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Bauer A, Klemm M, Rizas KD, Hamm W, von Stülpnagel L, Dommasch M, Steger A, Lubinski A, Flevari P, Harden M, Friede T, Kääb S, Merkely B, Sticherling C, Willems R, Huikuri H, Malik M, Schmidt G, Zabel M. Prediction of mortality benefit based on periodic repolarisation dynamics in patients undergoing prophylactic implantation of a defibrillator: a prospective, controlled, multicentre cohort study. Lancet 2019; 394:1344-1351. [PMID: 31488371 DOI: 10.1016/s0140-6736(19)31996-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND A small proportion of patients undergoing primary prophylactic implantation of implantable cardioverter defibrillators (ICDs) experiences malignant arrhythmias. We postulated that periodic repolarisation dynamics, a novel marker of sympathetic-activity-associated repolarisation instability, could be used to identify electrically vulnerable patients who would benefit from prophylactic implantation of ICDs by way of a reduction in mortality. METHODS We did a prespecified substudy of EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD), a prospective, investigator-initiated, non-randomised, controlled cohort study done at 44 centres in 15 EU countries. Patients aged 18 years or older with ischaemic or non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (≤35%) were eligible for inclusion if they met guideline-based criteria for primary prophylactic implantation of ICDs. Periodic repolarisation dynamics from 24-h Holter recordings were assessed blindly in patients the day before ICD implantation or on the day of study enrolment in patients who were conservatively managed. The primary endpoint was all-cause mortality. Propensity scoring and multivariable models were used to assess the interaction between periodic repolarisation dynamics and the treatment effect of ICDs on mortality. FINDINGS Between May 12, 2014, and Sept 7, 2018, 1371 patients were enrolled in our study. 968 of these patients underwent ICD implantation, and 403 were treated conservatively. During follow-up (median 2·7 years [IQR 2·0-3·3] in the ICD group and 1·2 years [0·8-2·7] in the control group), 138 (14%) patients died in the ICD group and 64 (16%) patients died in the control group. We noted a 43% reduction in mortality in the ICD group compared with the control group (adjusted hazard ratio [HR] 0·57 [95% CI 0·41-0·79]; p=0·0008). Periodic repolarisation dynamics significantly predicted the treatment effect of ICDs on mortality (adjusted p=0·0307). The mortality benefits associated with ICD implantation were greater in patients with periodic repolarisation dynamics of 7·5 deg or higher (n=199; adjusted HR 0·25 [95% CI 0·13-0·47] for the ICD group vs the control group; p<0·0001) than in those with periodic repolarisation dynamics less than 7·5 deg (n=1166; adjusted HR 0·69 [95% CI 0·47-1·00]; p=0·0492; pinteraction=0·0056). The number needed to treat was 18·3 (95% CI 10·6-4895·3) in patients with periodic repolarisation dynamics less than 7·5 deg and 3·1 (2·6-4·8) in those with periodic repolarisation dynamics of 7·5 deg or higher. INTERPRETATION Periodic repolarisation dynamics predict mortality reductions associated with prophylactic implantation of ICDs in contemporarily treated patients with ischaemic or non-ischaemic cardiomyopathy. Periodic repolarisation dynamics could help to guide treatment decisions about prophylactic ICD implantation. FUNDING The European Community's 7th Framework Programme.
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Vandenberk B, Rover C, Dunnink A, Friede T, Flevari P, Zabel M, Willems R. P2876Repeating non-invasive risk stratification tests improves the prediction of outcomes of ICD patients in the EUTrigTreat study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Non-invasive risk stratification of SCD aims to predict the risk by assessing measures of substrate (LVEF), of triggers (PVCs; T-wave alternans, TWA) and of autonomic function (heart rate turbulence, HRT). However, the value of repeating these tests during follow-up is unclear.
Purpose
To study the predictive value of repeated non-invasive risk assessment.
Methods
EUTrigTreat is a prospective trial aimed to improve non-invasive risk stratification in ICD patients. The study protocol included non-invasive testing at baseline and a repeat after 6 to 12 months. The population included ischemic and non-ischemic cardiomyopathies and arrhythmogenic heart disease. Test results were categorized as pathologic (1) versus non-pathologic (0) for LVEF ≤40%, PVCs >400 in 24h, abnormal exercise TWA (Cambridge Heart) and abnormal HRT (TO >0.1% and/or TS ≤2.0ms/RRI). Time dependent Cox regression modelling was performed for mortality, and a Fine-and- Gray competing risk analysis for shocks, including adjustment for independent predictors in the overall study population (mortality: age, LVEF, history of AF, NT-proBNP, NYHA class, eGFR; shocks: LVEF, secondary prevention).
Results
A total of 635 patients were included with a follow-up of 4.3±1.5 years, 96 (15%) received an ICD shock and 108 (17%) died. The table shows the results at baseline and with repeating the tests after 8±1 months.
Worsening of LVEF compared to a stable LVEF >40% and persistent abnormal HRT were independent predictors of mortality. Improvement in HRT was associated with a lower mortality. Worsened results upon TWA testing was associated with a 3 times higher risk of shocks. A persistent low LVEF was an independent predictor of both mortality and ICD shocks.
Baseline 1 (vs. 0) Worsening 0–1 (vs. 0–0) Improvement 1–0 (vs. 1–1) Stable 1–1 (vs. 0–0) HR (CI) HR (CI) HR (CI) HR (CI) Mortality LVEF (n=315) 1.85 (1.06–3.24) 3.47 (1.13–10.68) 0.88 (0.40–1.94) 2.22 (1.19–4.15) TWA (n=204) 0.62 (0.28–1.37) 0.80 (0.25–2.59) 0.67 (0.18–2.47) 0.59 (0.20–1.77) PVC (n=329) 1.26 (0.73–2.16) 0.99 (0.36–2.72) 0.63 (0.26–1.52) 1.38 (0.75–2.55) HRT (n=163) 2.57 (0.85–7.77) 4.01 (0.39–41.17) 0.10 (0.01–0.81) 8.71 (1.11–68.24) Shocks LVEF (n=338) 1.73 (0.93–3.22) 0.92 (0.13–6.67) 0.26 (0.06–1.08) 2.02 (1.09–3.76) TWA (n=256) 0.82 (0.39–1.70) 2.91 (1.04–8.13) 1.31 (0.48–3.59) 1.54 (0.54–4.43) PVC (n=366) 1.28 (0.70–2.34) 1.48 (0.54–4.09) 0.54 (0.16–1.81) 1.70 (0.86–3.35) HRT (n=188) 1.12 (0.50–2.50) 0.57 (0.13–2.52) 0.73 (0.20–2.64) 1.06 (0.43–2.61)
Conclusion
Repeating LVEF, TWA and HRT have the potential to improve risk stratification for mortality and shocks in ICD patients.
Acknowledgement/Funding
This research has received funding from European Community's Seventh Framework Program FP7: EUTrigTreat (grant agreement no. HEALTH-F2-2009-241526).
