [Accepted: 09/21/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation+mitral valve disease or with lone atrial fibrillation and compared it with controls. METHODS Left and right atrial appendages amputated during Maze III surgery for lone atrial fibrillation (n=85) or atrial fibrillation+mitral valve disease (n=26) were embedded in paraffin, sectioned, and stained with picrosirius red. Atria from 10 deceased patients without a cardiovascular history served as controls. A total of 1048 images (4-μm sections, 10-fold magnification, 4 images per appendage) were obtained and digitized. The percentage of fibrous tissue was calculated by quantitative morphometry. RESULTS Irrespective of the presence or absence of atrial fibrillation or mitral valve disease, more fibrous tissue was present in right atrial appendages than in left atrial appendages (12.7%±5.7% vs 8.2%±3.9%; P<.0001). The mean amount of fibrous tissue in the atria was significantly larger in patients with atrial fibrillation+mitral valve disease than in patients with lone AF and controls (13.6%±5.8%, 9.7%±3.2%, and 8.8%±2.4%, respectively; P<.01). No significant differences existed between patients with lone atrial fibrillation and patients without a cardiovascular history (controls). CONCLUSIONS Atria of patients with atrial fibrillation and mitral valve disease have more fibrosis than atria of patients with lone atrial fibrillation. However, patients with lone atrial fibrillation have an equal amount of atrial fibrosis compared with controls. These findings support the notion that fibrosis plays a more important role in the pathogenesis of atrial fibrillation secondary to mitral valve disease than in lone atrial fibrillation and potentially explains the relatively poor success of antiarrhythmic surgery in patients with mitral valve disease.
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ten Cate TJF, Kelder JC, Plokker HWM, Verzijlbergen JF, van Hemel NM. Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events. J Nucl Cardiol 2010; 17:216-24. [PMID: 20033856 DOI: 10.1007/s12350-009-9183-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 12/02/2009] [Indexed: 01/06/2023]
Abstract
BACKGROUND The value of myocardial perfusion SPECT (MPS) for patients with left bundle branch block (LBBB) or right ventricular apical (RVA) pacing seems reduced. The prognosis of patients with only abnormal activation related perfusion defects (AARD) due to LBBB or RVA-pacing is similar to those with a normal MPS. We assessed the prognostic value of MPS in patients with LBBB or RVA pacing. METHODS Patients with LBBB or RVA pacing referred for vasodilator stress MPS between April 2002 and January 2006 were analyzed. Group 1 are patients with normal MPS and MPS with AARD. Group 2 are patients with an MPS with a perfusion defect extending outside the AARD area. Events were cardiac death, acute myocardial infarction and coronary revascularization. RESULTS In Group 1 (101 patients) 12 events and in Group 2 (96 patients) 45 events occurred during a mean follow-up of 2.6 +/- 1.5 years. The prognosis of Group 2 was significantly worse (49%) compared with Group 1 (91%). The annual cardiac death rate was 0.7%/year in Group 1 and 6.4%/year in Group 2 (P < .001). The prognosis of patients with LBBB was not different from those with RVA pacing. CONCLUSION Group 2 had a significantly worse cardiac prognosis compared to Group 1. The annual cardiac death rate of <1% in Group 1 warrants a watchful waiting strategy, whereas the cardiac death rate in Group 2 warrants aggressive invasive coronary strategies.
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Affiliation(s)
- Tim J F ten Cate
- Department of Nuclear Medicine, Sint Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
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Coronel R, Langerveld J, Boersma LVA, Wever EFD, Bon L, van Dessel PFHM, Linnenbank AC, van Gilst WH, Ernst SMPG, Opthof T, van Hemel NM. Left atrial pressure reduction for mitral stenosis reverses left atrial direction-dependent conduction abnormalities. Cardiovasc Res 2009; 85:711-8. [PMID: 19939964 DOI: 10.1093/cvr/cvp374] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ruben Coronel
- Experimental Cardiology Group , Center for Heart Failure Research, Academic Medical Center, rm K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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van Hemel NM. Anticoagulation management during cardiac device surgery: many tastes tolerated? Heart Rhythm 2009; 6:1280-1. [PMID: 19656737 DOI: 10.1016/j.hrthm.2009.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Indexed: 11/17/2022]
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Delnoy PPHM, Ottervanger JP, Luttikhuis HO, Elvan A, Misier ARR, Beukema WP, van Hemel NM. Long-term clinical response of cardiac resynchronization after chronic right ventricular pacing. Am J Cardiol 2009; 104:116-21. [PMID: 19576330 DOI: 10.1016/j.amjcard.2009.02.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 11/25/2008] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
Abstract
Chronic right ventricular (RV) pacing might elicit unpredictably deleterious effects on left ventricular (LV) function similar to that of native left bundle branch block (LBBB). The objective of the present study was to evaluate the clinical and echocardiographic response to cardiac resynchronization therapy after years of chronic RV pacing. In this prospective observational study of 284 consecutive patients, cardiac resynchronization therapy was performed in 194 patients (68%) with a native LBBB and in 90 patients (32%) with a pacing-induced LBBB after chronic RV pacing (upgraded group). Echocardiographic and clinical parameters were evaluated in both groups at baseline and during 2 years of follow-up. The clinical response was defined as survival with improvement of > or =1 in the New York Heart Association class without heart failure hospitalization. Reverse LV remodeling was defined as LV end-systolic volume reduction of > or =15%. At baseline, the New York Heart Association class, quality of life, and exercise capacity were comparable but the LV ejection fraction was significant greater and the LV volumes were significant smaller in the upgraded group. Changes with time in the clinical parameters, echocardiographic parameters, and clinical response were not significantly different between the 2 groups. Reverse LV remodeling was observed in 86% in the upgraded group versus 78% of the native LBBB group after 1 year (p = 0.39). Survival was not significantly different between the 2 groups. In conclusion, comparable clinical and echocardiographic improvement was seen when resynchronization therapy was applied in patients with preceding chronic RV pacing compared with patients with a native LBBB.
