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Vriesendorp PA, Schinkel AFL, Liebregts M, Theuns DAMJ, van Cleemput J, Ten Cate FJ, Willems R, Michels M. Validation of the 2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:829-35. [PMID: 25922410 DOI: 10.1161/circep.114.002553] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The recently released 2014 European Society of Cardiology guidelines of hypertrophic cardiomyopathy (HCM) use a new clinical risk prediction model for sudden cardiac death (SCD), based on the HCM Risk-SCD study. Our study is the first external and independent validation of this new risk prediction model. METHODS AND RESULTS The study population consisted of a consecutive cohort of 706 patients with HCM without prior SCD event, from 2 tertiary referral centers. The primary end point was a composite of SCD and appropriate implantable cardioverter-defibrillator therapy, identical to the HCM Risk-SCD end point. The 5-year SCD risk was calculated using the HCM Risk-SCD formula. Receiver operating characteristic curves and C-statistics were calculated for the 2014 European Society of Cardiology guidelines, and risk stratification methods of the 2003 American College of Cardiology/European Society of Cardiology guidelines and 2011 American College of Cardiology Foundation/American Heart Association guidelines. During follow-up of 7.7±5.3 years, SCD occurred in 42 (5.9%) of 706 patients (ages 49±16 years; 34% women). The C-statistic of the new model was 0.69 (95% CI, 0.57-0.82; P=0.008), which performed significantly better than the conventional risk factor models based on the 2003 guidelines (C-statistic of 0.55: 95% CI, 0.47-0.63; P=0.3), and 2011 guidelines (C-statistic of 0.60: 95% CI, 0.50-0.70; P=0.07). CONCLUSIONS The HCM Risk-SCD model improves the risk stratification of patients with HCM for primary prevention of SCD, and calculating an individual risk estimate contributes to the clinical decision-making process. Improved risk stratification is important for the decision making before implantable cardioverter-defibrillator implantation for the primary prevention of SCD.
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Affiliation(s)
- Pieter A Vriesendorp
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.).
| | - Arend F L Schinkel
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Max Liebregts
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Dominic A M J Theuns
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Johan van Cleemput
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Folkert J Ten Cate
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Rik Willems
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Michelle Michels
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
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Goovaerts G, Vandenberk B, Willems R, Van Huffel S. Tensor-based detection of T wave alternans using ECG. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:6991-6994. [PMID: 26737901 DOI: 10.1109/embc.2015.7320001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
T wave alternans is defined as changes in the T wave amplitude in an ABABAB-pattern. It can be found in ECG signals of patients with heart diseases and is a possible indicator to predict the risk on sudden cardiac death. Due to its low amplitude, robust automatic T wave alternans detection is a difficult task. We present a new method to detect T wave alternans in multichannel ECG signals. The use of tensors (multidimensional matrices) permits the combination of the information present in different channels, making detection more reliable. The possibility of decomposition of incomplete tensors is exploited to deal with noisy ECG segments. Using a sliding window of 128 heartbeats, a tensor is constructed of the T waves of all channels. Canonical Polyadic Decomposition is applied to this tensor and the resulting loading vectors are examined for information about the T wave behavior in three dimensions. T wave alternans is detected using a sign change counting method that is able to extract both the T wave alternans length and magnitude. When applying this novel method to a database of patients with multiple positive T wave alternans tests using the clinically available spectral method tests, both the length and the magnitude of the detected T wave alternans is larger for these subjects than for subjects in a control group.
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Jacobs B, Willems R, Garweg C. Why it is important to use the correct dose of the non-vitamin K oral anticoagulants. Eur Heart J Cardiovasc Imaging 2014; 16:461. [DOI: 10.1093/ehjci/jeu302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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204
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Alzand BS, Phlips T, Willems R. Authors Reply to ‘Strategies for Overcoming T-Wave Oversensing’. Indian Pacing Electrophysiol J 2014; 14:315. [PMID: 25609903 PMCID: PMC4286958 DOI: 10.1016/s0972-6292(16)30824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Becker Sn Alzand
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium
| | - Tje Phlips
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium
| | - Rik Willems
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium
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Gillebert C, Marynissen T, Janssen R, Droogne W, Voros G, Garweg C, Willems R. How to choose between a pacemaker or defibrillator for resynchronization therapy? Acta Cardiol 2014; 69:483-9. [PMID: 25638835 DOI: 10.1080/ac.69.5.3044874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The choice between a resynchronization pacemaker (CRT-P) or defibrillator (CRT-D) is still a matter of debate. We hypothesised that when selecting patients based on co-morbidities and age as proposed by the ESC-guidelines, there would be no long-term survival benefit of CRT-D compared to CRT-P. METHODS We performed a retrospective analysis of patients who received a CRT device at the University Hospitals Leuven between 2001 and 2007. For the analysis of the association between predictors and outcome, uni- and multivariate Cox regression analyses were performed. We present data from three multivariate models. RESULTS A total of 144 CRT devices were implanted (CRT-D n=98, CRT-P n=46). Patients who received a CRT-P were older and had a higher prevalence of co-morbidities. Patients who received a CRT-D had a significant lower mortality. When applying incremental multivariate analysis using 1st variables with a P < 0.05 in univariate analysis, 2nd variables with a P < 0.10 and 3rd adding on top all the baseline variables that were significantly different between the two groups, the significance of a possible survival benefit for CRT-D over CRT-P disappeared: risk model 1, hazard ratio 2.21 (P = 0.008), risk model 2, HR 1.81 (P = 0.069), and risk model 3, HR 1.85 (P = 0.091). The use of amiodarone and the presence of COPD or renal insufficiency remained associated with a significant, higher mortality risk, while the use of beta blockers was protective in all three models. CONCLUSION The choice of a CRT-D seemed a predictor of improved survival in simple but not in more complex multivariable analyses. The fact that the survival benefit strongly depended on the number of co-variables suggests that it is at most marginal.
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Affiliation(s)
- Carl Gillebert
- Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Roel Janssen
- Dept. of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Walter Droogne
- Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Gabor Voros
- Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Rik Willems
- Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Dept. of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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206
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Alzand BSN, Leemput N, Willems R. Inappropriate implantable cardioverter-defibrillator shocks in a public swimming pool. Europace 2014; 16:1124-1124. [DOI: 10.1093/europace/eut344] [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: 08/30/2023] Open
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207
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Metaxas A, Willems R, Kooijman E, Renjaän V, Klein P, Windhorst A, Donck LV, Leysen J, Berckel BV. Subchronic treatment with phencyclidine in adolescence leads to impaired exploratory behavior in adult rats without altering social interaction orN-methyl-D-aspartate receptor binding levels. J Neurosci Res 2014; 92:1599-607. [DOI: 10.1002/jnr.23433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 11/08/2022]
Affiliation(s)
- A. Metaxas
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - R. Willems
- Neuroscience Discovery; Janssen Research and Development; a Division of Janssen Pharmaceutica NV; Beerse Belgium
| | - E.J.M. Kooijman
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - V.A. Renjaän
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - P.J. Klein
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - A.D. Windhorst
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - L. Ver Donck
- Neuroscience Discovery; Janssen Research and Development; a Division of Janssen Pharmaceutica NV; Beerse Belgium
| | - J.E. Leysen
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
| | - B.N.M. van Berckel
- Department of Radiology & Nuclear Medicine; Neuroscience Campus Amsterdam; VU University Medical Center; Amsterdam The Netherlands
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Abstract
A 50-year-old male with a CRT defibrillator received inappropriate ICD shocks due to T-wave oversensing. Decreasing the sensitivity to avoid T wave oversensing was not an option due to a suboptimal R-wave sensing amplitude. We decided to re-plug the LV lead in the RV port and the RV lead in the LV port. This however led to intermittent phrenic nerve stimulation due to mandatory bipolar (tip-ring) or unipolar (tip-can) pacing on the LV-lead from the RV port. Re-intervention was necessary with the implantation of an additional pacing/sensing RV lead. A software programmable choice to switch sensing and tachycardia detection from RV to LV lead could be a valuable feature in future CRT devices.