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Roggen M, Garweg C, Willems R, Gewillig M, Ector J. Paradoxical nonreentrant tachycardia induced by iatrogenic atrioventricular block. Acta Cardiol 2019; 74:423-424. [PMID: 30735477 DOI: 10.1080/00015385.2018.1521556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vermeersch K, Gabrovska M, Aumann J, Demedts IK, Corhay JL, Marchand E, Slabbynck H, Haenebalcke C, Haerens M, Hanon S, Jordens P, Peché R, Fremault A, Lauwerier T, Delporte A, Vandenberk B, Willems R, Everaerts S, Belmans A, Bogaerts K, Verleden GM, Troosters T, Ninane V, Brusselle GG, Janssens W. Azithromycin during Acute Chronic Obstructive Pulmonary Disease Exacerbations Requiring Hospitalization (BACE). A Multicenter, Randomized, Double-Blind, Placebo-controlled Trial. Am J Respir Crit Care Med 2019; 200:857-868. [DOI: 10.1164/rccm.201901-0094oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zabel M, Schlögl S, Lubinski A, Svendsen JH, Bauer A, Arbelo E, Brusich S, Conen D, Cygankiewicz I, Dommasch M, Flevari P, Galuszka J, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Kenttä T, Kucejko T, Haarmann H, Harden M, Iovev S, Kääb S, Kaliska G, Katsimardos A, Kasprzak JD, Qavoq D, Lüthje L, Malik M, Novotný T, Pavlović N, Perge P, Röver C, Schmidt G, Shalganov T, Sritharan R, Svetlosak M, Sallo Z, Szavits-Nossan J, Traykov V, Vandenberk B, Velchev V, Vos MA, Willich SN, Friede T, Willems R, Merkely B, Sticherling C. Present criteria for prophylactic ICD implantation: Insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project. J Electrocardiol 2019; 57S:S34-S39. [PMID: 31526572 DOI: 10.1016/j.jelectrocard.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. SUMMARY The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12‑lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. CONCLUSION The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular.
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Goovaerts G, Padhy S, Vandenberk B, Varon C, Willems R, Van Huffel S. A Machine-Learning Approach for Detection and Quantification of QRS Fragmentation. IEEE J Biomed Health Inform 2019; 23:1980-1989. [DOI: 10.1109/jbhi.2018.2878492] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vandenberk B, Siau C, Vandael E, Puype L, Branders J, Dewolf P, Foulon V, Willems R, Verelst S. A prolonged QTc-interval at the emergency department: Should we always be prepared for the worst? J Cardiovasc Electrophysiol 2019; 30:2041-2050. [PMID: 31402492 DOI: 10.1111/jce.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION QTc-interval prolongation is associated with ventricular arrhythmias and mortality in a general population. Bazett's correction formula (QTcB) is routinely used despite its overcorrection at high heart rates. Recently, we proposed a patient-specific QT correcting algorithm (QTcA) resulting in improved rate correction and predictive value in a general population. We hypothesize risk stratification at the Emergency Department (ED) could be improved using QTcA. METHODS AND RESULTS A retrospective case-control study including a randomized age- and sex-matched control population was performed at a tertiary care ED. A total of 1930 patients were included in the analysis (63.0% males, age 71.5 ± 15.6 years). Patient characteristics, history, and test results at the time of the electrocardiogram were collected. QTc was dichotomized as prolonged (>450 millisecond for men, >470 millisecond for women) or severely prolonged (>500 millisecond). Implementation of QTcA would reduce the number of patients considered to have a prolonged QTc by 65.2%, for severely prolonged QTc 79.6%. Multivariate regression was performed for in-hospital mortality, cardiovascular endpoints, and hospital admission. Neither a prolonged QTcB (HR 1.04; 95% CI, 0.64-1.69) nor QTcA (HR 0.76; 95% CI, 0.42-1.38) was an independent predictor of in-hospital mortality. A severely prolonged QTcA (OR, 2.54; 95% CI, 1.04-6.23) was an independent predictor of cardiovascular events. Both a prolonged QTcA (OR, 1.52; 95% CI, 1.06-2.18) and a prolonged QTcB (OR, 1.37; 95% CI, 1.05-1.79) were associated with higher hospitalization rates. CONCLUSIONS QTcA reduced the number of patients considered at risk. Neither QTcB nor QTcA were predictors of in-hospital mortality. A severely prolonged QTcA was associated with cardiovascular events.
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Garweg C, Vandenberk B, Foulon S, Haemers P, Ector J, Willems R. Leadless pacing with Micra TPS: A comparison between right ventricular outflow tract, mid-septal, and apical implant sites. J Cardiovasc Electrophysiol 2019; 30:2002-2011. [PMID: 31338871 DOI: 10.1111/jce.14083] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long-term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid-septal, and apical implant positions. METHODS All patients who underwent a Micra TPS implantation at the University Hospitals of Leuven were enrolled in this observational study. Right ventricular (RV) position of the device was assessed on per-procedural ventriculography. Paced QRS was analyzed and follow-up completed at 1 month and then every 6 months. RESULTS Among the 133 patients included (mean follow-up: 13 ± 11 months), 45 were implanted in the RVOT, 58 midseptally, and 30 at the apex. All implant procedures were successful and no pericardial effusion was encountered within the 30 days post-implant. Two major complications were reported with devices implanted at the apex. Pacing impedance was significantly higher in the RVOT compared to the mid-septal and apical position (P < .001). Pacing threshold and R-wave amplitude did not differ over time in either position. The median narrowest paced QRS duration was observed in the RVOT (142 ms) compared to mid-septal (159 ms; P < .001), and apical position (181 ms; P < .001). CONCLUSION Implantation of the Micra TPS in the RVOT is safe and feasible. Electrical performance over time was comparable to mid-septal and apical positions. The narrowest paced QRS complexes is achieved with RVOT pacing.
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Meyns B, Bogaert J, Willems R, Claus P, Delcroix M. Impaired Cardiac Reserve and Abnormal Vascular Load Limit Exercise Capacity in Chronic Thromboembolic Disease. JACC Cardiovasc Imaging 2019; 12:1444-1456. [DOI: 10.1016/j.jcmg.2018.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
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Morales JF, Varon C, Deviaene M, Milagro J, Testelmans D, Buyse B, Willems R, Orini M, Van Huffel S, Bailon R. Evaluation of Methods to Characterize the Change of the Respiratory Sinus Arrhythmia with Age in Sleep Apnea Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:1588-1591. [PMID: 31946199 DOI: 10.1109/embc.2019.8857957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The High Frequency (HF) band of the power spectrum of the Heart Rate Variability (HRV) is widely accepted to contain information related to the respiration. However, it is known that this often results in misleading estimations of the strength of the Respiratory Sinus Arrhythmia (RSA). In this paper, different approaches to characterize the change of the RSA with age, combining HRV and respiratory signals, are studied. These approaches are the bandwidths in the power spectral density estimations, bivariate phase rectified signal averaging, information dynamics, a time-frequency representation, and a heart rate decomposition based on subspace projections. They were applied to a dataset of sleep apnea patients, specifically to periods without apneas and during NREM sleep. Each estimate reflected a different relationship between RSA and age, suggesting that they all capture the cardiorespiratory information in a different way. The comparison of the estimates indicates that the approaches based on the extraction of respiratory information from HRV provide a better characterization of the age-dependent degradation of the RSA.