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Delnoy PPH, Ottervanger JP, Luttikhuis HO, Elvan A, Misier ARR, Beukema WP, van Hemel NM. Clinical response of cardiac resynchronization therapy in the elderly. Am Heart J 2008; 155:746-51. [PMID: 18371486 DOI: 10.1016/j.ahj.2007.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although prevalence of heart failure increases with age, in most clinical trials of cardiac resynchronization therapy (CRT), older patients are not included. Observational studies of effects of CRT in older patients had a small sample size. In the present study, the clinical and echocardiographic response to CRT in a larger group of elderly (age > 75 years) patients was evaluated. METHODS In this prospective observational study of 266 consecutive patients, CRT was performed in 107 elderly patients (40%) and 159 (60%) younger patients (age < or = 75 years). Echocardiographic and clinical parameters were evaluated at baseline and at 3, 12, and 24 months. RESULTS In the elderly group, mean age was 79 years compared with 67 years in patients aged < or = 75 years. Clinical baseline characteristics between the 2 groups were comparable. During follow-up, there was a comparable and sustained improvement in both groups according to New York Heart Association (NYHA) class, quality of life score, and left ventricular (LV) ejection fraction. Clinical response, defined as survival with improvement (> or = 1 score) of NYHA class without hospital admittance for heart failure, was seen in 67% and 69% (group aged < or = 75 years) versus 65% and 60% (group aged > 75 years) after 3 months and 1 year, respectively. Reverse LV remodeling defined as LV end-systolic volume reduction > or = 10% was seen in 79% and 87% (group aged < or = 75 years) versus 71% and 79% (group aged > 75 years) after 3 months and 1 year, respectively. Hospitalization for heart failure decreased significantly in both groups in the year after CRT. A subgroup analysis of 39 octogenarians (> 80 years) also showed a significant improvement in NYHA class and LV ejection fraction in this subgroup. Also, LV reverse remodeling occurred in a similar extent (75% and 84%) after 3 months and 1 year, respectively. CONCLUSIONS This study shows a clinical and echocardiographic improvement of CRT in patients aged > 75 years and even so in octogenarians.
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Jansen AHM, Bracke F, van Dantzig JM, Peels KH, Post JC, van den Bosch HCM, van Gelder B, Meijer A, Korsten HHM, de Vries J, van Hemel NM. The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy. Eur J Echocardiogr 2007; 9:483-8. [PMID: 17826355 DOI: 10.1016/j.euje.2007.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. METHODS AND RESULTS Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as >/=10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5-151.9; P = 0.004) independently predicted LV reverse remodeling. CONCLUSION In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized.