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Affiliation(s)
- Bsn Alzand
- Department of Cardiology, Glorieux General Hospital, Ronse, Belgium ; Department of Cardiology, OLV General Hospital, Aalst, Belgium ; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Tje Phlips
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - R Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium ; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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209
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Robyns T, Nuyens D, Van Casteren L, Corveleyn A, De Ravel T, Heidbuchel H, Willems R. Reduced Penetrance and Variable Expression of SCN5A Mutations and the Importance of Co-inherited Genetic Variants: Case Report and Review of the Literature. Indian Pacing Electrophysiol J 2014; 14:133-49. [PMID: 24948852 PMCID: PMC4032780 DOI: 10.1016/s0972-6292(16)30754-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mutations in the SCN5A gene are responsible for multiple phenotypical presentations including Brugada syndrome, long QT syndrome, progressive familial heart block, sick sinus syndrome, dilated cardiomyopathy, lone atrial fibrillation and multiple overlap syndromes. These different phenotypic expressions of a mutation in a single gene can be explained by variable expression and reduced penetrance. One of the possible explanations of these phenomena is the co-inheritance of genetic variants. We describe a family where the individuals exhibit a compound heterozygosity in the SCN5A gene including a mutation (R1632H) and a new variant (M858L). Individuals with both the mutation and new variant present with a more severe phenotype including spontaneous atrial tachyarrhythmia at young age. We give an overview of the different phenotypes of "SCN5A disease" and discuss the importance of co-inherited genetic variants in the expression of SCN5A disease.
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Affiliation(s)
- T Robyns
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - D Nuyens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - L Van Casteren
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - A Corveleyn
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - T De Ravel
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - H Heidbuchel
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - R Willems
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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210
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Vandael E, Marynissen T, Reyntens J, Spriet I, Vandenberghe J, Willems R, Foulon V. Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium. Int J Clin Pharm 2014; 36:757-65. [PMID: 24805801 DOI: 10.1007/s11096-014-9953-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/19/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Drug-induced QT-prolongation is an established risk factor for Torsade de pointes and sudden cardiac death. The list of QT-prolonging drugs is extensive and includes many drugs commonly used in psychiatry. AIM In this study we performed a cross-sectional analysis of medication profiles to assess the prevalence of drug interactions potentially leading to QT-prolongation. SETTING 6 psychiatric hospitals in Flanders, Belgium. METHODS For each patient, the full medication list was screened for the presence of interactions, with special attention to those with an increased risk for QT-prolongation. Current practice on QT monitoring and prevention of drug-induced arrhythmia was assessed. MAIN OUTCOME MEASURE Number of drug interactions with risk of QT-prolongation. RESULTS 592 patients (46 % female; mean age 55.7 ± 17.1 years) were included in the analysis. 113 QT-prolonging interactions were identified in 43 patients (7.3 %). QT-prolonging interactions occurred most frequently with antidepressants (n = 102) and antipsychotics (n = 100). The precautions and follow-up provided by the different institutions when combining QT-prolonging drugs were very diverse. CONCLUSION Drug combinations that are associated with QT-prolongation are frequently used in the chronic psychiatric setting. Persistent efforts should be undertaken to provide caregivers with clear guidelines on how to use these drugs in a responsible and safe way.
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Affiliation(s)
- Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium,
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211
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Garweg C, Derthoo D, Willems R. Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava. Acta Cardiol 2014; 69:220-1. [PMID: 24783481 DOI: 10.1080/ac.69.2.3017311] [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: 10/19/2022]
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212
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Vriesendorp PA, Liebregts M, Steggerda R, Schinkel A, Willems R, Ten Cate F, van Cleemput J, Ten Berg J, Michels M. LONG-TERM OUTCOME AFTER MEDICAL AND INVASIVE TREATMENT IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60763-4] [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: 10/25/2022]
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213
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Vriesendorp PA, Liebregts M, Steggerda R, Schinkel A, Willems R, Ten Cate F, van Cleemput J, Ten Berg J, Michels M. AMOUNT OF ALCOHOL HAS NO LONG-TERM EFFECT ON MORTALITY AFTER ALCOHOL SEPTAL ABLATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60878-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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214
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Deckx S, Marynissen T, Rega F, Ector J, Nuyens D, Heidbuchel H, Willems R. Predictors of 30-day and 1-year mortality after transvenous lead extraction: a single-centre experience. Europace 2014; 16:1218-25. [DOI: 10.1093/europace/eut410] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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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215
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Macquaide N, Tuan HTM, Hotta JI, Sempels W, Lenaerts I, Holemans P, Hofkens J, Jafri S, Willems R, Sipido KR. Structural and Functional Alteration of RyR Clusters After Remodeling in Persistent Atrial Fibrillation. Biophys J 2014. [DOI: 10.1016/j.bpj.2013.11.2428] [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: 10/23/2022] Open
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216
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Jenke A, Kanders M, Forcob S, Willems R, Wirth S, Postberg J. Fetal response to placental dysfunction leads to 5-hmeC and H2A.Z/H3 acetylation in NOS3 while short-termed mRNA boost entails deferred self-attenuation. Mol Cell Pediatr 2014. [PMCID: PMC4715156 DOI: 10.1186/2194-7791-1-s1-a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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217
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Marynissen T, Floré V, Heidbuchel H, Nuyens D, Ector J, Willems R. Heart rate turbulence predicts ICD-resistant mortality in ischaemic heart disease. Europace 2013; 16:1069-77. [PMID: 24196450 DOI: 10.1093/europace/eut303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/25/2022] Open
Abstract
AIMS In high-risk patients, implantable cardioverter-defibrillators (ICDs) can convert the mode of death from arrhythmic to pump failure death. Therefore, we introduced the concept of 'ICD-resistant mortality' (IRM), defined as death (a) without previous appropriate ICD intervention (AI), (b) within 1 month after the first AI, or (c) within 1 year after the initial ICD implantation. Implantable cardioverter-defibrillator implantation in patients with a high risk of IRM should be avoided. METHODS AND RESULTS Implantable cardioverter-defibrillator patients with ischaemic heart disease were included if a digitized 24 h Holter was available pre-implantation. Demographic, electrocardiographic, echocardiographic, and 24 h Holter risk factors were collected at device implantation. The primary endpoint was IRM. Cox regression analyses were used to test the association between predictors and outcome. We included 130 patients, with a mean left ventricular ejection fraction (LVEF) of 33.6 ± 10.3%. During a follow-up of 52 ± 31 months, 33 patients died. There were 21 cases of IRM. Heart rate turbulence (HRT) was the only Holter parameter associated with IRM and total mortality. A higher New York Heart Association (NYHA) class and a lower body mass index were the strongest predictors of IRM. Left ventricular ejection fraction predicted IRM on univariate analysis, and was the strongest predictor of total mortality. The only parameter that predicted AI was non-sustained ventricular tachycardia. CONCLUSION Implantable cardioverter-defibrillator implantation based on NYHA class and LVEF leads to selection of patients with a higher risk of IRM and death. Heart rate turbulence may have added value for the identification of poor candidates for ICD therapy. Available Holter parameters seem limited in their ability to predict AI.
