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Vandenberk B, Goovaerts G, Garweg C, Ector J, Van Huffel S, Willems R. Automated quantitative assessment of QRS fragmentation can improve non-invasive risk stratification. J Electrocardiol 2018. [DOI: 10.1016/j.jelectrocard.2017.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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152
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Vandenberk B, Robyns T, Goovaerts G, Claeys M, Helsen F, Van Soest S, Garweg C, Ector J, Van Huffel S, Willems R. Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy. J Electrocardiol 2017; 51:549-554. [PMID: 29275955 DOI: 10.1016/j.jelectrocard.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fragmented QRS (fQRS) on a 12-lead ECG has been linked with adverse outcome. However, the visual scoring of ECGs is prone to inter- and intra-observer variability. METHODS Five observers, two experienced and three novel, assessed fQRS in 712 digital ECGs, 100 were re-evaluated to assess intra-observer variability. Fleiss and Cohen's Kappa were calculated and compared between subgroups. RESULTS The inter-observer variability for assessing fQRS in all leads combined was substantial with a Kappa of 0.651. Experienced observers only had a better agreement with a Kappa of 0.823. Intra-observer variability ranged from 0.736 to 0.880. In the subgroup with ventricular pacing the inter-observer variability was even significantly larger when compared to ECGs with normal QRS duration (Kappa 0.493 vs 0.664, p<0.001). CONCLUSION The visual assessment of QRS fragmentation is prone to inter- and intra-observer variability, mainly influenced by the experience of the observers, the underlying rhythm and QRS morphology.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
| | - Tomas Robyns
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Griet Goovaerts
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Imec, Leuven, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Frederik Helsen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Van Soest
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; Imec, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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153
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Vandael E, Vandenberk B, Vandenberghe J, Willems R, Foulon V. Cases of drug-induced Torsade de Pointes: a review of Belgian cases in the EudraVigilance database. Acta Clin Belg 2017; 72:385-390. [PMID: 28335691 DOI: 10.1080/17843286.2017.1300217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/19/2022]
Abstract
OBJECTIVES Post-marketing surveillance is very important, especially for rare adverse drug reactions like QTc-prolongation and Torsade de Pointes (TdP). The objective of this study was to investigate the characteristics of Belgian cases of drug-related TdP reported in the EudraVigilance database. METHODS The EudraVigilance database was searched for Belgian post-marketing cases of TdP reported between December 2001-April 2015. These cases were identified with MedDRA preferred terms. Duplicate reports were excluded. Each included case report was reviewed to collect data about age, gender, seriousness, suspected drug, concomitant drugs, causality, and other known risk factors for QTc-prolongation. RESULTS Between 2001 and 2015, only 31 cases coded as TdP were identified; 16 cases were also coded as 'prolonged QT' and 2 patients died. In total, 21 suspected drugs were implicated and most of them (N = 11) were part of list 1 of CredibleMeds. The most common suspected drugs were citalopram (N = 4) and amiodarone (N = 3). In 18 cases, a pharmacodynamic drug-drug interaction with risk of QTc-prolongation was present. Most patients (N = 25) had ≥2 other risk factors for QTc-prolongation. CONCLUSION Over 15 years, only a low number of Belgian cases of TdP were identified in the EudraVigilance database. In most case reports, multiple risk factors for QTc-prolongation could be detected. This illustrates that there is a clear underreporting of QTc-prolongation and TdP in Belgium. Initiatives are needed to improve the awareness and knowledge of health care professionals regarding the risk of QTc-prolongation and TdP, both to prevent cases of TdP and to stimulate the reporting of these cases.