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Affiliation(s)
- Annemieke H M Jansen
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
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van Hemel NM. Adenosine and syncope: The conscious relationship? Heart Rhythm 2007; 4:877-8. [PMID: 17599670 DOI: 10.1016/j.hrthm.2007.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Indexed: 11/19/2022]
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Delnoy PPHM, Ottervanger JP, Luttikhuis HO, Elvan A, Misier ARR, Beukema WP, van Hemel NM. Comparison of usefulness of cardiac resynchronization therapy in patients with atrial fibrillation and heart failure versus patients with sinus rhythm and heart failure. Am J Cardiol 2007; 99:1252-7. [PMID: 17478153 DOI: 10.1016/j.amjcard.2006.12.040] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [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: 10/04/2006] [Revised: 12/07/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
The prevalence of atrial fibrillation (AF) in patients with heart failure is high, but data about the effects of cardiac resynchronization therapy (CRT) in patients with chronic AF are scarce. In this prospective observational study of 263 consecutive patients, CRT was performed in 96 patients (37%) with chronic AF and 167 patients (63%) with sinus rhythm (SR). Echocardiographic and clinical parameters were evaluated at baseline and 3 and 12 months. Reverse left ventricular (LV) remodeling is defined as LV end-systolic volume decrease > or =10%. Hospitalization rates for heart failure in the year before and after implantation were compared. Baseline characteristics between patients with and without AF were similar, but the AF group had smaller LV end-systolic and end-diastolic volumes and larger left atrial dimensions. New York Heart Association class, 6-minute walking distance, quality-of-life score, LV ejection fraction, and mitral regurgitation improved significantly at 3 and 12 months in both groups, and the changes were similar. Reverse LV remodeling after 3 and 12 months was 74% and 82% (AF group) versus 77% and 83%, respectively (SR group, p = 0.79). After 1 year, cardioversion had occurred in 25% of patients with AF. In the year after implantation, significant decreases in hospitalizations for heart failure in both groups (84% and 90%) were documented. Long-term mortality was almost equal in both groups. In conclusion, this large-scale study shows that the benefit of CRT in patients with chronic AF and heart failure is similar to that in patients with SR. Patients with chronic AF and heart failure should be considered candidates for CRT.
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Jansen AHM, van Dantzig JM, Bracke F, Peels KH, Koolen JJ, Meijer A, de Vries J, Korsten H, van Hemel NM. Improvement in diastolic function and left ventricular filling pressure induced by cardiac resynchronization therapy. Am Heart J 2007; 153:843-9. [PMID: 17452163 DOI: 10.1016/j.ahj.2007.02.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/13/2006] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Variable results of cardiac resynchronization therapy (CRT) on diastolic function have been described. We investigated 3 and 12 months' effect of CRT on diastolic function and left ventricular (LV) filling pressures and their relation to LV reverse remodeling. METHODS Fifty-two patients' (36 male, 69 +/- 8 years, QRS duration 170 +/- 29 milliseconds) echo-Doppler was performed before and 3 and 12 months after CRT. Tissue Doppler early diastolic annular (Em) and color M-mode-derived flow propagation (Vp) velocities were used to estimate LV filling pressures by E/Em and E/Vp ratios. RESULTS After 12 months, LV reverse remodeling (end-systolic volume decrease >15%) was observed in 58%. Despite a significantly more compromised baseline diastolic function of patients without LV reverse remodeling, multivariate analysis revealed that only LV dyssynchrony could predict LV reverse remodeling. Grades 2 and 3 diastolic function improved only in LV reverse remodeling patients (from 34% to 13% to 10%), whereas a nonsignificant increase from 59% to 67% to 72% was observed in patients without reverse remodeling. Irrespective of LV volume response, short-term symptomatic benefit was related to decreased filling pressure. However, after 12 months, E/Em and E/Vp only significantly decreased in patients with LV reverse remodeling (from 16.0 +/- 6 to 10.4 +/- 4 and 2.2 +/- 0.6 to 1.5 +/- 0.4, respectively). CONCLUSIONS Left ventricular reverse remodeling induced by CRT is accompanied by improvement in diastolic function and estimated LV filling pressure. Short-term symptomatic benefit was related to decreased filling pressure. However, for longer-term symptomatic improvement and decreased filling pressures, LV reverse remodeling appeared mandatory.
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Jansen AHM, van Dantzig JM, Bracke F, Meijer A, Peels KH, van den Brink RBA, Cheriex EC, Delemarre BJM, van der Wouw PA, Korsten HHM, van Hemel NM. Qualitative observation of left ventricular multiphasic septal motion and septal-to-lateral apical shuffle predicts left ventricular reverse remodeling after cardiac resynchronization therapy. Am J Cardiol 2007; 99:966-9. [PMID: 17398193 DOI: 10.1016/j.amjcard.2006.11.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 08/18/2006] [Revised: 11/07/2006] [Accepted: 11/07/2006] [Indexed: 11/23/2022]
Abstract
A multiphasic septal motion and typical septal-to-lateral apical shuffle of the left ventricle can be observed echocardiographically in some patients with left branch bundle block. The relation of both with left ventricular (LV) dyssynchrony according to tissue Doppler and LV reverse remodeling after cardiac resynchronization therapy was investigated. Fifty-three patients (37 men; age 68+/-8 years) with ischemic (n=26) or idiopathic (n=27) cardiomyopathy, baseline QRS duration 171+/-30 ms, LV ejection fraction 21+/-7%, and LV end-diastolic volume 257+/-91 ml were studied. LV dyssynchrony using tissue Doppler was considered present if the SD of the interval between QRS and onset of systolic velocity of 6 basal LV segments was >20 ms. Shuffle was evaluated visually independently by 5 cardiologists and considered present if observed in>or=1 view. LV reverse remodeling, defined as LV end-systolic volume decrease>or=10%, was observed in 37 patients (70%) after 3 months of CRT. Sensitivity and specificity of either shuffle or multiphasic septal motion for all 5 observers (range 90% to 97% and 67% to 83%, respectively) were found to predict LV dyssynchrony. To predict LV reverse remodeling, sensitivity and specificity from 87% to 92% and 69% to 81% were observed, respectively. In conclusion, the qualitative observation of a typical shuffle or multiphasic septal motion predicts LV dyssynchrony and LV reverse remodeling adequately.