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Affiliation(s)
- Thomas Marynissen
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Vincent Floré
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dieter Nuyens
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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218
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Lenaerts I, Driesen RB, Blanco NH, Holemans P, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R. Corrigendumto:Role of nitric oxide and oxidative stress in a sheep model of persistent atrial fibrillation Europace (2013) 15 (5): 754-760 first published online February 17, 2013 doi:10.1093/europace/eut012. Europace 2013. [DOI: 10.1093/europace/eut342] [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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219
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Garweg C, Willems R. Apparent delay in tachycardia detection due to ventricular pacing: what is the mechanism? Europace 2013; 15:1656. [DOI: 10.1093/europace/eut235] [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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220
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Van Bogaert P, Wouters K, Willems R, Mondelaers M, Clarke S. Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals. J Psychiatr Ment Health Nurs 2013; 20:679-86. [PMID: 22962847 DOI: 10.1111/jpm.12004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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] [Accepted: 08/16/2012] [Indexed: 11/28/2022]
Abstract
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care.
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Affiliation(s)
- P Van Bogaert
- Division of Nursing and Midwifery Science, Antwerp University, Wilrijk, Belgium.
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Vriesendorp PA, Schinkel AF, Van Cleemput J, Willems R, Jordaens LJ, Theuns DA, van Slegtenhorst MA, de Ravel TJ, ten Cate FJ, Michels M. Implantable cardioverter-defibrillators in hypertrophic cardiomyopathy: patient outcomes, rate of appropriate and inappropriate interventions, and complications. Am Heart J 2013; 166:496-502. [PMID: 24016499 DOI: 10.1016/j.ahj.2013.06.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM), but this can be prevented by an implantable cardioverter-defibrillator (ICD). The aim of this study is to evaluate HCM patients with ICDs for primary or secondary prevention of SCD. METHODS The study population consisted of all HCM patients with an ICD in 2 tertiary referral clinics. End points during follow-up were total and cardiac mortality, appropriate and inappropriate ICD intervention, and device-related complications. Cox-regression analysis was performed to identify predictors of outcome. RESULTS ICDs were implanted in 134 patients with HCM (mean age 44 ± 17 years, 34% women, 4.2 ± 4.8 years follow-up). Annualized cardiac mortality rate was 3.4% per year and associated with New York Heart Association class III or IV (HR 5.2 [2.0-14, P = .002]) and cardiac resynchronization therapy (HR 6.3 [2.1-20, P = .02]). Appropriate ICD interventions occurred in 38 patients (6.8%/year) and was associated with implantation for secondary prevention of SCD (HR 4.0 [1.8-9.1], P = .001) and male gender (HR 3.3 [1.2-9.0], P = .02). Inappropriate ICD intervention occurred in 21 patients (3.7%/year) and in 20 patients device related complications were documented (3.6%/year). CONCLUSION ICDs successfully abort life-threatening arrhythmias in HCM patients at increased risk of SCD with an annualized intervention rate of 6.8% per year. End-stage heart failure is the main cause of mortality in these patients. The annualized rate of inappropriate ICD intervention was 3.7% per year, whereas device-related complications occurred 3.6% per year.
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Stankovic I, Aarones M, Smith HJ, Voros G, Kongsgaard E, Neskovic AN, Willems R, Aakhus S, Voigt JU. Dynamic relationship of left-ventricular dyssynchrony and contractile reserve in patients undergoing cardiac resynchronization therapy. Eur Heart J 2013; 35:48-55. [DOI: 10.1093/eurheartj/eht294] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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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223
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224
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Haemers P, De Asmundis C, Sutherland G, Jakus N, Cikes M, Lenaerts I, Willems R, Claus P. A study of the proarrhythmogenic effect of acute left ventricular afterload increase: insights from a novel closed chest/pericardium model. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht311.5876] [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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225
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van Mansfeld R, de Vrankrijker L, Brimicombe R, Heijerman H, van Berkhout FT, van der Ent C, Wolfs T, Bonten M, Willems R. 140 Population structure of Pseudomonas aeruginosa and the prevalence of epidemic clones in patients with cystic fibrosis over four years. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60282-9] [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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226
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Sekar S, Jonckers E, Verhoye M, Willems R, Veraart J, Van Audekerke J, Couto J, Giugliano M, Wuyts K, Dedeurwaerdere S, Sijbers J, Mackie C, Ver Donck L, Steckler T, Van der Linden A. Subchronic memantine induced concurrent functional disconnectivity and altered ultra-structural tissue integrity in the rodent brain: revealed by multimodal MRI. Psychopharmacology (Berl) 2013; 227:479-91. [PMID: 23354531 DOI: 10.1007/s00213-013-2966-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND An effective NMDA antagonist imaging model may find key utility in advancing schizophrenia drug discovery research. We investigated effects of subchronic treatment with the NMDA antagonist memantine by using behavioural observation and multimodal MRI. METHODS Pharmacological MRI (phMRI) was used to map the neuroanatomical binding sites of memantine after acute and subchronic treatment. Resting state fMRI (rs-fMRI) and diffusion MRI were used to study the changes in functional connectivity (FC) and ultra-structural tissue integrity before and after subchronic memantine treatment. Further corroborating behavioural evidences were documented. RESULTS Dose-dependent phMRI activation was observed in the prelimbic cortex following acute doses of memantine. Subchronic treatment revealed significant effects in the hippocampus, cingulate, prelimbic and retrosplenial cortices. Decreases in FC amongst the hippocampal and frontal cortical structures (prelimbic, cingulate) were apparent through rs-fMRI investigation, indicating a loss of connectivity. Diffusion kurtosis MRI showed decreases in fractional anisotropy and mean diffusivity changes, suggesting ultra-structural changes in the hippocampus and cingulate cortex. Limited behavioural assessment suggested that memantine induced behavioural effects comparable to other NMDA antagonists as measured by locomotor hyperactivity and that the effects could be reversed by antipsychotic drugs. CONCLUSION Our findings substantiate the hypothesis that repeated NMDA receptor blockade with nonspecific, noncompetitive NMDA antagonists may lead to functional and ultra-structural alterations, particularly in the hippocampus and cingulate cortex. These changes may underlie the behavioural effects. Furthermore, the present findings underscore the utility and the translational potential of multimodal MR imaging and acute/subchronic memantine model in the search for novel disease-modifying treatments for schizophrenia.
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Affiliation(s)
- S Sekar
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Campus Drie Eiken, D.UC.109, Universiteitsplein 1, 2610, Wilrijk, Belgium.