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Affiliation(s)
- Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Experimental Cardiology – UZ Leuven, Leuven, Belgium
| | - Joris Vandenberghe
- Department of Neurosciences, KU Leuven – University of Leuven, Leuven, Belgium
- Liaison Psychiatry, KU Leuven – University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Cardiology – UZ Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven – University of Leuven, Leuven, Belgium
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154
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Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, Janssens S, Nuyens D. Response of Robyns to the Tse's letter to editor. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 29105240 DOI: 10.1111/anec.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Hua Rong Lu
- Global Safety Pharmacology, Discovery Sciences, A Division of Janssen Pharmaceutica NV, Janssen Research and Development, Beerse, Belgium
| | - David J Gallacher
- Global Safety Pharmacology, Discovery Sciences, A Division of Janssen Pharmaceutica NV, Janssen Research and Development, Beerse, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dieter Nuyens
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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155
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Ector J, Garweg C, Goovaerts G, Van Huffel S, Vandenberk B, Willems R. Automated quantitative assessment of QRS fragmentation can improve non-invasive risk stratification. J Electrocardiol 2017. [DOI: 10.1016/j.jelectrocard.2017.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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156
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Mo Y, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Long-Term Outcome After CRT in the Presence of Mechanical Dyssynchrony Seen With Chronic RV Pacing or Intrinsic LBBB. JACC Cardiovasc Imaging 2017; 10:1091-1099. [DOI: 10.1016/j.jcmg.2016.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
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157
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Vandenberk B, Robyns T, Garweg C, Floré V, Foulon S, Voros G, Ector J, Willems R. The impact of changes in LVEF and renal function on the prognosis of ICD patients after elective device replacement. Pacing Clin Electrophysiol 2017; 40:1147-1159. [DOI: 10.1111/pace.13176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Tomas Robyns
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Cardiology; University Hospitals Leuven; Leuven Belgium
| | | | - Vincent Floré
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
| | - Stefaan Foulon
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
| | - Gabor Voros
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Cardiology; University Hospitals Leuven; Leuven Belgium
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158
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Claus P, Bogaert J, Willems R, Delcroix M. P724Peak oxygen consumption in chronic thromboembolic pulmonary vascular disease is determined predominately by cardiac reserve and not by dead space ventilation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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159
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Jacobs B, Robyns T, Vandenberk B, Ector J, Willems R, Garweg C. P1702Evaluation of the shanghai score system as diagnostic and prognostic tool in brugada syndrome patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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160
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Pelli A, Haukilahti A, Kentta T, Junttila J, Bergau L, Zabel M, Malik M, Sticherling C, Reichlin T, Willems R, Vos M, Harden M, Friede T, Huikuri H. P1689Prognostic significance of different patterns and amplitude of QRS fragmentation in patients with implantable defibrillator in primary prevention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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161
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Abbas A, Ciara A, Daraban A, Kotrc M, Aarones M, Aakhus S, Fehske W, Winter S, Penicka M, Szulik M, Faber L, Willems R, Kukulski T, Stankovic I, Voigt J. P5464Mechanical dyssynchrony assessment improves the prognostic value of current guidelines based patient selection for CRT. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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162
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Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Paul Herijgers
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
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163
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Stankovic I, Belmans A, Prinz C, Ciarka A, Maria Daraban A, Kotrc M, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2017; 18:1109-1117. [DOI: 10.1093/ehjci/jex188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 01/22/2023] Open
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164
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Goovaerts G, Vandenberk B, Willems R, Van Huffel S. Automatic detection of T wave alternans using tensor decompositions in multilead ECG signals. Physiol Meas 2017; 38:1513-1528. [DOI: 10.1088/1361-6579/aa7876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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165
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Floré V, Vandenberk B, Belmans A, Garweg C, Ector J, Willems R. Introducing ICD-resistant mortality as an end point to evaluate the clinical efficacy of an implantable cardioverter-defibrillator in ischaemic cardiomyopathy. Acta Cardiol 2017; 73:19-27. [PMID: 28685657 DOI: 10.1080/00015385.2017.1322776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE A new end point called ICD-resistant mortality was evaluated to assess the clinical efficacy of ICD implantations. METHODS AND RESULTS In 302 ICD patients with ischaemic cardiomyopathy, we investigated which clinical parameters predicted useful ICD implantations using cumulative incidence competing risk analysis. Implantation was deemed clinically useful when the ICD provided appropriate therapy and the patient survived implantation by 1 year and the first shock by 30 days. ICD-resistant mortality (ICDRM) was defined as death within 30 days after the first shock, within 1 year of implantation or without previous appropriate ICD therapy. After 5 years, ICDRM occurred in 23% of implantations, while 36% were clinically useful. After multivariable analysis, ICDRM was associated with LVEF <35% (HR: 2.63; p = .005), beta-blocker dose <50% (HR: 2.0; p = .01) and anterior or diffuse infarct location (HR: 3.61; p = .001 and HR: 2.89; p = .02). Useful ICD implantations were associated with beta-blocker dose <50% (HR: 1.64; p = .02) and non-anterior infarct location (HR: 3.22 vs anterior and 1.59 vs diffuse; combined p<.001). CONCLUSIONS Five years after implantation, an ICD could be classified as useful in 1 out of 3, while ICDRM occurred in one out of four patients. At 10 years, up to 80% of implantations could be categorized. Lower LVEF was related with significantly higher incidence of ICDRM. Anterior infarcts were associated with more ICDRM and less useful implantations than non-anterior infarcts. Future risk stratification for ICD should focus more on the discrimination between arrhythmic risk, probably preventable by ICDs and ICD-resistant mortality risk.