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van Hemel NM, Holwerda KJ, Slegers PC, Spierenburg HAM, Timmermans AAJM, Meeder JG, van der Kemp P, Kelder JC, Stofmeel MAM. The contribution of rate adaptive pacing with single or dual sensors to health-related quality of life. ACTA ACUST UNITED AC 2007; 9:233-8. [PMID: 17350981 DOI: 10.1093/europace/eum021] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The characteristics of sensors to perform rate adaptive pacing are well established but whether their contribution improves health-related quality of life (QoL) remains disputable. To compare the effects on QoL with an integrated dual sensor [minute ventilation (MV) and acceleration, TT sensor] with a single MV sensor, and with no rate adaptive pacing. METHODS AND RESULTS This Dutch multi centre, prospective, single- (patient) blind study was performed in patients after first pacemaker (PM) implant for sick sinus syndrome or AV block. After a 3-month 'sensor off'-period following DDD PM implantation, where the latter 2 months permitted the MV sensor to learn the intrinsic rhythm, a 2-month period of DDDR with TT sensor or 2 months of DDDR with MV sensor, subsequently the two modes were crossed over. Quality of life was determined with Aquarel, the disease-specific instrument for PM patients. Heart rate, percentages of sensor driven and intrinsic rhythm were retrieved from PM memories. Sixty-four patients completed the 7-month study. In sick sinus patients, percentages of sensor-driven pacing occurred significantly more frequently than in AV block patients After implant QoL improved significantly: before 71.3 and after 83.5% (P < 0.001) measured with Aquarel and in 3 of 9 SF-36 scales, but no significant additive QoL benefit with dual or MV sensor pacing was observed. Pacing diagnosis, percentages of rate adaptive pacing, and heart rate influencing medication did not influence this result. CONCLUSION Pacemaker implantation strongly improves QoL, but neither single- nor dual- sensor-driven pacing offered additional improvement in QoL during the initial 8 months after the first PM implant.
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Affiliation(s)
- Norbert M van Hemel
- Rodger Crowson Foundation for Cardiac Arrhythmias Studies, 3984 PC Odijk, The Netherlands.
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de Voogt WG, van Hemel NM, van de Bos AA, Koïstinen J, Fast JH. Verification of pacemaker automatic mode switching for the detection of atrial fibrillation and atrial tachycardia with Holter recording. Europace 2007; 8:950-61. [PMID: 17043069 DOI: 10.1093/europace/eul112] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Verification of the accuracy of onset, offset, and duration of automatic mode switching (AMS) of pacemakers compared with onset and end of atrial fibrillation (AF) or atrial tachycardia (AT). Correct pacemaker diagnosis of atrial tachyarrhythmias (AA) is indispensable for reliable automatic prevention and intervention algorithms of AA. METHODS AND RESULTS Comparison was made of the AMS registration of the pacemaker-stored electrograms (EGMs) and the number and cumulative duration of these episodes with continuous 7-day Holter monitoring. Atrial sensitivity was kept at 0.5 mV and far field R-wave recognition in the atrial channel was excluded by blanking of this signal. Lead types were confined to leads with short-ring tip spacing (10-13.8 mm). During Holter monitoring, 18 of 57 included patients with standard reason for pacemaker implantation showed episodes of AF or AT. Cumulative duration of AF and AT from Holter was correctly interpreted by the pacemaker in 99.9% of the patients. All episodes of AF, as seen on the Holter recording, were recognized by the pacemaker (correlation 99.9%). During AF, multiple episodes of undersensing were detected. The number of AMS episodes was influenced by undersensing during AF. The influence of these short episodes of undersensing on the total duration of AF was trivial (cumulative duration of AF was 99.9% correct). In patients with AT without AF on Holter (n=7) and in contrast to the AF episodes, the cumulative AT duration did not correlate well (63%) with the Holter recordings. The number of AMS episodes in the setting of AT was influenced by the atrial tachycardia detection rate setting and the duration of the post-ventricular atrial blanking interval. CONCLUSION The total duration of AF is correctly represented by the total duration of AMS and can be considered a reliable measure of total AF duration. AT duration was poorly correlated with AMS duration. The number of mode switches does not reflect the number of episodes of AF/AT. Increased memory capacity allowing the storing of all EGMs triggered by the initiation of AF/AT would be the ideal setting with which to optimize the diagnostic performance of pacemakers.