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Floré V, Claus P, Symons R, Smith GL, Sipido KR, Willems R. Can body surface microvolt T-wave alternans distinguish concordant and discordant intracardiac alternans? Pacing Clin Electrophysiol 2013; 36:1007-16. [PMID: 23614703 DOI: 10.1111/pace.12139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/13/2013] [Accepted: 02/15/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There is convincing experimental evidence that cellular action potential duration (APD) alternans is arrhythmogenic but its relationship with body surface microvolt T-wave alternans (MTWA) remains unclear. We investigated the relationship between MTWA and APD alternans induced by alternating cycle length (CL) pacing in a pig model. METHODS In 10 pigs, catheters in the right atrium (RA) and right (RV) and left ventricle (LV) allowed pacing and recording of monophasic action potentials (MAP). During RA pacing at stable 500-ms CL, LV was paced at alternating CL (505 ms and 495 ms). Changing the alternating LV (A-LV) pacing delay changes the size of the region with alternating ventricular activation. Spectral analysis of intracardiac MAP was correlated with body surface MTWA. In a similar setup (during alternating pacing in RV and LV), we investigated concordant versus discordant APD alternans. RESULTS Pacing the LV with subtle alternating cycle lengths at short A-LV delay leads to broad QRS (97 ± 10 ms), body surface MTWA (mean Valt 4.2 ± 1.8 µV), and positive RR-interval alternans. At longer A-LV delay, not resulting in QRS widening (68 ± 5 ms), body surface RR alternans was absent but MTWA remained detectable and was even more pronounced (8.7 ± 5.1 µV, P < 0.01). During both concordant and discordant pacing MTWA was present. The precordial leads were better for detecting discordant APD alternans (8.0 ± 2.9 µV and 12.8 ± 4.52 µV, P = 0.02). CONCLUSION MTWA is a potent technique to detect subtle and isolated intracardiac APD alternans that is artificially induced by alternating pacing. In the same model, discordant activation alternans can only be discriminated from concordant when using a quantifying approach of MTWA analysis.
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Affiliation(s)
- Vincent Floré
- Department of Cardiovascular Diseases, Division of Experimental Cardiology, University of Leuven, Campus Gasthuisberg, Herestraat, Leuven, Belgium
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van Geldorp IE, Vanagt WY, Vugts G, Willems R, Rega F, Gewillig M, Delhaas T. Late recovery of atrioventricular conduction after postsurgical chronic atrioventricular block is not exceptional. J Thorac Cardiovasc Surg 2013; 145:1028-1032. [DOI: 10.1016/j.jtcvs.2012.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/27/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Lenaerts I, Driesen RB, Blanco NH, Holemans P, Heidbüchel H, Janssens S, Balligand JL, Sipido KR, Willems R. Role of nitric oxide and oxidative stress in a sheep model of persistent atrial fibrillation. ACTA ACUST UNITED AC 2013; 15:754-60. [DOI: 10.1093/europace/eut012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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230
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Ciampi Q, Rigo F, Grolla E, Cortigiani L, Picano E, Stankovic I, Aarones M, Smith H, Ciarka A, Voros G, Willems R, Kongsgaard E, Aakhus S, Voigt JU, Gabrielli L, Brambila C, Bijnens B, Marin J, Sitges I, Pare C, Mont L, Brugada J, Sitges M, Mizia-Stec K, Wita K, Mizia M, Wrobel W, Gasior Z, Chrzanowski L, Kukulski T, Lowalik AKI, Brzezinska B, Gosciniak-Plonska E, Nasis A, Moir S, Meredith I, Cameron J, Barton T, Mottram P. Oral Abstract Session * Stress echocardiography - Expanding applications: Dobutamine stress echo. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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231
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Floré V, Willems R. T-wave alternans and beat-to-beat variability of repolarization: pathophysiological backgrounds and clinical relevance. Acta Cardiol 2012; 67:713-8. [PMID: 23393943 DOI: 10.1080/ac.67.6.2184675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this review, we focus on temporal variability of cardiac repolarization. This phenomenon has been related to a higher risk for ventricular arrhythmia and is therefore interesting as a marker of sudden cardiac death risk. We review two non-invasive clinical techniques quantifying repolarization variability: T-wave alternans (TWA) and beat-to-beat variability of repolarization (BVR). We discuss their pathophysiological link with ventricular arrhythmia and the current clinical relevance of these techniques.
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Affiliation(s)
- Vincent Floré
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
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232
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Geselle PJ, Poesen R, Rega F, Koopman P, Nuyens D, Heidbuchel H, Willems R. Transvenous extraction of pacing and defibrillator leads--a single-centre experience. Acta Cardiol 2012; 67:641-8. [PMID: 23393934 DOI: 10.1080/ac.67.6.2184666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Worldwide, the number of transvenous extractions of chronically implanted endocardial leads rapidly increases. Despite great technical progress, lead extraction remains a challenging procedure with possible life-threatening complications. We present the success and complication rate of lead extractions in the University Hospitals Leuven, and investigated a possible relationship between the use of powered sheaths and lead type, fixation, location and implantation time. METHODS We present an observational retrospective cohort study of 157 patients admitted to the University Hospitals Leuven between January 2005 and December 2010, for the transvenous removal of a total of 259 endocardial leads. RESULTS Complete procedural success was achieved in 92% of patients (n = 144). Of all leads, 94% (n = 243) were completely extracted. Only in 5 patients (3%), lead extraction failed. Leads that could not be removed were significantly older (134.1 +/- 90.7 months vs. 73.1 +/- 61.9 months; P = 0.02). In the other 8 patients the leads were partially removed with a remaining major retained lead fragment in 2 and a minor fragment in 6 patients. Major procedural complication rate was 2.5% (n = 4). There were no procedure-related deaths. Powered sheaths were used significantly more for the extraction of defibrillator leads (51%) (vs. pacing leads (33%; P = 0.015)) and right ventricular located leads (43%) (vs. other location (28%; P = 0.011)). However, when comparing the need of powered sheaths for the extraction of right ventricular defibrillator leads vs. right ventricular pacing leads, only a trend to higher use was noticed (51 vs. 39%; P = 0.146). Powered sheath use was not related to fixation type. Leads that required the use of a powered sheath were implanted significantly longer (112 +/- 69.5 months vs. 41.7 +/- 33.7 months; P = 0.001). CONCLUSIONS Chronically implanted endocardial leads can be transvenously extracted in a high number of cases and with a low risk of procedural complications. Powered sheaths proved to be a helpful tool to extract leads that could not be removed by manual traction. Powered sheaths are necessary for leads with longer implantation duration and are more often used for the extraction of defibrillator leads.
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Affiliation(s)
| | - Ruben Poesen
- Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Koopman
- Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Dieter Nuyens
- Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Rik Willems
- Cardiology, University Hospitals Leuven, Leuven, Belgium
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Tenenbaum T, Franz A, Neuhausen N, Willems R, Brade J, Schweitzer-Krantz S, Adams O, Schroten H, Henrich B. Clinical characteristics of children with lower respiratory tract infections are dependent on the carriage of specific pathogens in the nasopharynx. Eur J Clin Microbiol Infect Dis 2012; 31:3173-82. [DOI: 10.1007/s10096-012-1682-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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Simjee S, Blackman Northwood J, Shryock T, de Jong A, Willems R. MLST typing of Enterococcus faecium and Enterococcus faecalis recovered from healthy pigs and chickens across Europe and sequence type comparisons with the international MLST database. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.328] [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: 10/28/2022] Open
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235
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Floré V, Willems R. Preventing Sudden Cardiac Death in Patients with Ischaemic Cardiomyopathy. Eur Cardiol 2012. [DOI: 10.15420/ecr.2012.8.2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sudden cardiac death (SCD) is an important cause of mortality. In this article, we review the definition, impact and underlying aetiology of SCD. Ventricular tachyarrhythmia accounts for the majority of SCDs and can be caused by various underlying heart diseases, the most frequent being ischaemic cardiomyopathy. The most effective ways to reduce the risk of SCD in ischaemic cardiomyopathy are the optimal prevention of recurrent coronary ischaemia and the use of an implantable cardioverter-defibrillator (ICD) in high-risk patients. We discuss current patient selection for ICD implantation and focus on the need for, and possibilities to improve, SCD risk stratification.