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Hoedemakers S, Vandenberk B, Liebregts M, Bringmans T, Vriesendorp P, Willems R, Van Cleemput J. Long-term outcome of conservative and invasive treatment in patients with hypertrophic obstructive cardiomyopathy. Acta Cardiol 2019; 74:253-261. [PMID: 30451084 DOI: 10.1080/00015385.2018.1491673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and objective: Treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM) can be either conservative or invasive (alcohol septal ablation (ASA) and myectomy). As there is no clear consensus on the long-term effects of these different strategies, the aim was to compare the long-term outcome in a large tertiary referral university hospital. Methods: We retrospectively included 106 HOCM patients. Twenty-nine (27.4%) patients were treated conservatively, 25 (23.6%) underwent ASA and 52 (49.0%) myectomy. Endpoints were all-cause mortality and sudden cardiac death (SCD)-related events (including SCD, aborted SCD and appropriate ICD shocks). Kaplan-Meier survival analysis and Cox proportional hazard regression models were used. Results: The mean follow-up period was 7.7 ± 4.9 years. Overall, there was no significant difference in survival between the three treatment strategies (p = 0.7). Annual rates of SCD-related events at 5 years and the complete follow-up period were significantly higher (p = 0.034) after conservative treatment (4.9%/year and 2.7%/year, respectively) compared to ASA (0.9%/year, 0.5%/year) and myectomy (1.0%/year, 0.6%/year). Independent predictors of SCD-related events were: conservative treatment (HR 10.66; 1.88-60.55), a known mutation (HR 9.36; 1.43-61.20), left ventricular wall thickness (LVWT) > 30 mm (HR 6.48; 1.05-39.92) and non-sustained VT (HR 16.82; 2.29-123.29). Invasive treatment resulted in a significant higher proportion of patients requiring pacing (p = 0.033). Conclusions: Long-term mortality rates for patients with HOCM are similarly low between treatment groups. However, conservative treatment was associated with SCD-related events, as were known mutations, increased LVWT and non-sustained VT. Invasive treatment was associated with a higher need for implantation of a pacemaker.
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Milagro J, Deviaene M, Gil E, Lázaro J, Buyse B, Testelmans D, Borzée P, Willems R, Van Huffel S, Bailón R, Varon C. Autonomic Dysfunction Increases Cardiovascular Risk in the Presence of Sleep Apnea. Front Physiol 2019; 10:620. [PMID: 31164839 PMCID: PMC6534181 DOI: 10.3389/fphys.2019.00620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/02/2019] [Indexed: 01/08/2023] Open
Abstract
The high prevalence of sleep apnea syndrome (SAS) and its direct relationship with an augmented risk of cardiovascular disease (CVD) have raised SAS as a primary public health problem. For this reason, extensive research aiming to understand the interaction between both conditions has been conducted. The advances in non-invasive autonomic nervous system (ANS) monitoring through heart rate variability (HRV) analysis have revealed an increased sympathetic dominance in subjects suffering from SAS when compared with controls. Similarly, HRV analysis of subjects with CVD suggests altered autonomic activity. In this work, we investigated the altered autonomic control in subjects suffering from SAS and CVD simultaneously when compared with SAS patients, as well as the possibility that ANS assessment may be useful for the early stage identification of cardiovascular risk in subjects with SAS. The analysis was performed over 199 subjects from two independent datasets during night-time, and the effects of the physiological response following an apneic episode, sleep stages, and respiration on HRV were taken into account. Results, as measured by HRV, suggest a decreased sympathetic dominance in those subjects suffering from both conditions, as well as in subjects with SAS that will develop CVDs, which was reflected in a significantly reduced sympathovagal balance (p < 0.05). In this way, ANS monitoring could contribute to improve screening and diagnosis, and eventually aid in the phenotyping of patients, as an altered response might have direct implications on cardiovascular health.
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Heidbuchel H, Willems R, Jordaens L, Olshansky B, Carre F, Lozano IF, Wilhelm M, Müssigbrodt A, Huybrechts W, Morgan J, Anfinsen OG, Prior D, Mont L, Mairesse GH, Boveda S, Duru F, Kautzner J, Viskin S, Geelen P, Cygankiewicz I, Hoffmann E, Vandenberghe K, Cannom D, Lampert R. Intensive recreational athletes in the prospective multinational ICD Sports Safety Registry: Results from the European cohort. Eur J Prev Cardiol 2019; 26:764-775. [DOI: 10.1177/2047487319834852] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background In the ICD Sports Safety Registry, death, arrhythmia- or shock-related physical injury did not occur in athletes who continue competitive sports after implantable cardioverter-defibrillator (ICD) implantation. However, data from non-competitive ICD recipients is lacking. This report describes arrhythmic events and lead performance in intensive recreational athletes with ICDs enrolled in the European recreational arm of the Registry, and compares their outcome with those of the competitive athletes in the Registry. Methods The Registry recruited 317 competitive athletes ≥ 18 years old, receiving an ICD for primary or secondary prevention (234 US; 83 non-US). In Europe, Israel and Australia only, an additional cohort of 80 ‘auto-competitive’ recreational athletes was also included, engaged in intense physical activity on a regular basis (≥2×/week and/or ≥ 2 h/week) with the explicit aim to improve their physical performance limits. Athletes were followed for a median of 44 and 49 months, respectively. ICD shock data and clinical outcomes were adjudicated by three electrophysiologists. Results Compared with competitive athletes, recreational athletes were older (median 44 vs. 37 years; p = 0.0004), more frequently men (79% vs. 68%; p = 0.06), with less idiopathic ventricular fibrillation or catecholaminergic polymorphic ventricular tachycardia (1.3% vs. 15.4%), less congenital heart disease (1.3% vs. 6.9%) and more arrhythmogenic right ventricular cardiomyopathy (23.8% vs. 13.6%) ( p < 0.001). They more often had a prophylactic ICD implant (51.4% vs. 26.9%; p < 0.0001) or were given a beta-blocker (95% vs. 65%; p < 0.0001). Left ventricular ejection fraction, ICD rate cut-off and time from implant were similar. Recreational athletes performed fewer hours of sports per week (median 4.5 vs. 6 h; p = 0.0004) and fewer participated in sports with burst-performances ( vs. endurance) as their main sports: 4% vs. 65% ( p < 0.0001). None of the athletes in either group died, required external resuscitation or was injured due to arrhythmia or shock. Freedom from definite or probable lead malfunction was similar (5-year 97% vs. 96%; 10-year 93% vs. 91%). Recreational athletes received fewer total shocks (13.8% vs. 26.5%, p = 0.01) due to fewer inappropriate shocks (2.5% vs. 12%; p = 0.01). The proportion receiving appropriate shocks was similar (12.5% vs. 15.5%, p = 0.51). Recreational athletes received fewer total (6.3% vs. 20.2%; p = 0.003), appropriate (3.8% vs. 11.4%; p = 0.06) and inappropriate (2.5% vs. 9.5%; p = 0.04) shocks during physical activity. Ventricular tachycardia/fibrillation storms during physical activity occurred in 0/80 recreational vs. 7/317 competitive athletes. Appropriate shocks during physical activity were related to underlying disease ( p = 0.004) and competitive versus recreational sports ( p = 0.004), but there was no relation with age, gender, type of indication, beta-blocker use or burst/endurance sports. The proportion of athletes who stopped sports due to shocks was similar (3.8% vs. 7.5%, p = 0.32). Conclusions Participants in recreational sports had less frequent appropriate and inappropriate shocks during physical activity than participants in competitive sports. Shocks did not cause death or injury. Recreational athletes with ICDs can engage in sports without severe adverse outcomes unless other reasons preclude continuation.