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Affiliation(s)
- Willem G de Voogt
- Department of Cardiology, St Lucas Andreas Hospital, J. Tooropstraat 164, 1061 AE Amsterdam, The Netherlands.
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Jansen AHM, Peels KH, Bracke F, van Dantzig JM, Meijer A, van der Voort PH, van Gelder B, Korsten HHM, van Hemel NM. Relation of isovolumic times after cardiac resynchronization therapy to improvement in exercise capacity. Am J Cardiol 2007; 99:75-8. [PMID: 17196466 DOI: 10.1016/j.amjcard.2006.07.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 03/30/2006] [Revised: 07/21/2006] [Accepted: 07/21/2006] [Indexed: 11/17/2022]
Abstract
Isovolumic times (IVTs) comprise a determinant of exercise capacity in cardiomyopathy. We postulated that an increase in exercise capacity after cardiac resynchronization therapy (CRT) might be related to a more efficient cardiac cycle due to decreasing IVTs and increased filling times. According to standard selection criteria, a CRT device was implanted in 52 patients (37 men; 69 +/- 8 years) with a QRS duration of 174 +/- 30 ms. The etiology was ischemic in 22 and idiopathic in 30 patients. A 6-minute walking test (MWT) and echocardiographic Doppler were performed before and 3 and 6 months after CRT. Timing cycles were obtained with echocardiographic Doppler. An improvement in MWT by >15% (responders) after 6 months of CRT was observed in 46% of patients. The MWT was moderately correlated with baseline time intervals (IVT r = -0.44, filling time r = 0.52), but not to baseline left ventricular ejection fraction (r = -0.06). However, change in the MWT after 3 and 6 months was best related to changes in IVT (r = -0.66 and -0.68, respectively). Receiver-operating characteristic curve analysis of baseline IVT showed that an IVT >29% predicted exercise response with a positive predictive value of 89% and a negative predictive value of 77%. In conclusion, improvement in exercise tolerance after CRT is associated with a decrease in prolonged IVT. Baseline IVT might be used as an adjunctive parameter for selecting symptomatic responders to CRT.
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Ballaux PKEW, Geuzebroek GSC, van Hemel NM, Kelder JC, Dossche KME, Ernst JMPG, Boersma LVA, Wever EFD, Brutel de la Rivière A, Defauw JJAMT. Freedom from atrial arrhythmias after classic maze III surgery: A 10-year experience. J Thorac Cardiovasc Surg 2006; 132:1433-40. [PMID: 17140972 DOI: 10.1016/j.jtcvs.2006.06.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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: 08/18/2005] [Revised: 05/07/2006] [Accepted: 06/06/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We studied the persistence of favorable outcome, the occurrence of new atrial arrhythmias, and sinus node dysfunction in patients who underwent the maze III procedure. METHODS Preoperative, in-hospital, and follow-up data of 203 patients who underwent the maze III procedure between June 1993 and June 2003 were collected. A total of 139 patients underwent the maze procedure for lone atrial fibrillation, and 64 patients underwent the maze procedure and concomitant cardiac surgery. RESULTS There was no 30-day postoperative mortality. During a mean follow-up of 4.0 +/- 2.6 years, 12 patients (6%) died (2 cardiac related). At the end of follow-up, freedom from supraventricular arrhythmias was 80% for the lone atrial fibrillation group and 64% for the concomitant atrial fibrillation group. Freedom from stroke during follow-up was 100% in the lone atrial fibrillation group and 97% in the concomitant group. Multivariate analysis revealed that rhythm at 1-year follow-up (P < .001; odds ratio 9.56, 95% confidence limits 3.92-23.31) and preoperative left atrium dimension (P = .028; odds ratio 1.06 for every millimeter, 95% confidence limits 1.01-1.12) were predictors of success at the end of follow-up. CONCLUSIONS This study shows that the favorable results of the maze III procedure in terms of freedom from supraventricular arrhythmias persist in most patients for at least 4 years.