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Affiliation(s)
- Vincent Floré
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Belmans
- Institute for Biostatistics and Statistical Bioinformatics, University of Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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166
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Heidbuchel H, Olshansky B, Cannom D, Jordaens L, Willems R, Carre F, Fernandez Lozano I, Wilhelm M, Mussigbrodt A, Huybrechts W, Morgan J, Anfinsen OG, Prior D, Mont L, Lampert R. 592Intensive recreational vs. competitive athletes in the prospective multinational ICD Sports Safety Registry: results from the European recreational cohort. Europace 2017. [DOI: 10.1093/ehjci/eux143.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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167
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Helsen F, Van De Bruaene A, Gabriels C, Claeys M, Troost E, Vörös G, Willems R, Voigt JU, Budts W. Prognostic significance of improvement in right ventricular systolic function during cardiac resynchronization therapy. Acta Cardiol 2017. [PMID: 28636525 DOI: 10.1080/00015385.2017.1305177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objectives There is conflicting evidence concerning the role of right ventricular (RV) systolic dysfunction in the long-term clinical outcome after cardiac resynchronization therapy (CRT). Therefore we aimed to assess evolution of RV systolic function during CRT, covariates associated with its improvement, and its impact on outcome. Methods and results All CRT device implantations (Jan 2009-Dec 2011) in our institution were reviewed. Records of 69 patients (25% female, mean age 62.8 ± 9.2 years, mean left ventricular (LV) ejection fraction 27 ± 8%) were analyzed. Baseline RV fractional area change (FAC) < 35% was present in 37 patients (54%). At one year, 24 of them (65%) improved in RV FAC. LV remodeling and mitral regurgitation were significantly associated with the likelihood of RV FAC improvement (OR 4.80, 95% CI 1.13-20.46, P = 0.034 and OR 0.32, 95% CI 0.12-0.89, P = 0.029, respectively). The composite endpoint of death or heart transplantation occurred in 23 patients (33%) over a mean follow-up of 2.8 ± 1.4 years. RV FAC at one year (HR 0.90, 95% CI 0.86-0.94, P < .001) was, independently of NYHA class and LV remodeling, associated with clinical outcome. Conclusions RV systolic function might improve during CRT. This seems mainly due to changed left-sided hemodynamics and LV remodeling. Good RV systolic function is independently related with better outcome.
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Affiliation(s)
- Frederik Helsen
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Charlien Gabriels
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Troost
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Gábor Vörös
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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168
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Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, Ector J, Willems R. P475QT correction and predictive value of QTc in atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux141.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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169
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Robyns T, Nuyens D, Vandenberk B, Garweg C, Ector J, Corveleyn A, Breckpot J, Willems R. P270Individualized QT correction (QTi) derived from holter recordings is a powerful tool in the diagnosis of LQTS. Europace 2017. [DOI: 10.1093/ehjci/eux171.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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170
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Robyns T, Nuyens D, Vandenberk B, Kuiperi C, Breckpot J, Corveleyn A, Van Cleemput J, Willems R. P1597QT rate dependence in risk stratification for sudden death in hypertrophic cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux158.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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171
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Garweg C, Vandenberk B, Voros G, Ector J, Foulon S, Willems R. P1772Leadless cardiac pacing system as first choice within patients with challenging conditions for conventional pacing. Europace 2017. [DOI: 10.1093/ehjci/eux161.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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172
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Robyns T, Kuiperi C, Willems R, Corveleyn A, Nuyens D. Targeted capture sequencing in a large LQTS family reveals a new pathogenic mutation c.2038delG in KCNH2 initially missed due to allelic dropout. Acta Cardiol 2017. [DOI: 10.1080/ac.70.6.3120197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Cuno Kuiperi
- Department of Human Genetics, University Hospitals Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Anniek Corveleyn
- Department of Human Genetics, University Hospitals Leuven, Belgium
| | - Dieter Nuyens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
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173
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Vandael E, Vandenberk B, Vandenberghe J, Pincé H, Willems R, Foulon V. Incidence of Torsade de Pointes in a tertiary hospital population. Int J Cardiol 2017; 243:511-515. [PMID: 28576628 DOI: 10.1016/j.ijcard.2017.05.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple risk factors play a role in the development of QTc-prolongation and Torsade de Pointes (TdP). Cases of TdP are underreported and data on the incidence of TdP is scarce. The aim of this study was to investigate the incidence of TdP in a Belgian university hospital and describe the characteristics of TdP-cases using a risk score. METHODS All cases from 2011 till 2013 coded with the ICD-9 code 427.1 in the University Hospitals of Leuven were selected. The medical files were reviewed and demographical, medical, medication and electrocardiographic data were collected. We focused on TdP-cases that were probably caused by the acquired long QT-syndrome. The RISQ-PATH score was used to quantify the risk in these cases (≥10 points as high risk for QTc-prolongation/TdP). RESULTS Over three years, 41 TdP-cases were identified of which 19 cases were secondary to the acquired long QT-syndrome (52.6% females, mean age of 74±12years). This corresponds with an incidence of 0.16‰/year in a hospital population. Most of the patients (N=17) were treated with at least one QTc-prolonging drug (most frequently amiodarone, sotalol and furosemide) of whom 12 patients with ≥1 QTc-prolonging drug of list 1 of CredibleMeds. Fifteen patients had an electrocardiogram in a 24-hours interval before the TdP with a prolonged QTc-interval (≥450/470ms). All the patients had a RISQ-PATH score≥10. CONCLUSIONS Although the incidence of 0.16‰/year might seem low, this means that approximately 173 possibly lethal TdP-cases can be expected in Belgian hospitals each year. All TdP-cases were associated with a high RISQ-PATH score.