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Miljoen H, Ector J, Garweg C, Saenen J, Huybrechts W, Sarkozy A, Willems R, Heidbuchel H. Differential presentation of atrioventricular nodal re-entrant tachycardia in athletes and non-athletes. Europace 2019; 21:944-949. [DOI: 10.1093/europace/euz001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/03/2019] [Indexed: 01/02/2023] Open
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Garweg C, Splett V, Sheldon TJ, Chinitz L, Ritter P, Steinwender C, Lemme F, Willems R. Behavior of leadless AV synchronous pacing during atrial arrhythmias and stability of the atrial signals over time-Results of the MARVEL Evolve subanalysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:381-387. [PMID: 30687931 DOI: 10.1111/pace.13615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The MARVEL study demonstrated at a single time point that accelerometer (ACC)-based atrial sensing improves atrioventricular (AV) synchrony (AVS) in patients with AV block and a Micra pacemaker (Medtronic, Minneapolis, MN, USA). The purpose of the MARVEL Evolve substudy was to assess the performance over time. METHODS This prospective single-center study compared AVS and ACC signals at two visits ≥6 months apart. Custom software was temporarily downloaded into the Micra at each visit and AVS was measured during 30 min at rest. RESULTS Nine patients from the MARVEL study were enrolled. The mean (±standard deviation) age was 82.3 ± 6.0 years old, 67% were male, and a Micra was implanted for 6.0 ± 6.4 months. High-degree AV block was present in four patients, whereas five with predominantly intrinsic conduction required intermittent pacing for bradycardia. The mean interval between visits was 7.1 ± 0.6 months. Seven patients had normal sinus node function at both visits and were included in a paired analysis. Both ACC signal amplitude (visit 2-visit 1 = 1.4 mG; 95% confidence interval [CI] [-25.8 to 28.4 mG]; P = 0.933) and AVS (visit 1: 90.8%, 95% CI [72.4, 97.4] and visit 2: 91.4%, 95% CI [63.8, 98.5]; P = 0.740) remained stable. Three patients had spontaneous atrial tachycardia. During atrial fibrillation, no atrial contraction was detected or tracked. During atrial flutter, intermittent tracking resulted in a ventricular rate of 60 ± 8 beats per minute (bpm); there was no ventricular pacing >100 bpm. CONCLUSION ACC signals amplitude and performance of AVS pacing were stable over time. During atrial arrhythmias, the AV synchronous pacing mode behaved safely.
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Mairesse GH, Le Polain de Waroux JB, Willems R, Aelvoet W, Blankoff I, Vijgen J, Verbeet T. Quality assessment in Belgian arrhythmology: the Belgian heart rhythm association (BeHRA) databases. Acta Cardiol 2019; 74:46-51. [PMID: 29463193 DOI: 10.1080/00015385.2018.1440904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report presents and discusses, on behalf of the Belgian College of Cardiology, the evolution of the peer review process in arrhythmology, focussing on pacemaker implantation. Data from the last 22 years are compared. The national annual increase in implants is around 1%, clinical patient characteristics remained stable over the years while dual chamber pacing was proportionally increasing. Analyses of the normalised sick sinus and complete atrioventricular block ratios revealed a quite homogenous practice between centres and patient district with the only exception of the two more crowded districts. Battery longevity and infection rate were also assessed. With an incidence of 1/1000 device-years follow-up, Belgium remains below accepted European levels.
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Garweg C, Willems R. Leadless pacing using the transcatheter pacing system (Micra TPS) in the real world: initial Swiss experience from the Romandie region. Europace 2019; 21:356-357. [DOI: 10.1093/europace/euy272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beela AS, Duchenne J, Petrescu A, Ünlü S, Penicka M, Aakhus S, Winter S, Aarones M, Stefanidis E, Fehske W, Willems R, Szulik M, Kukulski T, Faber L, Ciarka A, Neskovic AN, Stankovic I, Voigt JU. Sex-specific difference in outcome after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2019; 20:504-511. [DOI: 10.1093/ehjci/jey231] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/22/2018] [Indexed: 01/06/2023] Open
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Claessen G, La Gerche A, Van De Bruaene A, Claeys M, Willems R, Dymarkowski S, Bogaert J, Claus P, Budts W, Heidbuchel H, Gewillig M. Heart Rate Reserve in Fontan Patients: Chronotropic Incompetence or Haemodynamic Limitation? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bergau L, Willems R, Sprenkeler DJ, Fischer TH, Flevari P, Hasenfuß G, Katsaras D, Kirova A, Lehnart SE, Lüthje L, Röver C, Seegers J, Sossalla S, Dunnink A, Sritharan R, Tuinenburg AE, Vandenberk B, Vos MA, Wijers SC, Friede T, Zabel M. Data on differential multivariable risk prediction of appropriate shock vs. competing mortality. Data Brief 2018; 21:2110-2116. [PMID: 30533459 PMCID: PMC6262164 DOI: 10.1016/j.dib.2018.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
This data article features supplementary figures and tables related to the article “Differential Multivariable risk prediction of appropriate shock vs. competing mortality – a prospective cohort study to estimate benefits from implantable cardioverter defibrillator therapy” (Bergau et al., 2018) [1]. The figures show the clinical study CONSORT graph (data that show the number of patients not-analyzable as well as a distribution of patients by outcomes) and the correlation scatter plot for risk scores of appropriate shock vs. mortality (data that show the calculated score values of the two scores plotted against each other). The tables show the results for the univariate Cox regressions for prediction of mortality and appropriate shock. For further information, please see Bergau et al. (2018) [1].