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Affiliation(s)
- Philippe K E W Ballaux
- Heart Lung Center Utrecht, Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
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Jansen AHM, Bracke F, van Dantzig JM, Meijer A, Korsten EHM, Peels KH, van Hemel NM. Optimization of Pulsed Wave Tissue Doppler to Predict Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2006; 19:185-91. [PMID: 16455423 DOI: 10.1016/j.echo.2005.08.021] [Citation(s) in RCA: 24] [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: 06/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The optimal use of pulsed wave Doppler tissue imaging (DTI) in predicting left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) was investigated. METHODS DTI was performed in 69 patients before and 3 months after CRT. Echocardiographic reverse remodeling was observed in 38 patients. LV dyssynchrony was measured with the time to onset or peak systolic velocity in 2- and 6-basal segment models. RESULTS The time to onset and either the standard deviation of 6 segments of > 20 ms or a delay of > or = 60 ms between any 2 of 6 segments had a similar predictive accuracy (sensitivity, 97% and 95%, respectively; specificity, 74% and 73%, respectively). The time to peak systolic velocity or evaluating 2 segments was less accurate. CONCLUSIONS Evaluation of 6 segments is necessary to predict LV reverse remodeling after CRT. The time to onset of systolic velocity is superior to the time to peak velocity.
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van Hemel NM. Left is worse than right: the outcome of bundle branch block in middle-aged menThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology. Eur Heart J 2005; 26:2222-3. [PMID: 16214834 DOI: 10.1093/eurheartj/ehi390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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ten Cate TJF, Visser FC, Panhuyzen-Goedkoop NM, Verzijlbergen JF, van Hemel NM. Pacemaker-related myocardial perfusion defects worsen during higher pacing rate and coronary flow augmentation. Heart Rhythm 2005; 2:1058-63. [PMID: 16188581 DOI: 10.1016/j.hrthm.2005.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 03/17/2005] [Accepted: 07/13/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Asynchronous activation resulting from right ventricular apical (RVA) pacing can adversely affect left ventricular function and myocardial perfusion despite normal coronary arteries. This situation makes detection of coronary heart disease in paced patients difficult. OBJECTIVES The purpose of this study was to assess the distribution, extent, and severity of myocardial perfusion defects with RVA pacing at low and high rates and increased coronary blood flow with adenosine. METHODS Fourteen patients with permanent RVA pacing and angiographically normal coronary arteries underwent myocardial perfusion single-photon emission computed tomography at rest at low and high pacing rates and with pacing at low rates with adenosine. Data were analyzed semi-quantitatively using a 20-segment scoring model and coded using a four-point scoring system. RESULTS At rest, 23 (55%) of 42 coronary flow territories showed abnormal perfusion and 52 (19%) of 280 corresponding segments demonstrated abnormal perfusion; mean perfusion score was 0.22. After high-rate pacing, perfusion was abnormal in 31 (74%) of 42 flow territories and 122 (44%) of 280 segments; mean perfusion score was 0.67. Adenosine infusion resulted in 28 (67%) of 42 abnormal flow territories and 90 (32%) of 280 abnormal segments; mean perfusion score was 0.44. Perfusion defects were observed most often in close proximity to the origin of the pacing site. CONCLUSION RVA pacing results in myocardial perfusion defects. The false-positive findings are present at rest and more obvious with high-rate pacing than during adenosine infusion. Detection of coronary artery disease should be performed with caution in RVA paced patients because of the high number of perfusion defects observed in the absence of coronary artery disease.
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Affiliation(s)
- Tim J F ten Cate
- Department of Nuclear Medicine, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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Stofmeel MAM, van Stel HF, van Hemel NM, Grobbee DE. The relevance of health related quality of life in paced patients. Int J Cardiol 2005; 102:377-82. [PMID: 16004880 DOI: 10.1016/j.ijcard.2004.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 03/31/2004] [Revised: 08/17/2004] [Accepted: 10/04/2004] [Indexed: 11/18/2022]
Abstract
With the tremendous advances in cardiac pacing during the past four decades, cardiac pacemaker implantation is now a common clinical procedure. In recent years, the indications for permanent pacemakers have expanded. This increase in reasons for pacing and shift in mode of pacing have been caused by the evolution of pacemaker therapy from a life-saving measure (mortality), to one aimed at improving health-related quality of life (HRQoL). Until now the efficacy of pacing therapy has predominantly been measured using "objective" criteria. However, in recent years the importance of HRQoL as an outcome measure has increasingly been recognized as patients prefer quality over quantity of life. In this review we describe the development and testing of Aquarel, a new developed HRQoL questionnaire for pacemaker patients, composed of a generic core module with disease specific add-ons. Current and future research to improve the Aquarel questionnaire is also described.