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Affiliation(s)
- Eline Vandael
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000 Leuven, Belgium.
| | - Bert Vandenberk
- KU Leuven - University of Leuven, Department of Cardiovascular Sciences, 3000 Leuven, Belgium; University Hospitals Leuven, Cardiology, 3000 Leuven, Belgium
| | - Joris Vandenberghe
- KU Leuven - University of Leuven, Department of Neurosciences, 3000 Leuven, Belgium; University Hospitals Leuven, Psychiatry, 3000 Leuven, Belgium
| | - Hilde Pincé
- KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, 3000 Leuven, Belgium; University Hospitals Leuven, Medical Coding Department and Management Information Reporting, 3000 Leuven, Belgium
| | - Rik Willems
- KU Leuven - University of Leuven, Department of Cardiovascular Sciences, 3000 Leuven, Belgium; University Hospitals Leuven, Cardiology, 3000 Leuven, Belgium
| | - Veerle Foulon
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000 Leuven, Belgium
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174
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Popovic N, Haemers P, Willems R, Claus P. Combined reconstruction of atrial morphology and paracardial fat depositions to study remodeling in atrial fibrillation. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:485-488. [PMID: 28268377 DOI: 10.1109/embc.2016.7590745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia. AF is shown to be a progressive disease, which is strongly associated with important structural (morphological and histological), electrical and mechanical remodeling of the left atrium (LA). Adipose tissue accumulation has been shown to be a risk factor in AF. We set out to explore the connection between adipose tissue coverage of the LA surface, for both the complete LA and specific regions and the progression of AF. In this study we propose a methodology to study the regional coverage of the left-atrial wall with adipose tissue based on magnetic resonance data. Validation was performed in a sheep model. While the total amount of left-atrial adipose tissue was higher in the sheep with AF, no changes in regional coverage were observed.
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175
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Vandenberk B, Hinderks M, Voros G, Garweg C, Vanhaecke J, Willems R. The evolution and benefit of device therapy in patients listed for heart transplant. Europace 2017; 20:786-793. [DOI: 10.1093/europace/euw436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/21/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Mark Hinderks
- Department of Internal Medicine University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Gabor Voros
- Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Johan Vanhaecke
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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176
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Helsen F, Vandenberk B, De Meester P, Van De Bruaene A, Gabriels C, Troost E, Gewillig M, Meyns B, Willems R, Budts W. Appearance of QRS fragmentation late after Mustard/Senning repair is associated with adverse outcome. Heart 2017; 103:1036-1042. [DOI: 10.1136/heartjnl-2016-310512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 11/04/2022] Open
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177
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Vandenberk B, Vandael E, Garweg C, Foulon V, Ector J, Willems R. Which Correction Formula for the Qt-interval Should Be Implemented In A Computer Based Hospital Wide Qt-monitoring System? J Electrocardiol 2016. [DOI: 10.1016/j.jelectrocard.2016.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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178
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Sciot B, Vandenberk B, Huijghebaert S, Goovaerts G, Van Huffel S, Ector J, Willems R. Influence of food intake on the QT and QT/RR relation. J Electrocardiol 2016; 49:720-7. [DOI: 10.1016/j.jelectrocard.2016.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Indexed: 10/21/2022]
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179
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Locati ET, Moya A, Oliveira M, Tanner H, Willems R, Lunati M, Brignole M. External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study. Europace 2016; 18:1265-72. [PMID: 26519025 PMCID: PMC4974630 DOI: 10.1093/europace/euv311] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS SYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin. METHODS AND RESULTS Consecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T(®), Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0-15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3-29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4-9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001). CONCLUSION The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.