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Macquaide N, Hotta JI, Tuan HT, Williams GS, Willems R, Jafri S, Hofkens J, Sipido KR. Variable RyR Cluster Morphology in Sheep Atrial Myocytes: Super Resolution Measurement and Ca2+ Release Simulation. Biophys J 2012. [DOI: 10.1016/j.bpj.2011.11.1705] [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: 11/27/2022] Open
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237
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Seegers J, Vos MA, Flevari P, Willems R, Sohns C, Vollmann D, Lüthje L, Kremastinos DT, Floré V, Meine M, Tuinenburg A, Myles RC, Simon D, Brockmöller J, Friede T, Hasenfuß G, Lehnart SE, Zabel M. Rationale, objectives, and design of the EUTrigTreat clinical study: a prospective observational study for arrhythmia risk stratification and assessment of interrelationships among repolarization markers and genotype. Europace 2011; 14:416-22. [PMID: 22117037 PMCID: PMC3283222 DOI: 10.1093/europace/eur352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims The EUTrigTreat clinical study has been designed as a prospective multicentre observational study and aims to (i) risk stratify patients with an implantable cardioverter defibrillator (ICD) for mortality and shock risk using multiple novel and established risk markers, (ii) explore a link between repolarization biomarkers and genetics of ion (Ca2+, Na+, K+) metabolism, (iii) compare the results of invasive and non-invasive electrophysiological (EP) testing, (iv) assess changes of non-invasive risk stratification tests over time, and (v) associate arrythmogenomic risk through 19 candidate genes. Methods and results Patients with clinical ICD indication are eligible for the trial. Upon inclusion, patients will undergo non-invasive risk stratification, including beat-to-beat variability of repolarization (BVR), T-wave alternans, T-wave morphology variables, ambient arrhythmias from Holter, heart rate variability, and heart rate turbulence. Non-invasive or invasive programmed electrical stimulation will assess inducibility of ventricular arrhythmias, with the latter including recordings of monophasic action potentials and assessment of restitution properties. Established candidate genes are screened for variants. The primary endpoint is all-cause mortality, while one of the secondary endpoints is ICD shock risk. A mean follow-up of 3.3 years is anticipated. Non-invasive testing will be repeated annually during follow-up. It has been calculated that 700 patients are required to identify risk predictors of the primary endpoint, with a possible increase to 1000 patients based on interim risk analysis. Conclusion The EUTrigTreat clinical study aims to overcome current shortcomings in sudden cardiac death risk stratification and to answer several related research questions. The initial patient recruitment is expected to be completed in July 2012, and follow-up is expected to end in September 2014. Clinicaltrials.gov identifier: NCT01209494.
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Affiliation(s)
- Joachim Seegers
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg-August-Universität, Göttingen, Germany
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238
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Floré V, Claus P, Antoons G, Oosterhoff P, Holemans P, Vos MA, Sipido KR, Willems R. Microvolt T-wave alternans and beat-to-beat variability of repolarization during early postischemic remodeling in a pig heart. Heart Rhythm 2011; 8:1050-7. [DOI: 10.1016/j.hrthm.2011.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
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Koopman P, Nuyens D, Garweg C, La Gerche A, De Buck S, Van Casteren L, Alzand B, Willems R, Heidbuchel H. Efficacy of radiofrequency catheter ablation in athletes with atrial fibrillation. Europace 2011; 13:1386-93. [DOI: 10.1093/europace/eur142] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [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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240
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Deshmukh A, Sharma SS, Gobal FG, Singla SS, Hebbar PH, Paydak HP, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Shavadia J, Otieno H, Yonga G, Jinah A, Qvist JF, Soerensen PH, Dixen U, Ramirez-Marrero MA, Perez-Villardon B, Gaitan-Roman D, Jimenez-Navarro M, Delgado-Prieto JL, De Teresa-Galvan E, De Mora-Martin M, Deshmukh A, Hebbar PB, Wei WX, Gobal FG, Singla SS, Sharma SS, Paydak HP, Bardari S, Zecchin M, Salame' R, Vitali Serdoz L, Di Lenarda A, Guerrini N, Barbati G, Sinagra G, Hanazawa K, Kaitani K, Nakagawa Y, Lenaerts I, Driesen R, Hermida N, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R, Sehra R, Krummen D, Briggs C, Narayan S, Tanaka Y, Hirao K, Nakamura T, Inaba O, Yagishita A, Higuchi K, Hachiya H, Isobe M, Kallergis E, Kanoupakis EM, Mavrakis HE, Goudis CA, Maliaraki NE, Vardas PE, Sehra R, Krummen D, Briggs C, Narayan S, Kiuchi K, Piorkowski C, Kircher S, Gaspar T, Watanabe N, Bollmann A, Hindricks G, Wauters K, Grosse A, Raffa S, Brunelli M, Geller JC, Maggioni AP, Gonzini L, Gussoni G, Vescovo G, Gulizia M, Pirelli S, Mathieu G, Di Pasquale G, Zecchin M, Bardari S, Vitali Serdoz L, Salame R, Buja G, Rovai N, Gargaro A, Sperzel J, Knops RE, Meine M, Speca G, Santini L, Haarbo J, Dubin K, Di Lenarda A, Carlson M, Garcia Quintana A, Mendoza-Lemes H, Garcia Perez L, Led Ramos S, Caballero Dorta E, Matinez De Espronceda M, Piro Mastracchio V, Serrano Arriezu L, Sciarra L, Barbati G, Marziali M, Marras E, Rebecchi M, Allocca G, Lioy E, Delise P, Calo' L, Santobuono VE, Iacoviello M, Nacci F, Magnani S, Luzzi G, Puzzovivo A, Memeo M, Quadrini F, Favale S, Trucco ME, Arce M, Palazzolo J, Uribe W, Baranchuk A, Sinagra G, Femenia F, Maggi R, Furukawa T, Croci F, Solano A, Brignole M, Lebreiro A, Sousa A, Correia AS, Lourenco P, Sakamoto T, Oliveira S, Paiva M, Freitas J, Maciel