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de Voogt WG, van Mechelen R, van den Bos AA, Scheffer M, van Hemel NM, Levine PA. Electrical characteristics of low atrial septum pacing compared with right atrial appendage pacing. Europace 2005; 7:60-6. [PMID: 15670969 DOI: 10.1016/j.eupc.2004.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2004] [Accepted: 10/06/2004] [Indexed: 10/25/2022] Open
Abstract
AIM The study was designed to compare the electrical characteristics of atrial leads placed in the low atrial septum (LAS) with those placed in the right atrial appendage (RAA) associated with dual chamber pacing. METHODS In 86 patients an active-fixation (St. Jude Medical's Tendril DX model 1388T) atrial lead was positioned in RAA and in 86 patients the same model atrial lead was placed in the LAS. Pacing thresholds, sensing thresholds, impedances and the Far Field paced R-Wave (FFRW) amplitude and timing were compared at 6 weeks and at 3 and 6 months. RESULTS The pacing threshold did not differ between groups. Sensed voltage of the P-wave was higher in the LAS compared with the RAA at 3 and 6 months (P=0.004). Impedance was higher in the LAS at 6 weeks and 3 months (P=0.002) but this difference was no longer significant at 6 months (P=0.05). The atrial sensed FFRW voltage was significantly higher in the LAS position compared with the RAA at 3 and 6 months follow-up (P=0.0002). FFRW voltage>1 mV was seen in 87% of the RAA pacing group and in 94% of the LAS pacing group (P=ns). The time between the ventricular pacing stimulus and the sensed FFRW in the atrium, (V spike-FFRW) in RAA was longer than in LAS at all follow-up measurements (P=0.006). CONCLUSIONS The electrical characteristics of LAS pacing makes this alternative position in the atrium safe and feasible. Though statistical differences were found in P-wave sensing (LAS higher voltage than in the RAA) and FFRW sensing was higher in the LAS compared with the RAA this did not interfere with the clinical applicability of the LAS as alternative pacing site.
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Potse M, van Dessel PFHM, Linnenbank AC, Grimbergen CA, van Hemel NM, de Bakker JMT. Properties of unipolar electrograms recorded with a multielectrode basket catheter. J Electrocardiol 2004; 37:1-10. [PMID: 15132363 DOI: 10.1016/j.jelectrocard.2003.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the past few years, clinical trials with multielectrode "basket" catheters have provided unique recordings from the endocardium of intact in-situ human hearts. Analysis of these recordings is difficult because unipolar electrograms obtained from a basket catheter in the blood-filled cavity differ from those obtained by other mapping techniques such as endocardial balloons used during antiarrhythmic surgery. We investigated these differences using basket catheter recordings obtained in isolated porcine and canine hearts that could be filled with perfusion fluid and evacuated at will. The results indicated that the differences between basket and balloon recordings are largely attributable to the presence and absence of blood. Activation maps obtained in the presence and absence of blood were usually similar and only differed in a minority of cases at sites in which electrograms revealed multiple deflections. In conclusion, unipolar mapping using a basket catheter can be used with confidence for the creation of activation maps if appropriate care is taken in the interpretation of fractionated electrograms.
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Affiliation(s)
- Mark Potse
- Department of Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Groutars RGEJ, Verzijlbergen JF, Tiel-van Buul MMC, Zwinderman AH, Ascoop CAPL, van Hemel NM, van der Wall EE. The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease. Int J Cardiovasc Imaging 2003; 19:229-38. [PMID: 12834160 DOI: 10.1023/a:1023637804898] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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] [Indexed: 11/12/2022]
Abstract
BACKGROUND In order to evaluate the diagnostic efficacy of the 1-day separate acquisition dual-isotope single-photon emission computed tomography (SPECT) protocol, using 201Tl for the rest and 99mTc-tetrofosmin for the stress images, a consecutive series of patients with suspected or known coronary artery disease (CAD) was studied that also underwent coronary angiography. METHODS The results of myocardial SPECT, using a semi-quantitative visual analysis, were acquired in 123 patients and compared with the results of coronary angiography. Sensitivity and specificity were calculated, using thresholds of > or = 50 and > or = 70% stenosis. As an alternative for specificity, the normalcy rate was determined in a separate group of 87 patients with a < 5% pre-test likelihood of CAD. RESULTS The prevalence of CAD using > or =50 and > or = 70% stenosis was 88 and 78%, respectively. The sensitivity for detection of patients with > or = 50 and > or = 70% stenosis was 94 and 97%, respectively while specificity was 62 and 59%, respectively. The high rate of false positive perfusion defects resulting in a low specificity could be explained by specific clinical issues. However, the routine assessment with additional clinical and electrocardiographic data resulted in a correct interpretation of most of the false positive perfusion defects. The positive predictive value was 92 and 85% and the negative predictive value 46 and 77%, using thresholds of > or = 50 and > or = 70% stenosis, respectively. The normalcy rate was 91%. CONCLUSION The one-day separate acquisition rest 201Tl/stress 99mTc-tetrofosmin SPECT protocol is an efficient procedure for myocardial perfusion scintigraphy with high sensitivity for detection of CAD. Specific clinical issues caused a low value for specificity. Therefore, clinical information and knowledge of the electrocardiogram is essential for a correct interpretation of SPECT images.