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Affiliation(s)
- E T Locati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - A Moya
- Univeristy Hospital Vall d'Hebron, Barcelona, Spain University Hospital QuironDexeus, Barcelona, Spain
| | | | | | | | - M Lunati
- Department of Cardiovascular-Cardiology 3, Electrophysiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - M Brignole
- Lavagna Hospital, Lavagna, Genova, Italy
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180
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Abstract
Background Drug safety precautions recommend monitoring of the corrected QT interval. To determine which QT correction formula to use in an automated QT‐monitoring algorithm in our electronic medical record, we studied rate correction performance of different QT correction formulae and their impact on risk assessment for mortality. Methods and Results All electrocardiograms (ECGs) in patients >18 years with sinus rhythm, normal QRS duration and rate <90 beats per minute (bpm) in the University Hospitals of Leuven (Leuven, Belgium) during a 2‐month period were included. QT correction was performed with Bazett, Fridericia, Framingham, Hodges, and Rautaharju formulae. In total, 6609 patients were included (age, 59.8±16.2 years; 53.6% male and heart rate 68.8±10.6 bpm). Optimal rate correction was observed using Fridericia and Framingham; Bazett performed worst. A healthy subset showed 99% upper limits of normal for Bazett above current clinical standards: men 472 ms (95% CI, 464–478 ms) and women 482 ms (95% CI 474–490 ms). Multivariate Cox regression, including age, heart rate, and prolonged QTc, identified Framingham (hazard ratio [HR], 7.31; 95% CI, 4.10–13.05) and Fridericia (HR, 5.95; 95% CI, 3.34–10.60) as significantly better predictors of 30‐day all‐cause mortality than Bazett (HR, 4.49; 95% CI, 2.31–8.74). In a point‐prevalence study with haloperidol, the number of patients classified to be at risk for possibly harmful QT prolongation could be reduced by 50% using optimal QT rate correction. Conclusions Fridericia and Framingham correction formulae showed the best rate correction and significantly improved prediction of 30‐day and 1‐year mortality. With current clinical standards, Bazett overestimated the number of patients with potential dangerous QTc prolongation, which could lead to unnecessary safety measurements as withholding the patient of first‐choice medication.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Tomas Robyns
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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181
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Vandenberk B, Hnatkova K, Goovaerts G, Garweg C, Ector J, Van Huffel S, Malik M, Willems R. Inappropriate ICD shocks do not induce pro-arrhythmic electrocardiographic changes in men. SCAND CARDIOVASC J 2016; 51:47-52. [PMID: 27268510 DOI: 10.1080/14017431.2016.1197418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Longer-term electrocardiographic effects of multiple inappropriate ICD shocks were investigated to study their hypothesized pro-arrhythmic potential. DESIGN Thirteen male patients with ischemic cardiomyopathy who received ≥2 inappropriate shocks within 24 h and for whom 12-lead ECGs were available both before and within 72h after the inappropriate shocks were analyzed. Exclusion criteria included continuous ventricular pacing, underlying AF, events within 6 weeks after lead implantation and concomitant acute medical problems. RESULTS A total of 149 inappropriate shocks (mean 11 ± 19) were received. There were no significant differences in any of the measured intervals or morphological indices, nor was there a correlation between the "before-after" differences and the number of shocks received. Non-significant changes showed Percentage of Loop Area increase and relative T-wave Residuum decrease while the opposite changes have previously been associated with arrhythmic risk. CONCLUSIONS No potentially pro-arrhythmic electrocardiographic changes were found 19 h after multiple inappropriate shocks.
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Affiliation(s)
- Bert Vandenberk
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Clinical Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Katerina Hnatkova
- c National Heart and Lung Institute, Imperial College , London , England
| | - Griet Goovaerts
- d Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics , University of Leuven , Leuven , Belgium.,e iMinds, Medical IT , Leuven , Belgium
| | - Christophe Garweg
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Clinical Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Joris Ector
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Clinical Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Sabine Van Huffel
- d Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics , University of Leuven , Leuven , Belgium.,e iMinds, Medical IT , Leuven , Belgium
| | - Marek Malik
- c National Heart and Lung Institute, Imperial College , London , England
| | - Rik Willems
- a Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,b Department of Clinical Cardiology , University Hospitals Leuven , Leuven , Belgium
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182
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Robyns T, Nuyens D, Vandenberk B, Ector J, Garweg C, Kuiperi C, Corveleyn A, Willems R. 96-71: Altered heart rate variability in long QT syndrome assessed by 24 hour holter recordings. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i79a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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183
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Vandenberk B, Robyns T, Garweg C, Ector J, Willems R. 216-73: QT/RR regression correlation coefficient as non-invasive risk stratification tool. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i29b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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184
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Vandenberk B, Röver C, Vos M, Friede T, Flevari P, Zabel M, Willems R. 153-01: Repeated assessment of non-invasive risk stratification in the EUTrigTreat study. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i111b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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185
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Vandenberk B, Robyns T, Garweg C, Ector J, Willems R. 16-84: Deceleration capacity discriminates arrhythmic from mortality risk in primary prevention ICD recipients. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i22a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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186