MJ, Linker N, Rieger G, Garutti C, Edvardsson N, Salguero Bodes R, De Riva Silva M, Kumagai K, Fontenla Cerezuela A, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Garcia Alvarez S, Arribas Ynsaurriaga F, Petix NR, Del Rosso A, Guarnaccia V, Zipoli A, Fuke E, Rabajoli F, Foglia Manzillo G, Tolardo C, Checchinato C, Chiaravallotti S, Santarone M, Spinnler MT, Podoleanu C, Maggi R, Brignole M, Nishiuchi S, Frigy A, Dobreanu D, Ginghina C, Carasca E, Hayashi T, Miki Y, Naito S, Oshima S, Hof IE, Vonken E, Velthuis BK, Meine M, Hauer RNW, Loh KP, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Lim HE, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Wichterle D, Bulkova V, Fiala M, Chovancik J, Simek J, Peichl P, Cihak R, Kautzner J, Glick A, Viskin S, Belhassen B, Navarrete A, Conte F, Ishti A, Sai D, Moran M, Chitovova Z, Ahmed H, Mares K, Skoda J, Sediva L, Petru J, Reddy VY, Neuzil P, Schmidt M, Dorwarth U, Leber A, Wankerl M, Krieg J, Straube F, Reif S, Hoffmann E, Mikhaylov E, Tikhonenko V, Lebedev D, Lim HE, Shin SY, Yong HS, Choi CU, Choi JI, Kim SH, Kim EJ, Na JO, Matsuo S, Yamane T, Hioki M, Ito K, Narui R, Date T, Sugimoto K, Yoshimura M, Rolf S, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Batalov R, Popov S, Antonchenko I, Suslova T, Fichtner S, Czudnochowsky U, Estner HL, Ammar S, Reents T, Jilek C, Hessling G, Deisenhofer I, Pokushalov E, Romanov A, Corbucci G, Artemenko S, Losik D, Shabanov V, Turov A, Elesin D, Mikhaylov E, Abramov M, Lebedev D, Piorkowski C, Sanders P, Jais P, Roberts-Thomson K, Hindricks G, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Roux Y, Tenkorang J, Carroz P, Schlaepfer J, Pascale P, Forclaz A, Fromer M, Pruvot E, Fiala M, Wichterle D, Bulkova V, Sknouril L, Nevralova R, Chovancik J, Dorda M, Januska J, Brunelli M, Grosse A, Santi R, Wauters K, Geller C, Kumagai K, Nakamura K, Hayashi T, Kasseno K, Naito S, Sakamoto T, Oshima S, Taniguchi K, Wutzler A, Rolf S, Huemer M, Parwani A, Boldt LH, Blaschke D, Dietz R, Haverkamp W, Coutu B, Malanuk R, Ait Said M, Vicentini A, Schade S, Ando K, Rousseauplasse A, Deering T, Picarra BC, Santos AR, Dionisio P, Semedo P, Matos R, Leitao M, Jacinto A, Trinca M, Wan C, Glad J, Szymkiewicz S, Habibovic M, Versteeg H, Pelle AJM, Theuns DAMJ, Jordaens L, Pedersen SS, Pakarinen S, Toivonen L, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Maier SKG, Lobitz N, Paule S, Becher J, Mustafa G, Ibrahim A, King G, Foley B, Wilkoff B, Freedman R, Hayes D, Kalbfleisch S, Kutalek S, Schaerf R, Fazal IA, Tynan M, Plummer CJ, Mccomb JM, Oto A, Aytemir K, Yorgun H, Canpolat U, Kaya EB, Tokgozoglu L, Kabakci G, Ozkutlu H, Greenberg S, Hamati F, Styperek R, Alonso J, Peress D, Bolanos O, Augostini R, Pelini M, Zhang S, Stoycos S, Witsaman S, Mowrey K, Bremer J, Oza A, Ciconte G, Mazzone P, Paglino G, Marzi A, Vergara P, Sora N, Gulletta S, Della Bella P, Nagashima M, Goya M, Soga Y, Hiroshima K, Andou K, Hayashi K, An Y, Nobuyoshi M, Kutarski A, Malecka B, Pietura R, Osmancik P, Herman D, Stros P, Kocka V, Tousek P, Linkova H, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Plebani L, Marino PN, Gorev MV, Alimov DG, Raju P, Kully S, Ugni S, Furniss S, Lloyd G, Patel NR, Richards MW, Warren CE, Anderson MH, Hero M, Rey JL, Ouali S, Azzez S, Kacem S, Hammas S, Ben Salem H, Neffeti E, Remedi F, Boughzela E, Kronborg MB, Mortensen PT, Poulsen SH, Nielsen JC, Simantirakis EN, Kontaraki JE, Arkolaki EG, Chrysostomakis SI, Nyktari EG, Patrianakos AP, Vardas PE, Funck RC, Harink C, Mueller HH, Koelsch S, Maisch B, Bortnik M, Occhetta E, Dell'era G, Degiovanni A, Bolzani V, Marino PN, Costandi P, Shehada RE, Butala N, Coppola B, Taborsky M, Heinc P, Fedorco M, Doupal V, Di Cori A, Zucchelli G, Soldati E, Segreti L, De Lucia R, Viani S, Paperini L, Bongiorni MG, Gutleben KJ, Kranig W, Barr C, Morgenstern MM, Simon M, Dalal YH, Landolina M, Pierantozzi A, Agricola T, Lunati M, Pisano' E, Lonardi G, Bardelli G, Zucchi G, Thibault B, Dubuc M, Karst E, Ryu K, Paiement P, Carlson MD, Farazi T, Alhous H, Mont L, Porres JM, Alzueta J, Beiras X, Fernandez-Lozano I, Macias A, Ruiz R, Brugada J, Viani SM, Segreti L, Di Cori A, Zucchelli G, Paperini L, Soldati E, De Lucia R, Bongiorni MG, Seifert M, Schau T, Moeller V, Meyhoefer J, Butter C, Ganiere V, Niculescu V, Domenichini G, Stettler C, Defaye P, Burri H, Stockburger M, De Teresa E, Lamas G, Desaga M, Koenig C, Cobo E, Navarro X, Wiegand U, Blich M, Carasso S, Suleiman M, Marai I, Gepstein L, Boulos M, Sasov M, Liska B, Margitfalvi P, Malacky T, Svetlosak M, Goncalvesova E, Hatala R, Takaya Y, Noda T, Yamada Y, Okamura H, Satomi K, Shimizu W, Aihara N, Kamakura S, Proclemer A, Boveda S, Oswald H, Scipione P, Rousseauplasse A, Da Costa A, Brzozowski W, Tomaszewski A, Kutarski A, Wysokinski A, Arbelo E, Tamborero D, Vidal B, Tolosana JM, Sitges M, Matas M, Brugada J, Mont L, Botto GL, Dicandia CD, Mantica M, La Rosa C, D' Onofrio A, Molon G, Raciti G, Verlato R, Foley PWX, Chalil S, Ratib K, Smith REA, Printzen F, Auricchio A, Leyva F, Abu Sham'a R, Buber J, Luria D, Kuperstein R, Feinberg M, Granit H, Eldar M, Glikson M, Osmancik P, Herman D, Stros P, Vondrak K, Abu Sham'a R, Nof E, Kuperstein R, Carasso S, Feinberg M, Lipchenca I, Eldar M, Glikson M, Vatasescu RG, Iorgulescu C, Caldararu C, Vasile A, Bogdan S, Constantinescu D, Dorobantu M, Sakaguchi H, Miyazaki A, Yamamoto T, Fujimoto K, Ono S, Ohuchi H, Martinelli M, Martins S, Molina R, Siqueira S, Nishioka SAD, Peixoto GL, Alkmim-Teixeira R, Costa R, Versteeg H, Meine MM, Tuinenburg AE, Doevendans PA, Denollet J, Pedersen SS, Goscinska-Bis K, Zupan I, Van Der H, Anselme F, Hartog H, Block M, Borri A, Padeletti L, Toniolo M, Zanotto G, Rossi A, Raytcheva E, Tomasi L, Vassanelli C, Fernandez Lozano I, Mitroi C, Toquero Ramos J, Castro Urda V, Monivas Palomero V, Corona Figueroa A, Ruiz Bautista L, Alonso Pulpon L, Jadidi AS, Sacher F, Shah AS, Scherr D, Derval N, Hocini M, Haissaguerre M, Jais