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Vandael E, Vandenberk B, Vandenberghe J, Van den Bosch B, Willems R, Foulon V. A smart algorithm for the prevention and risk management of QTc prolongation based on the optimized RISQ-PATH model. Br J Clin Pharmacol 2018; 84:2824-2835. [PMID: 30112769 PMCID: PMC6255989 DOI: 10.1111/bcp.13740] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/31/2022] Open
Abstract
AIMS QTc prolongation is a complex problem linked with multiple risk factors. The RISQ-PATH score was previously developed to identify high-risk patients for QTc prolongation. The aim of this study was to optimize and validate this risk score in a large patient cohort, and to propose an algorithm to generate smart QT signals in the electronic medical record. METHODS A retrospective study was performed in the Nexus hospital network (n = 17) in Belgium. All electrocardiograms performed in 2015 in both ambulatory and hospitalized patients were collected together with risk factors for QTc prolongation (training database). Multiple logistic regression was performed to obtain the optimal prediction (RISQ-PATH) model. The model was tested in a validation database (electrocardiograms between January and April 2016). RESULTS In total, 60 208 patients (52.8% males, mean age 63 ± 18 years) were included; 3543 patients (5.9%) had a QTc ≥ 450(♂)/470(♀) ms and 453 (0.8%) a QTc ≥ 500 ms. The optimized RISQ-PATH model has an area under the ROC-curve of 0.772 [95% CI 0.763-0.780] to predict QTc ≥ 450(♂)/470(♀)ms. A predicted probability of ≥0.035 was set as cutoff for a high risk of QTc prolongation. This cutoff resulted in a sensitivity of 87.4% [95% CI 86.2-88.5] and a specificity of 46.2% [95% CI 45.8-46.6]. These results could be confirmed for QTc ≥ 500 ms and in the validation database (n = 28 400). CONCLUSIONS The RISQ-PATH model, with a cutoff probability of 0.035, predicted a prolonged QTc interval ≥ 450/470 ms or ≥500 ms with a sensitivity of ±87% and a specificity of ±45%. This RISQ-PATH model can be used in clinical decision support systems to create smart QT alerts.
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Garweg C, De Buck S, Vandenberk B, Willems R, Ector J. High-Detailed evaluation of the right atrial anatomy by three-dimensional rotational angiography during ablation procedures for atrioventricular nodal reentrant tachycardia and atrial flutter. SCAND CARDIOVASC J 2018; 52:268-274. [PMID: 30445881 DOI: 10.1080/14017431.2018.1546893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM 3D Rotational angiography (3DRA) allows for detailed reconstruction of atrial anatomy and is often used to facilitate pulmonary vein isolation. This study aimed to reappraise the anatomy of the right atrium (RA) using 3DRA, specifically looking at Koch's triangle and the cavotricuspid isthmus (CTI) in atrio-ventricular reentrant tachycardia (AVNRT) and atrial flutter (AFl) ablation. METHODS AND RESULTS 3DRA was performed in 97 patients: AVNRT = 51 and AFl = 46. Dimensions of Koch's triangle and CTI were highly variable between individuals but were not different in both ablation groups. RA volume was significantly larger in AFl patients (p = .004) while indexed RA volume to the body surface area (RAVI) was lightly different (p = .024). In univariate Cox analysis, age (p = .003), RAVI (p < .001) and previous ablation of AFl (p = .003) were predictors of AF occurrence . In multivariate Cox analysis, RAVI was the only independent predictor of AF occurrence. RAVI >80 ml/m2 was a strong predictor for AF during follow-up. CONCLUSION 3DRA allows for detailed per-procedural evaluation of RA anatomy and revealed a great variability in Koch's triangle and CTI dimensions and morphology. RA enlargement as measured by RAVI was an independent predictor for AF occurrence during follow-up.
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Olshansky B, Atteya G, Cannom D, Heidbuchel H, Saarel EV, Anfinsen OG, Cheng A, Gold MR, Müssigbrodt A, Patton KK, Saxon LA, Wilkoff BL, Willems R, Dziura J, Li F, Brandt C, Simone L, Wilhelm M, Lampert R. Competitive athletes with implantable cardioverter-defibrillators-How to program? Data from the Implantable Cardioverter-Defibrillator Sports Registry. Heart Rhythm 2018; 16:581-587. [PMID: 30389442 DOI: 10.1016/j.hrthm.2018.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Athletes with an implantable cardioverter-defibrillator (ICD) may require unique optimal device-based tachycardia programming. OBJECTIVE The purpose of this study was to assess the association of tachycardia programming characteristics of ICDs with occurrence of shocks, transient loss-of-consciousness, and death among athletes. METHODS A subanalysis of a prospective, observational, international registry of 440 athletes with ICDs followed for a median of 44 months was performed. Programming characteristics were divided into groups for rate cutoff (very high, high, or low) and detection (long-detection interval [>nominal] or nominal). Endpoints included total, appropriate, and inappropriate shocks, transient loss-of-consciousness, and mortality. RESULTS In this cohort, 62% were programmed with high-rate cutoff and 30% with long detection. No athlete died of an arrhythmia (related or unrelated) to ICD shocks. Three patients had sustained ventricular tachycardia below programmed detection rate, presenting as palpations and/or dizziness. ICD shocks were received by 98 athletes (64 appropriate, 32 inappropriate); 2 patients received both. Programming a high-rate cutoff was associated with decreased risk of total (P = .01) and inappropriate (P = .04) shocks overall and during competition or practice. Programming long-detection intervals was associated with fewer total shocks. Single- vs dual-chamber devices and the number of zones were unrelated to risk of shock. Transient loss-of-consciousness, associated with 27 appropriate shocks, was not related to programming characteristics. CONCLUSION High-rate cutoff and long-detection duration programming of ICDs in athletes at risk for sudden death can reduce total and inappropriate ICD shocks without affecting survival or the incidence of transient loss-of-consciousness.
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Zabel M, Sticherling C, Willems R, Lubinski A, Bauer A, Bergau L, Braunschweig F, Brugada J, Brusich S, Conen D, Cygankiewicz I, Flevari P, Taborsky M, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Iovev S, Kääb S, Kaliska G, Kasprzak JD, Lüthje L, Malik M, Novotny T, Pavlović N, Schmidt G, Shalganov T, Sritharan R, Schlögl S, Szavits Nossan J, Traykov V, Tuinenburg AE, Velchev V, Vos MA, Willich SN, Friede T, Svendsen JH, Merkely B. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation. ESC Heart Fail 2018; 6:182-193. [PMID: 30299600 PMCID: PMC6351896 DOI: 10.1002/ehf2.12367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/30/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value. Methods and results The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.