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Vandenberk B, Garweg C, Voros G, Floré V, Marynissen T, Sticherling C, Zabel M, Ector J, Willems R. Changes in Implantation Patterns and Therapy Rates of Implantable Cardioverter Defibrillators over Time in Ischemic and Dilated Cardiomyopathy Patients. Pacing Clin Electrophysiol 2016; 39:848-57. [PMID: 27198580 DOI: 10.1111/pace.12891] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/30/2016] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical guidelines on implantable cardioverter defibrillator (ICD) therapy changed significantly in the last decades with potential inherent effects on therapy efficacy. We aimed to study therapy rates in time and the association between therapies and mortality. METHODS All patients receiving an ICD, primary and secondary prevention, were included in a single-center retrospective registry. Information on first appropriate and inappropriate therapies was documented. Dates of implant were divided in P1: 1996-2001, P2: 2002-2008, and P3: 2009-2014. RESULTS A total of 727 patients, 84.9% male-66.4% ischemic cardiomyopathy (ICM)-56% primary prevention-mean follow-up 5.2 ± 4.1 years, were included. There was a shift from secondary to primary prevention indications, from ischemic to non-ICM, and from single chamber to cardiac resynchronization therapy defibrillator devices. The annual 1- and 3-year appropriate shock (AS) rate declined from 29.4% and 15.1% in P1, over 13.3% and 9.2% in P2 to 7.8% and 5.7% in P3 (log-rank P < 0.001), while inappropriate shock (IAS) rates remained unchanged (log-rank P = 0.635). After multivariate regression analysis a higher age at implant, lower left ventricular ejection fraction, history of stroke, diabetes mellitus, intake of loop diuretics or digitalis, higher creatinine, and longer QTc were independent predictors of mortality. CONCLUSION These changes in clinical practice with a shift to primary prevention and rise in non-ICM implants caused a significant decrease in AS incidence, while IAS remained stable. Receiving AS or IAS was not an independent predictor of mortality in our real-life cohort.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Gabor Voros
- Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Floré
- Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Markus Zabel
- University Medical Center Goettingen, Goettingen, Germany
| | - Joris Ector
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Cardiology, University Hospitals Leuven, Leuven, Belgium
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187
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Gürel E, Prinz C, Van Casteren L, Gao H, Willems R, Voigt JU. The Impact of Function-Flow Interaction on Left Ventricular Efficiency in Patients with Conduction Abnormalities: A Particle Image Velocimetry and Tissue Doppler Study. J Am Soc Echocardiogr 2016; 29:431-40. [DOI: 10.1016/j.echo.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Indexed: 10/22/2022]
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188
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Claessen G, La Gerche A, Voigt JU, Dymarkowski S, Schnell F, Petit T, Willems R, Claus P, Delcroix M, Heidbuchel H. Accuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function During Exercise. JACC Cardiovasc Imaging 2016; 9:532-43. [DOI: 10.1016/j.jcmg.2015.06.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/09/2015] [Accepted: 06/18/2015] [Indexed: 10/22/2022]
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189
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Haemers P, Suffee N, Hamdi H, Guedj K, Farahmand P, Popovic N, Claus P, Leprince P, Nicoletti A, Jalife J, Wolke C, Lendeckel U, Jaïs P, Willems R, Hatem S. 0118 : Fatty infiltration of the subepicardium of the atrial myocardium is replaced by fibrosis during atrial fibrillation in human and sheep. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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190
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Robyns T, Kuiperi C, Willems R, Corveleyn A, Nuyens D. Targeted capture sequencing in a large LQTS family reveals a new pathogenic mutation c.2038delG in KCNH2 initially missed due to allelic dropout. Acta Cardiol 2016; 70:747-9. [PMID: 26717233 DOI: 10.2143/ac.70.6.3120197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a new mutation in KCNH2 (c.2038delG) resulting in a frameshift and premature truncation of the IKr channel protein in a large LQTS family with several sudden death cases. This mutation was initially missed by mutation scanning with DHPLC due to allelic dropout and only retrieved after repeat genetic testing with targeted capture and massive parallel sequencing. There was full penetrance of this mutation, only if an individualized QT correction derived from 24-hour Holter data was used. This case again underscores the importance of repeat genetic testing in robust cases of LQTS that remained genotype negative with mutation scanning techniques.
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191
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Garweg C, Ector J, Willems R. Leadless cardiac pacemaker as alternative in case of congenital vascular abnormality and pocket infection. Europace 2016; 18:1564. [DOI: 10.1093/europace/euw023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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192
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Almodares Q, Cordeiro F, Van Der Ven JPG, Garweg C, Wahi S, Mo VY, Beladan CC, Yang LT, Wallentin Guron C, Thurin A, Fu M, Thunstrom E, Johansson MC, Leao S, Moz M, Magalhaes P, Trigo J, Mateus PS, Ferreira A, Moreira JI, Bossers S, Korteweg L, Duppen N, Kapusta L, Kuipers I, Kroft L, Ten Harkel A, Van Iperen G, Helbing W, Haemers P, De Buck S, Willems R, Ector J, Chong A, Bellucci BM, Fisher JM, Balekian AA, Mateescu AD, Predescu L, Calin A, Rosca M, Inta O, Egher L, Platon P, Ginghina C, Popescu BA, Tsai WC. Moderated Posters session: there are other cardiac chambers than the left ventricleP977Right atrial enlargement is a predictor of five-year mortality in elderly patients with heart failureP978Left atrial enlargement and long-term prognosis of ST-segment elevation myocardial infarction: comparison of indexed volume and area.P979Atrial function in total cavopulmonary connection: differences between ILT and ECC and relation with exercise capacityP980Imaging of the right atrium anatomy using 3D rotational angiography during ablation: comparison between right atrial flutter and atrioventricular nodal reentrant tachycardiaP983Direct comparison of non-invasive estimation of mean pulmonary artery pressure with right heart catheter measurements - which echocardiographic technique is best?P984PAAT, RVET, and Vmax versus RVSP to predict pulmonary hypertensionP985Correlates of brain natriuretic peptide in patients with pulmonary hypertension and pressure versus volume right ventricular overload: an echocardiographic-catheterization studyP986Incremental prognostic value of echocardiographic parameters over CHA2DS2-VASc score in atrial fibrillation. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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193