P, Castrejon Castrejon S, Largo-Aramburu C, Sachar J, Gang E, Estrada A, Doiny D, De Miguel E, Merino JL, Vergara P, Trevisi N, Ricco A, Petracca F, Baratto F, Bisceglie A, Maccabelli G, Della Bella P, El-Damaty A, Sapp J, Warren J, Macinnis P, Horacek M, Dinov B, Schoenbauer R, Piorkowski C, Bollmann A, Sommer P, Braunschweig F, Hindricks G, Arya A, Andreu D, Berruezo A, Ortiz JT, Silva E, Mont L, De Caralt TM, Fernandez-Armenta J, Brugada J, Castrejon Castrejon S, Estrada A, Doiny D, Perez-Silva A, Ortega M, Lopez-Sendon JL, Merino JL, Regoli F, Faletra F, Nucifora G, Pasotti E, Moccetti T, Klersy C, Auricchio A, Casella M, Dello Russo A, Moltrasio M, Zucchetti M, Fassini G, Di Biase L, Natale A, Tondo C, Sakamoto T, Kumagai K, Matsuhashi N, Nishiuchi S, Fuke E, Hayashi T, Naito S, Oshima S, Weig HJ, Kerst G, Weretk S, Seizer P, Gawaz MP, Schreieck J, Sarquella-Brugada G, Prada F, Brugada J, Reents T, Ammar S, Fichtner S, Salling CM, Jilek C, Kolb C, Hessling G, Deisenhofer I, Pytkowski M, Maciag A, Farkowski M, Jankowska A, Kowalik I, Kraska A, Szwed H, Maury P, Hocini M, Sacher F, Duparc A, Mondoly P, Rollin A, Jais P, Haissaguerre M, Pap R, Kohari M, Bencsik G, Makai A, Saghy L, Forster T, Ebrille E, Scaglione M, Raimondo C, Caponi D, Di Donna P, Blandino A, Delcre SDL, Gaita F, Roca Luque I, Dos LDS, Rivas NRG, Pijuan APD, Perez J, Casaldaliga J, Garcia-Dorado DGD, Moya AMM, Sato H, Yagi T, Yambe T, Streitner F, Dietrich C, Mahl E, Schoene N, Veltmann C, Borggrefe M, Kuschyk J, Sadarmin PP, Wong KCK, Rajappan K, Bashir Y, Betts TR, Svetlosak M, Leclercq C, Martins R, Hatala R, Daubert JC, Mabo P, Koide M, Hamano G, Taniguchi T, Yamato M, Sasaki N, Hirooka K, Ikeda Y, Yasumura Y, Dichtl W, Wolber T, Paoli U, Bruellmann S, Berger T, Stuehlinger M, Duru F, Hintringer F, Kanoupakis E, Mavrakis H, Kallergis E, Koutalas E, Saloustros I, Goudis C, Chlouverakis G, Vardas P, Herre JM, Saeed M, Saberi L, Neuman S, An Y, Ando K, Goya M, Nagashima M, Yamaji K, Soga Y, Iwabuchi M, Nobuyoshi M, Baranchuk A, Femenia F, Miranda Hermosilla R, Lopez Diez JC, Serra JL, Valentino M, Retyk E, Galizio N, Kwasniewski W, Filipecki A, Orszulak W, Urbanczyk-Swic D, Trusz - Gluza M, Piot O, Degand B, Da Costa A, Donofrio A, Scanu P, Quesada A, Rousseauplasse A, Padeletti L, Kloppe A, Mijic D, Bogossian H, Zarse M, Lemke B, Tyler J, Comfort G, Kalbfleisch S, Deering TF, Epstein AE, Greenberg SMG, Goldman DS, Rhude J, Majewski JP, Lelakowski J, Tomala I, Santos CM, Miranda RS, Sousa PJ, Cavaco DM, Adragao PP, Knops RE, Wilde AA, Da Costa A, Belhameche M, Hermida JS, Dovellini E, Frohlig G, Siot P, Degand B, Duray GZ, Israel CW, Brachmann J, Seidl KH, Foresti M, Birkenhauer F, Hohnloser SH, Ferreira C, Mateus P, Ribeiro H, Carvalho S, Ferreira A, Moreira J, Kadro W, Rahim H, Turkmani M, Abu Lebdeh M, Altabban A, Raimondo C, Scaglione M, Ebrille E, Caponi D, Di Donna P, Cerrato N, Delcre SDL, Gaita F, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Kvantaliani T, Akhvlediani M, Namdar M, Steffel J, Jetzer S, Bayrak F, Chierchia GB, Jenni R, Duru F, Brugada P, Bakos Z, Medvedev M MM, Jonas Carlsson JC, Fredrik Holmqvist FH, Pyotr Platonov PP, Nurbaev T, Pirnazarov M, Nikishin A, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Simeonidou E, Kastellanos S, Varounis C, Michalakeas C, Koniari C, Nikolopoulou A, Anastasiou-Nana M, Furukawa Y, Yamada T, Morita T, Tanaka K, Iwasaki Y, Kawasaki M, Kuramoto Y, Fukunami M, Blanche C, Tran N, Rigamonti F, Zimmermann M, Okisheva E, Tsaregorodtsev D, Sulimov V, Novikova D, Popkova T, Udachkina E, Korsakova Y, Volkov A, Novikov A, Alexandrova E, Nasonov E, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Kartsagoulis E, Asimakopoulos S, Stefanadis C, Marocolo M, Barbosa Neto O, Carvalho AC, Marques Neto SR, Mota GR, Barbosa PRB, Fernandez-Fernandez A, Manzano Fernandez S, Pastor-Perez FJ, Barquero-Perez O, Goya-Esteban R, Salar M, Rojo-Alvarez JL, Garcia-Alberola A, Takigawa M, Kawamura M, Aiba T, Kamakura S, Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [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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Cottens D, Van De Bruaene A, Troost E, Willems R, Moons P, Budts W. Influence of percutaneous transcatheter closure of an atrial septal defect on the atrioventricular conduction. Acta Cardiol 2011; 66:309-14. [PMID: 21744700 DOI: 10.1080/ac.66.3.2114130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed at determining the effect of percutaneous ASD closure on the AV conduction. Percutaneous closure of ostium secundum atrial septal defects (ASDs) has been widely accepted and has become the standard treatment of this malformation. However, some complications have been reported. Because of the close proximity between the discs of the device and the atrioventricular (AV) node, atrioventricular conduction disturbances (AVCD) are a likely complication. METHODS AND RESULTS From the database of congenital heart disease, 46 patients (mean age 54 +/- 12 y) who underwent percutaneous ASD closure and 46 patients who underwent a percutaneous patent foramen ovale (PFO) closure were matched according to age, gender and follow-up time. Demographic, clinical, biochemical, and ECG variables were compared. Before closure, the PR interval in the ASD group was significantly longer than in the PFO group (169 +/- 22 ms versus 158 +/- 25 ms, P= 0.031), which persisted after a mean follow-up time of 4.5 years (180 +/- 39 ms versus 163 +/- 23 ms, P= 0.007). PR interval increased significantly from closure to latest follow-up in the ASD (P=0.038), but not in the PFO group (P=0.058). CONCLUSIONS ASD patients presented with significantly longer PR interval than PFO patients before closure. In contrast with the PFO group, the PR interval increased in the ASD group after medium-term follow-up. These findings indicate the need for further follow-up after ASD repair in order to detect potential late AVCD.