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De Coster T, Claus P, Seemann G, Willems R, Sipido KR, Panfilov AV. Myocyte Remodeling Due to Fibro-Fatty Infiltrations Influences Arrhythmogenicity. Front Physiol 2018; 9:1381. [PMID: 30344493 PMCID: PMC6182296 DOI: 10.3389/fphys.2018.01381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
The onset of cardiac arrhythmias depends on the electrophysiological and structural properties of cardiac tissue. Electrophysiological remodeling of myocytes due to the presence of adipocytes constitutes a possibly important pathway in the pathogenesis of atrial fibrillation. In this paper we perform an in-silico study of the effect of such myocyte remodeling on the onset of atrial arrhythmias and study the dynamics of arrhythmia sources—spiral waves. We use the Courtemanche model for atrial myocytes and modify their electrophysiological properties based on published cellular electrophysiological measurements in myocytes co-cultered with adipocytes (a 69–87 % increase in APD90 and an increase of the RMP by 2.5–5.5 mV). In a generic 2D setup we show that adipose tissue remodeling substantially affects the spiral wave dynamics resulting in complex arrhythmia and such arrhythmia can be initiated under high frequency pacing if the size of the remodeled tissue is sufficiently large. These results are confirmed in simulations with an anatomically accurate model of the human atria.
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Garweg C, Ector J, Voros G, Greyling A, Vandenberk B, Foulon S, Willems R. Monocentric experience of leadless pacing with focus on challenging cases for conventional pacemaker. Acta Cardiol 2018; 73:459-468. [PMID: 29189109 DOI: 10.1080/00015385.2017.1410351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Leadless cardiac pacemaker has been developed to reduce complications related to cardiac pacing and is considered as an alternative to conventional pacemaker although safety and efficacy data in clinical practice are limited. The purpose of this study was to investigate the safety and efficacy profile of Micra Transcatheter Pacing System (TPS) used in daily clinical activity with a focus on challenging cases for conventional pacing. METHODS A total of 66 patients (46 men, 79.1 ± 9.7 years) having a Class I or II indication for ventricular pacing underwent a Micra TPS implant procedure. All patients were enrolled in a prospective registry. Follow-up visits were scheduled at discharge and after 1, 3, 6 and 12 months. RESULTS Primary indication for pacing was third degree atrioventricular block (30.3%), sinus node dysfunction (21.2%) or permanent atrial fibrillation with bradycardia (45.5%). The device was successfully implanted in 65 patients (98.5%). During follow-up of 10.4 ± 6.1 months (range 1-23 months), electrical measurements remained stable. Mean pacing capture threshold, pacing impedance and R-wave sensing were respectively 0.57 ± 0.32 V, 580 ± 103 Ohms, 10.62 ± 4.36 mV at the last follow-up. One major (loss of function) and three minor adverse events occurred. Pericardial effusion, dislodgement, device related infection or pacemaker syndrome were not observed. Micra TPS implantation was straightforward for patients with congenital or acquired cardiac and/or vascular abnormalities, previous tricuspid surgery and after heart transplantation. CONCLUSION Our experience confirms that implantation of Micra is safe and efficient in a real world population including patients who present a challenging condition for conventional pacing.
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Vandenberk B, Junttila MJ, Robyns T, Garweg C, Ector J, Huikuri HV, Willems R. Combining noninvasive risk stratification parameters improves the prediction of mortality and appropriate ICD shocks. Ann Noninvasive Electrocardiol 2018; 24:e12604. [PMID: 30265438 DOI: 10.1111/anec.12604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) results from a complex interplay of abnormalities in autonomic function, myocardial substrate and vulnerability. We studied whether a combination of noninvasive risk stratification tests reflecting these key players could improve risk stratification. METHODS Patients implanted with an ICD in whom 24-hr holter recordings were available prior to implant were included. QRS fragmentation (fQRS) was selected as measure of myocardial substrate and a high ventricular premature beat count (VPB >10/hr) for arrhythmic vulnerability. From receiver operating characteristics analysis, detrended fluctuation analysis (DFA), turbulence slope, and deceleration capacity were selected for autonomic function. Adjusted Cox regression analysis with comparison of C-statistics was performed to predict first appropriate shock (AS) and total mortality. RESULTS A total of 220 patients were included in the analysis with an overall follow-up of 4.3 ± 3.1 years. A model including VPB >10/hr, inferior fQRS, and abnormal nonedited DFA was the best for prediction of AS after 1 year of follow-up with a trends toward improvement of the C-statistics compared to baseline (p = 0.055). The risk increased significantly with every abnormal test (HR 1.793, 95%CI 1.255-2.564). A model including fQRS in any region and abnormal edited DFA was the best for prediction of mortality after 3 years of follow-up with significant improvement of the C-statistics (p = 0.023). Each abnormal test was associated with a significant increase in mortality (HR 5.069, 95%CI 1.978-12.994). CONCLUSION Combining noninvasive risk stratification tests according to their physiological background can improve the risk prediction of SCD and mortality.
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Robyns T, Nuyens D, Lu HR, Gallacher DJ, Vandenberk B, Garweg C, Ector J, Pagourelias E, Van Cleemput J, Janssens S, Willems R. Prognostic value of electrocardiographic time intervals and QT rate dependence in hypertrophic cardiomyopathy. J Electrocardiol 2018; 51:1077-1083. [PMID: 30497734 DOI: 10.1016/j.jelectrocard.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/26/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Preventing sudden cardiac death (SCD) is one of the main goals in hypertrophic cardiomyopathy (HCM). Many variables have been proposed, however the European and American guidelines do not incorporate any ECG or Holter monitoring derived variables other than the presence of ventricular arrhythmia in their risk stratification models. In the present study we evaluated electrocardiographic parameters in risk stratification of HCM. METHODS AND RESULTS Novel electrocardiographic parameters including the index of cardio-electrophysiological balance (iCEB), individualized QT correction (QTi) and QT rate dependence were evaluated along with established risk factors. A composite endpoint of SCD was defined as out of hospital cardiac arrest, appropriate ICD shock and sustained ventricular tachycardia. Cox regression analysis was used to evaluate predictors of SCD. Out of the 466 HCM patients, 31 reached the composite endpoint during a follow up of 75 ± 86 months. In a multivariate model, nor iCEB, QTi or QT rate dependence were predictors of SCD. Only male gender (p < 0.01; OR 13.1; CI 1.74-98.83), negative T waves in the inferior leads (p = 0.04; OR 2.51; CI 1.03-6.13) and familial sudden death (p < 0.01; OR 3.03; CI 1.39-6.59) were significant predictors. On top of either the ESC risk score or the 3 traditional 'American risk factors', only male gender was a significant predictor of SCD. CONCLUSION No ECG or Holter monitoring parameters added in risk stratification for SCD in HCM. However, male gender and negative T waves in the inferior leads are promising novel markers to evaluate in larger cohorts.