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Haemers P, Hamdi H, Guedj K, Suffee N, Farahmand P, Popovic N, Claus P, LePrince P, Nicoletti A, Jalife J, Wolke C, Lendeckel U, Jaïs P, Willems R, Hatem SN. Atrial fibrillation is associated with the fibrotic remodelling of adipose tissue in the subepicardium of human and sheep atria. Eur Heart J 2015; 38:53-61. [DOI: 10.1093/eurheartj/ehv625] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/12/2015] [Accepted: 10/27/2015] [Indexed: 11/15/2022] Open
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194
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Belmans A, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT). Eur Heart J Cardiovasc Imaging 2015; 17:262-9. [DOI: 10.1093/ehjci/jev288] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/04/2015] [Indexed: 11/14/2022] Open
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195
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Haemers P, Sutherland G, Cikes M, Jakus N, Holemans P, Sipido KR, Willems R, Claus P. Further insights into blood pressure induced premature beats: Transient depolarizations are associated with fast myocardial deformation upon pressure decline. Heart Rhythm 2015; 12:2305-15. [DOI: 10.1016/j.hrthm.2015.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Indexed: 11/28/2022]
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196
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Macquaide N, Tuan HTM, Hotta JI, Sempels W, Lenaerts I, Holemans P, Hofkens J, Jafri MS, Willems R, Sipido KR. Ryanodine receptor cluster fragmentation and redistribution in persistent atrial fibrillation enhance calcium release. Cardiovasc Res 2015; 108:387-98. [PMID: 26490742 PMCID: PMC4648199 DOI: 10.1093/cvr/cvv231] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/06/2015] [Indexed: 12/19/2022] Open
Abstract
AIMS In atrial fibrillation (AF), abnormalities in Ca(2+) release contribute to arrhythmia generation and contractile dysfunction. We explore whether ryanodine receptor (RyR) cluster ultrastructure is altered and is associated with functional abnormalities in AF. METHODS AND RESULTS Using high-resolution confocal microscopy (STED), we examined RyR cluster morphology in fixed atrial myocytes from sheep with persistent AF (N = 6) and control (Ctrl; N = 6) animals. RyR clusters on average contained 15 contiguous RyRs; this did not differ between AF and Ctrl. However, the distance between clusters was significantly reduced in AF (288 ± 12 vs. 376 ± 17 nm). When RyR clusters were grouped into Ca(2+) release units (CRUs), i.e. clusters separated by <150 nm, CRUs in AF had more clusters (3.43 ± 0.10 vs. 2.95 ± 0.02 in Ctrl), which were more dispersed. Furthermore, in AF cells, more RyR clusters were found between Z lines. In parallel experiments, Ca(2+) sparks were monitored in live permeabilized myocytes. In AF, myocytes had >50% higher spark frequency with increased spark time to peak (TTP) and duration, and a higher incidence of macrosparks. A computational model of the CRU was used to simulate the morphological alterations observed in AF cells. Increasing cluster fragmentation to the level observed in AF cells caused the observed changes, i.e. higher spark frequency, increased TTP and duration; RyR clusters dispersed between Z-lines increased the occurrence of macrosparks. CONCLUSION In persistent AF, ultrastructural reorganization of RyR clusters within CRUs is associated with overactive Ca(2+) release, increasing the likelihood of propagating Ca(2+) release.
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Affiliation(s)
- Niall Macquaide
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, Campus Gasthuisberg O/N 7th Floor, Herestraat 49, B-3000 Leuven, Belgium Department of Molecular Neuroscience, George Mason University, Fairfax, VA, USA Institute of Cardiovascular Sciences, University of Glasgow, Glasgow, UK
| | | | - Jun-Ichi Hotta
- Laboratory of Photochemistry and Spectroscopy, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - Wouter Sempels
- Laboratory of Photochemistry and Spectroscopy, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - Ilse Lenaerts
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, Campus Gasthuisberg O/N 7th Floor, Herestraat 49, B-3000 Leuven, Belgium
| | - Patricia Holemans
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, Campus Gasthuisberg O/N 7th Floor, Herestraat 49, B-3000 Leuven, Belgium
| | - Johan Hofkens
- Laboratory of Photochemistry and Spectroscopy, Department of Chemistry, KU Leuven, Leuven, Belgium
| | - M Saleet Jafri
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, Campus Gasthuisberg O/N 7th Floor, Herestraat 49, B-3000 Leuven, Belgium Department of Molecular Neuroscience, George Mason University, Fairfax, VA, USA Institute of Cardiovascular Sciences, University of Glasgow, Glasgow, UK
| | - Karin R Sipido
- Department of Cardiovascular Sciences, Experimental Cardiology, KU Leuven, Campus Gasthuisberg O/N 7th Floor, Herestraat 49, B-3000 Leuven, Belgium
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197
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Floré V, Claus P, Vos MA, Vandenberk B, Van Soest S, Sipido KR, Adriaenssens T, Bogaert J, Desmet W, Willems R. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction. J Cardiovasc Transl Res 2015; 8:484-92. [PMID: 26350221 DOI: 10.1007/s12265-015-9649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/03/2015] [Accepted: 08/21/2015] [Indexed: 12/01/2022]
Abstract
The purpose of this study is to investigate the relationship between T-wave alternans (TWA), infarct size and microvascular obstruction (MVO) and recurrent cardiac morbidity after ST elevation myocardial infarction (STEMI). One hundred six patients underwent TWA testing 1-12 months and 57 patients underwent cardiac magnetic resonance imaging (MRI) in the first 2-4 days after STEMI. During follow-up (3.5 ± 0.5 years), death (n = 2), ventricular tachycardia (n = 3), supraventricular tachycardia (n = 4), heart failure (n = 3) and recurrent coronary ischemia (n = 25) were observed. After multivariate analysis, positive TWA (HR2.59, CI1.10-6.11, p0.024) and larger MVO (HR1.08, CI1.01-1.16, p0.034) were associated with recurrent angina or ACS. Presence of MVO was correlated with TWA (Spearman rho 0.404, p0.002) and the impairment of LVEF (-0.524, p < 0.001). Patients after STEMI remain at a high risk of symptoms of coronary ischemia. The presence of MVO and TWA 1-12 months after STEMI is related to each other and to recurrent angina or ACS.