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Abstract
BACKGROUND Unmodified maze III operations show long-term eradication of atrial fibrillation (AF) in more than 85% of patients with or without structural heart disease. The effect of this procedure on atrial volumes is not known. METHODS Two patient populations were studied: (1) patients undergoing unmodified maze III operations combined with surgical structural heart disease, mostly mitral valve operations (group A; n = 32); and (2) patients with only AF selected for unmodified maze III operations (group B; n = 32). In groups A and B, transthoracic Doppler echocardiographic studies were prospectively made preoperatively, and at 3 and 12 months postoperatively. Left and right atrial dimensions and volumes and atrial contractions were determined and compared with base line patient characteristics and 12 months arrhythmia outcomes. RESULTS One year postoperatively all patients were alive. In groups A and B, 92% were free of AF and other atrial arrhythmias. A significant reduction of left atrial volume at 1 year postoperatively was apparent in group A, whereas the left atrial volume did not change significantly in group B. The reduction observed in group A was not related to postoperative age, type or duration of AF, or late atrial arrhythmia outcome. In both groups the right atrial volume remained unchanged at 12 months postoperatively. CONCLUSIONS The unmodified maze III operation does not affect atrial volume in patients without structural heart disease. In patients with structural heart disease, the mitral valve operation contributes to the reduction of left atrial volume and dimension by improving the hemodynamic condition.
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Affiliation(s)
- Emile R Jessurun
- Department of Cardiology Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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van Dessel PF, van Hemel NM, Groenewegen AS, de Bakker JM, Linnebank AC, Defauw JJ. Contribution of body surface mapping to clinical outcome after surgical ablation of postinfarction ventricular tachycardia. J Electrocardiol 2002; 35:35-44. [PMID: 11786945 DOI: 10.1054/jelc.2002.30703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article investigates the influence of body surface mapping on outcome of ventricular antiarrhythmic surgery. Preoperative mapping is advocated to optimize map-guided antiarrhythmic surgery of postinfarction ventricular tachycardia. We sequentially analyzed the results of catheter activation sequence mapping, body surface mapping, and intraoperative multielectrode mapping in 54 patients and made a comparison with 30 control patients (group B) in whom catheter activation sequence mapping was omitted. Endpoints were actuarial survival, freedom of arrhythmia, and comparability of the localisation of sites of ventricular tachycardia origin. A total of 128 morphologically different monomorphic sustained ventricular tachycardias were mapped in group A. In group A, 87 ventricular tachycardias were mapped preoperatively with body surface mapping and 30 ventricular tachycardias with catheter activation sequence mapping. In 19 of 24 ventricular tachycardias (79%) that were localized with both mapping methods the ventricular tachycardia exit site was similar. In-hospital death was 1 of 85 (1.2%). Actuarial freedom from ventricular arrhythmias at 4-year follow-up was 74.1 +/- 6.0% in group A vs. 90.0+/-5.5% in group B (P =.10). In group A 14 of 54 patients died (29.6%), whereas 4 of 30 patients (13.3%) died in group B (P =.09). Arrhythmia freedom and survival is as good in patients mapped with body surface mapping only as in patients mapped with body surface mapping and catheter activation sequence mapping.
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Affiliation(s)
- Pascal F van Dessel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Groutars RGEJ, Verzijlbergen JF, Zwinderman AH, Tiel-Van Buul MMC, Ascoop CAPL, van Hemel NM, van der Wall EE. Incremental prognostic value of myocardial SPET with dual-isotope rest (201)Tl/stress (99m)Tc-tetrofosmin. Eur J Nucl Med Mol Imaging 2002; 29:46-52. [PMID: 11807606 DOI: 10.1007/s002590100653] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incremental prognostic value of dual-isotope myocardial perfusion scintigraphy using technetium-99m tetrofosmin for the stress images was evaluated in 597 consecutive patients with known or suspected coronary artery disease. We used semi-quantitative visual analysis with a five-point scoring system and calculated the summed stress score, the summed rest score and the summed difference score. During the 2-year follow-up period, 46 "hard" cardiac events occurred: 16 cardiac deaths and 30 non-fatal myocardial infarctions. Kaplan-Meier analysis demonstrated a favourable prognosis for patients with normal scans as compared with patients with mildly to moderately or severely abnormal scans ( P<0.001). Multivariate analysis demonstrated incremental prognostic information for nuclear variables. A very low rate of hard cardiac events was observed in patients with a low summed stress score. Thus, nuclear variables provide incremental prognostic information and could be used to guide the management process with respect to whether or not to proceed with further invasive procedures.
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SippensGroenewegen A, Spekhorst H, van Hemel NM, Kingma J, Hauer RN, Janse MJ, Dunning AJ. Body surface mapping during endocardial pacing at multiple left ventricular sites: QRS variability in patients with prior myocardial infarction. J Am Coll Cardiol 1990. [DOI: 10.1016/0735-1097(90)92483-i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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