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Bergau L, Vos MA, Willems R, Luethje L, Tuinenburg AT, Vandenberk B, Seegers J, Sossalla S, Flevari P, Lehnart S, Roever C, Friede T, Hasenfuss G, Zabel M. P2915Multivariable risk prediction of appropriate shock and mortality in ICD patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Robyns T, Breckpot J, Nuyens D, Vandenberk B, Corveleyn A, Kuiperi C, Van Aelst L, Van Cleemput J, Willems R. P6322Genotype phenotype relation in patients with hypertrophic cardiomyopathy: development of a model to predict the genetic yield. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Claeys M, Verbelen T, Rega F, Minami T, Los J, Vandenberk B, Holemans P, Willems R, Claus P. P249Cardiac resynchronisation in experimental right heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Huikuri HV, Junttila MJ, Willems R, Bergau L, Malik M, Vandenberg B, Vos MA, Schmidt G, Merkely B, Lubinski A, Svetsolak M, Braunschweig F, Harden M, Zabel M, Sticherling C. P605Appropriate shocks and mortality in diabetic vs. non-diabetic patients with prophylactic implantable cardioverter-defibrillator. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pelli A, Kentta TV, Junttila MJ, Bergau L, Zabel M, Malik M, Sticherling C, Reichlin T, Willems R, Vos MA, Harden M, Friede T, Huikuri HV. P3451Electrocardiogram as a predictor of survival without appropriate shocks in primary prophylactic ICD patients: a retrospective multi-center study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, Ector J, Willems R. QT correction across the heart rate spectrum, in atrial fibrillation and ventricular conduction defects. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1101-1108. [DOI: 10.1111/pace.13423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/16/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
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Bergau L, Willems R, Sprenkeler DJ, Fischer TH, Flevari P, Hasenfuß G, Katsaras D, Kirova A, Lehnart SE, Lüthje L, Röver C, Seegers J, Sossalla S, Dunnink A, Sritharan R, Tuinenburg AE, Vandenberk B, Vos MA, Wijers SC, Friede T, Zabel M. Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy. Int J Cardiol 2018; 272:102-107. [PMID: 29983251 DOI: 10.1016/j.ijcard.2018.06.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/18/2018] [Accepted: 06/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. METHODS For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. RESULTS The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. CONCLUSIONS In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks.
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Van Oekelen O, Vermeersch K, Everaerts S, Vandenberk B, Willems R, Janssens W. Significance of prolonged QTc in acute exacerbations of COPD requiring hospitalization. Int J Chron Obstruct Pulmon Dis 2018; 13:1937-1947. [PMID: 29942126 PMCID: PMC6005315 DOI: 10.2147/copd.s157630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background A prolonged QT interval is associated with increased risk of Torsade de Pointes and cardiovascular death. The prevalence and clinical relevance of QT prolongation in acute exacerbations of COPD (AECOPD), with high risk for cardiac morbidity and mortality, is currently unclear. Methods A dual cross-sectional study strategy was therefore designed. A retrospective study evaluated 140 patients with an AECOPD requiring hospitalization, half of which had prolonged QTc on the admission ECG. Univariate and multivariate analyses were conducted to determine associated factors; Kaplan–Meier and Cox regression analyses to assess prognostic significance. A prospective study evaluated 180 pulmonary patients with acute respiratory problems requiring hospitalization, to determine whether a prolonged QTc at admission represents an AECOPD-specific finding and to investigate the change in QTc-duration during hospitalization. Results Retrospectively, hypokalemia, cardiac troponin T and conductance abnormalities on ECG were significantly and independently associated with QTc prolongation. A prolonged QTc was associated with increased all-cause mortality (HR 2.698 (95% CI 1.032–7.055), p=0.043), however, this association was no longer significant when corrected for age, FEV1 and cardiac troponin T. Prospectively, QTc prolongation was observed in 1/3 of the patients diagnosed with either an AECOPD, lung cancer, pulmonary infection or miscellaneous acute pulmonary disease, and was not more prevalent in AECOPD. The QTc-duration decreased significantly during hospitalization in patients with and without COPD. Conclusion A prolonged QTc is a marker of underlying cardiovascular disease during an AECOPD. It is not COPD-specific, but a common finding during the acute phase of a pulmonary disease requiring urgent hospital admission.
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Al-Atia B, Vandenberk B, Vörös G, Garweg C, Ector J, Willems R. Predictors of a high defibrillation threshold test during routine ICD implantation. Acta Cardiol 2018; 73:267-273. [PMID: 28885097 DOI: 10.1080/00015385.2017.1371455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is growing evidence that routine defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation is not necessary. However a small group of patients might be at risk if no DFT testing is performed. METHODS Patients with a new pectoral ICD implantation in our hospital between 2006 and 2014 were included in a retrospective registry. A clinical high DFT was defined as a safety margin <10 J of the maximal device output. Logistic regression for prediction of high DFT was performed using patient characteristics, clinical, echocardiographic and device-related parameters. RESULTS DFT testing was performed in 788/864 (91.2%) procedures. In 76 (8.8%) patients no DFT testing was performed mainly due to atrial fibrillation, intra-cardiac thrombus, hemodynamic instability or logistical reasons. A high DFT was present in 44 (5.6%) patients. A QRS duration ≥150 ms, a low left ventricular ejection fraction (LVEF ≤25%), a severely dilated left ventricle ≥60 mm and right sided pre-pectoral implantations were univariate predictors of a high DFT. Independent predictors of a high DFT were a LVEF ≤25% (HR 2.195, 95%CI 1.085-4.443) and right sided pre-pectoral implantations (HR 3.135, 95% CI 1.186-8.287). CONCLUSIONS A high DFT is still present in about 5% of patients and is more frequent in patients with a severely dilated left ventricle, a very low LVEF, right sided pre-pectoral implantation and wider QRS duration. It might be clinically important to continue DFT testing in these high risk patients.
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Sticherling C, Arendacka B, Svendsen JH, Wijers S, Friede T, Stockinger J, Dommasch M, Merkely B, Willems R, Lubinski A, Scharfe M, Braunschweig F, Svetlosak M, Zürn CS, Huikuri H, Flevari P, Lund-Andersen C, Schaer BA, Tuinenburg AE, Bergau L, Schmidt G, Szeplaki G, Vandenberk B, Kowalczyk E, Eick C, Juntilla J, Conen D, Zabel M. Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries. Europace 2018; 20:963-970. [PMID: 29016784 PMCID: PMC5982785 DOI: 10.1093/europace/eux176] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/27/2017] [Indexed: 12/29/2022] Open
Abstract
Aims Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. Methods and results Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value < 0.0001). An appropriate ICD shock occurred in 66 women (8%) and 514 men (14%; HR 0.61; 95% CI: 0.47-0.79; P = 0.0002). Conclusion Our retrospective analysis of 14 local registries in 11 European countries demonstrates that fewer women than men undergo ICD implantation for primary prevention. After multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.