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Affiliation(s)
- V Floré
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. .,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - P Claus
- Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - M A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - B Vandenberk
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - S Van Soest
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - K R Sipido
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - T Adriaenssens
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J Bogaert
- Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - W Desmet
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - R Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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198
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Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, Janssens S, Nuyens D. Evaluation of Index of Cardio-Electrophysiological Balance (iCEB) as a New Biomarker for the Identification of Patients at Increased Arrhythmic Risk. Ann Noninvasive Electrocardiol 2015; 21:294-304. [PMID: 26305685 DOI: 10.1111/anec.12309] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 03/30/2015] [Revised: 05/27/2015] [Accepted: 06/29/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Recently a new risk marker for drug-induced arrhythmias called index of cardio-electrophysiological balance (iCEB), measured as QT interval divided by QRS duration, was evaluated in an animal model. It was hypothesized that iCEB is equivalent to the cardiac wavelength λ (λ = effective refractory period (ERP) x conduction velocity) and that an increased or decreased value of iCEB would potentially predict an increased susceptibility to TdP or non-TdP mediated VT/VF, respectively. METHODS First, the correlation between QT interval and ERP was evaluated by invasively measuring ERP during a ventricular stimulation protocol in humans (N = 40). Then the effect of administration of sotalol and flecainide on iCEB was measured in 40 patients with supraventricular tachycardias. Finally iCEB was assessed in carriers of a long QT syndrome (LQTS, N = 70) or Brugada syndrome (BrS, N = 57) mutation and compared them with genotype negative family members (N = 65). RESULTS The correlation between QT interval and ERP was established (Pearson R(2) = 0.25) which suggests that iCEB≈ERPxCV≈QT/QRS. Sotalol administration increased iCEB (+ 0.23; P = 0.01), while it decreased with the administration of flecainide (-0.21, P = 0.03). In the LQTS group iCEB was increased (5.22 ± 0.93, P < 0.0001) compared to genotype negative family members (4.24 ± 0.5), while it was decreased in the BrS group (3.52 ± 0.43, P < 0.0001). CONCLUSIONS Our data suggest that iCEB (QT/QRS) is a simple but effective ECG surrogate of cardiac wavelength. iCEB is increased in situations that predispose to TdP and is decreased in situations that predispose to non-TdP mediated VT/VF. Therefore, iCEB might serve as a noninvasive and readily measurable marker to detect increased arrhythmic risk.
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Affiliation(s)
- Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Hua Rong Lu
- Global Safety Pharmacology, Discovery Sciences, Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - David J Gallacher
- Global Safety Pharmacology, Discovery Sciences, Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Dieter Nuyens
- Department of Cardiovascular Diseases, University Hospitals, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Belgium
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200
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Baur LHB, Schreurs WMJ, van Leeuwen-Wintjes HR, Berendsen CL, Willems R, Winkens RAG, Vliegen R, Theunissen P, Gomez Garcia EB. A white raven detected by imaging. Neth Heart J 2015; 23:402-4. [PMID: 26031635 PMCID: PMC4497990 DOI: 10.1007/s12471-015-0706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this case report is to describe a rare case of a patient with a phaeochromocytoma with several cardiovascular complications, which can be attributed to the tumour. Detection of a phaeochromocytoma sometimes needs a ‘Sherlock Holmes spirit’ or simply time.
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Affiliation(s)
- L H B Baur
- Department of Cardiology, Atrium-Orbis location Heerlen, Henri Dunantstraat 5, 6401 CX, Heerlen, The Netherlands,
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