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Robyns T, Nuyens D, Vandenberk B, Kuiperi C, Corveleyn A, Breckpot J, Garweg C, Ector J, Willems R. Genotype-phenotype relationship and risk stratification in loss-of-function SCN5A mutation carriers. Ann Noninvasive Electrocardiol 2018; 23:e12548. [PMID: 29709101 DOI: 10.1111/anec.12548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Loss-of-function (LoF) mutations in the SCN5A gene cause multiple phenotypes including Brugada Syndrome (BrS) and a diffuse cardiac conduction defect. Markers of increased risk for sudden cardiac death (SCD) in LoF SCN5A mutation carriers are ill defined. We hypothesized that late potentials and fragmented QRS would be more prevalent in SCN5A mutation carriers compared to SCN5A-negative BrS patients and evaluated risk markers for SCD in SCN5A mutation carriers. METHODS We included all SCN5A loss-of-function mutation carriers and SCN5A-negative BrS patients from our center. A combined arrhythmic endpoint was defined as appropriate ICD shock or SCD. RESULTS Late potentials were more prevalent in 79 SCN5A mutation carriers compared to 39 SCN5A-negative BrS patients (66% versus 44%, p = .021), while there was no difference in the prevalence of fragmented QRS. PR interval prolongation was the only parameter that predicted the presence of a SCN5A mutation in BrS (OR 1.08; p < .001). Four SCN5A mutation carriers, of whom three did not have a diagnostic type 1 ECG either spontaneously or after provocation with a sodium channel blocker, reached the combined arrhythmic endpoint during a follow-up of 44 ± 52 months resulting in an annual incidence rate of 1.37%. CONCLUSION LP were more frequently observed in SCN5A mutation carriers, while fQRS was not. In SCN5A mutation carriers, the annual incidence rate of SCD was non-negligible, even in the absence of a spontaneous or induced type 1 ECG. Therefore, proper follow-up of SCN5A mutation carriers without Brugada syndrome phenotype is warranted.
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Dries E, Vandenberk B, Gilbert G, Amoni M, Holemans P, Willems R, Claus P, Sipido KR. P519Regional heterogeneity of hyperactive non-coupled ryanodine receptors makes the peri-infarct region more prone to triggered activities after myocardial infarction. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Suárez-León AA, Varon C, Willems R, Van Huffel S, Vázquez-Seisdedos CR. T-wave end detection using neural networks and Support Vector Machines. Comput Biol Med 2018; 96:116-127. [PMID: 29567483 DOI: 10.1016/j.compbiomed.2018.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE In this paper we propose a new approach for detecting the end of the T-wave in the electrocardiogram (ECG) using Neural Networks and Support Vector Machines. METHODS Both, Multilayer Perceptron (MLP) neural networks and Fixed-Size Least-Squares Support Vector Machines (FS-LSSVM) were used as regression algorithms to determine the end of the T-wave. Different strategies for selecting the training set such as random selection, k-means, robust clustering and maximum quadratic (Rényi) entropy were evaluated. Individual parameters were tuned for each method during training and the results are given for the evaluation set. A comparison between MLP and FS-LSSVM approaches was performed. Finally, a fair comparison of the FS-LSSVM method with other state-of-the-art algorithms for detecting the end of the T-wave was included. RESULTS The experimental results show that FS-LSSVM approaches are more suitable as regression algorithms than MLP neural networks. Despite the small training sets used, the FS-LSSVM methods outperformed the state-of-the-art techniques. CONCLUSION FS-LSSVM can be successfully used as a T-wave end detection algorithm in ECG even with small training set sizes.
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Lapage L, Foulon S, Berti D, Poels P, Hoekman B, Vermeulen J, Ector J, Haemers P, Voros G, Garweg C, Willems R. 63Outsourcing telecardiology services: the possible decline in clinical workload could be lower than expected. Europace 2018. [DOI: 10.1093/europace/euy015.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bergau L, Willems R, Tuinenburg A, Vos MA, Flevari P, Luethje L, Fischer TH, Vandenberk B, Sprenkeler D, Roever C, Hasenfuss G, Lehnart SE, Friede T, Zabel M. P1223Prediction model for shock risk and mortality in ICD patients. Europace 2018. [DOI: 10.1093/europace/euy015.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lapage L, Foulon S, Berti D, Poels P, Hoekman B, Vermeulen J, Ector J, Haemers P, Voros G, Garweg C, Willems R. P1227A prospective analysis of the detailed workload of a telecardiology service. Europace 2018. [DOI: 10.1093/europace/euy015.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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145
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Lapage L, Foulon S, Berti D, Poels P, Hoekman B, Vermeulen J, Ector J, Haemers P, Voros G, Garweg C, Willems R. 64Patient driven contacts: an unforseen burden for a telecardiology service. Europace 2018. [DOI: 10.1093/europace/euy015.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Billiet A, Schurmans W, Haemers P, Garweg C, Willems R, Ector J. P337Safety of rapid ventricular pacing to acquire three-dimensional rotational angiography during ablation of atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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147
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Lapage L, Foulon S, Berti D, Poels P, Hoekman B, Vermeulen J, Ector J, Haemers P, Voros G, Garweg C, Willems R. P423A retrospective analysis of the workload in a telecardiology service. Europace 2018. [DOI: 10.1093/europace/euy015.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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148
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Ector J, David W, Willems J, De Buck S, De Potter T, Schurmans W, Haemers P, Garweg C, Willems R. P302An augmented reality approach to guide epicardial access during cardiac ablation procedures. Europace 2018. [DOI: 10.1093/europace/euy015.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beela AS, Ünlü S, Duchenne J, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Penicka M, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Faber L, Stankovic I, Voigt JU. Assessment of mechanical dyssynchrony can improve the prognostic value of guideline-based patient selection for cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2018; 20:66-74. [DOI: 10.1093/ehjci/jey029] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/06/2018] [Indexed: 11/14/2022] Open
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De Coster T, Claus P, Kazbanov IV, Haemers P, Willems R, Sipido KR, Panfilov AV. Arrhythmogenicity of fibro-fatty infiltrations. Sci Rep 2018; 8:2050. [PMID: 29391548 PMCID: PMC5795000 DOI: 10.1038/s41598-018-20450-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/18/2018] [Indexed: 12/14/2022] Open
Abstract
The onset of cardiac arrhythmias depends on electrophysiological and structural properties of cardiac tissue. One of the most important changes leading to arrhythmias is characterised by the presence of a large number of non-excitable cells in the heart, of which the most well-known example is fibrosis. Recently, adipose tissue was put forward as another similar factor contributing to cardiac arrhythmias. Adipocytes infiltrate into cardiac tissue and produce in-excitable obstacles that interfere with myocardial conduction. However, adipose infiltrates have a different spatial texture than fibrosis. Over the course of time, adipose tissue also remodels into fibrotic tissue. In this paper we investigate the arrhythmogenic mechanisms resulting from the presence of adipose tissue in the heart using computer modelling. We use the TP06 model for human ventricular cells and study how the size and percentage of adipose infiltrates affects basic properties of wave propagation and the onset of arrhythmias under high frequency pacing in a 2D model for cardiac tissue. We show that although presence of adipose infiltrates can result in the onset of cardiac arrhythmias, its impact is less than that of fibrosis. We quantify this process and discuss how the remodelling of adipose infiltrates affects arrhythmia onset.
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