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Affiliation(s)
- Daan Cottens
- Dept. of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | | | - Els Troost
- Dept. of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Rik Willems
- Dept. of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Philip Moons
- Centre for Health Services and Nursing Research, Catholic University Leuven, Belgium
| | - Werner Budts
- Dept. of Cardiovascular Medicine, University Hospitals Leuven, Belgium
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Van der Bij AK, Van Mansfeld R, Peirano G, Goessens WHF, Severin JA, Pitout JDD, Willems R, Van Westreenen M. First outbreak of VIM-2 metallo-β-lactamase-producing Pseudomonas aeruginosa in The Netherlands: microbiology, epidemiology and clinical outcomes. Int J Antimicrob Agents 2011; 37:513-8. [PMID: 21497065 DOI: 10.1016/j.ijantimicag.2011.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 02/07/2011] [Accepted: 02/09/2011] [Indexed: 12/22/2022]
Abstract
This study was designed to investigate the prevalence and characteristics of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa in a tertiary care centre in The Netherlands, a country that is considered to have a low prevalence of antibiotic-resistant bacteria. Imipenem-resistant P. aeruginosa isolates cultured from clinical specimens during 2008-2009 were analysed phenotypically and molecularly by polymerase chain reaction (PCR) with sequencing. Genotyping was performed by multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA). Clinical information was obtained by electronic chart review for all patients infected or colonised with an imipenem-resistant P. aeruginosa isolate that was included in the study. In total, 106 imipenem-resistant P. aeruginosa isolates were included. The bla(VIM-2) gene was detected in 35/106 isolates (33%) and was associated with integrons. Compared with non-MBL-producing imipenem-resistant P. aeruginosa, VIM-2 MBL-producing isolates showed higher rates of multidrug resistance. Patients with VIM-2 MBL-producing isolates were more likely to be admitted to the Intensive Care Unit (ICU) and had a higher risk of invasive infection, including development of bacteraemia. MLVA identified two separate VIM-2 MBL-producing clones, responsible for outbreaks in the ICU but also affecting 10 other departments. This is the first reported outbreak of VIM-2 MBL-producing P. aeruginosa in The Netherlands. Once introduced, VIM-2 MBL-producing P. aeruginosa cause significant infections and are easily spread within the hospital setting.
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Affiliation(s)
- A K Van der Bij
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Cools T, Rossenbacker T, Floré V, Nuyens D, Heidbüchel H, Willems R. Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions? Acta Cardiol 2011; 66:145-51. [PMID: 21591571 DOI: 10.1080/ac.66.2.2071244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Randomized controlled trials have proven the efficacy of implantable cardioverter/defibrillators (ICDs) to prevent sudden cardiac death (SCD) in primary prevention. However,long-term data on the incidence of appropriate and inappropriate interventions in real life and on the predictive value of commonly used clinical variables to guide patient selection are scarce. METHODS We retrospectively studied 101 patients who received an ICD for primary prophylaxis of SCD: 63.4% with ischaemic heart disease (IHD) and 36.6% with idiopathic dilated cardiomyopathy (IDCM). The mean follow-up period was 26.2 (+/- 14.8; median 27.8; range 5.6-70.5) months. Age, left ventricular ejection fraction (LVEF), QRS duration, NYHA class and electrophysiological study (EPS) outcome were evaluated as predictors of ICD intervention. RESULTS At 2 years the cumulative incidence of appropriate (17.5% in IHD; 28% in IDCM; P= 0.63) and inappropriate (12.8% in IHD, 15.4% in IDCM; P = 0.62) interventions was similar in both groups. Atrial fibrillation was the most common cause of inappropriate interventions in the IHD group, sinus tachycardia in the IDCM group. Advanced age was associated with less inappropriate interventions (HR: 0.96 (95% confidence interval (CI) 0.94-0.98); P < 0.01), and a better LVEF with less appropriate interventions (HR: 0.97 (95% Cl 0.94-0.99); P < 0.01). This amounted in a significant absolute difference in the number of appropriate interventions between the group with a LVEF < 25% and 25-34% after 3 years of follow-up of 42% in IHD (48% vs 6%). A prolonged QRS duration was associated with a slightly elevated risk for appropriate interventions only in the IHD group (HR: 1.01 (95% CI 1.00-1.03); P = 0.04). On the other hand, increased NYHA class was only associated with increased risk for appropriate interventions in the IDCM group (HR: 5.24 (95% CI1.11-24.74); P= 0.04). No significant statistical association was found between a positive EPS and appropriate or inappropriate interventions. CONCLUSIONS In primary prevention, during a mean follow-up of 2 years, one in five patients had a possibly live-saving appropriate intervention. However, the incidence of inappropriate interventions was substantial. Predictors for appropriate interventions were: (i) LVEF in the total study group, (ii) NYHA class in the IDCM group and (iii) QRS duration in the IHD group.
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Affiliation(s)
- Thijs Cools
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
| | - Tom Rossenbacker
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Floré
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
| | - Dieter Nuyens
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbüchel
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Cardiovascular medicine, University Hospitals Leuven, Leuven, Belgium
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Claessen G, Colyn E, La Gerche A, Koopman P, Alzand B, Garweg C, Willems R, Nuyens D, Heidbuchel H. Long-term endurance sport is a risk factor for development of lone atrial flutter. Heart 2011; 97:918-22. [PMID: 21398696 DOI: 10.1136/hrt.2010.216150] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate whether in a population of patients with 'lone atrial flutter', the proportion of those engaged in long-term endurance sports is higher than that observed in the general population. DESIGN An age and sex-matched retrospective case-control study. SETTING A database with 638 consecutive patients who underwent ablation for atrial flutter at the University of Leuven. Sixty-one patients (55 men, 90%) fitted the inclusion criteria of 'lone atrial flutter', ie, aged 65 years or less, without documented atrial fibrillation and without identifiable underlying disease (including hypertension). Sex, age and inclusion criteria-matched controls, two for each flutter patient, were selected in a general practice in the same geographical region. METHODS Sports activity was evaluated by detailed questionnaires, which were available in 58 flutter patients (95%). A transthoracic echocardiogram was performed in all lone flutter patients. MAIN OUTCOME MEASURES Types of sports, number of years of participation and average number of hours per week. RESULTS The proportion of regular sportsmen (≥3 h of sports practice per week) among patients with lone atrial flutter was significantly higher than that observed in the general population (50% vs 17%; p<0.0001). The proportion of sportsmen engaged in long-term endurance sports (participation in cycling, running or swimming for ≥3 h/week) was also significantly higher in lone flutter patients than in controls (31% vs 8%; p=0.0003). Those flutter patients performing endurance sports had a larger left atrium than non-sportsmen (p=0.04, by one-way analysis of variance). CONCLUSION A history of endurance sports and subsequent left atrial remodelling may be a risk factor for the development of atrial flutter.
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Affiliation(s)
- Guido Claessen
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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Lenaerts I, Holemans P, Pokreisz P, Sipido KR, Janssens S, Heidbuchel H, Willems R. Nitric oxide delays atrial tachycardia-induced electrical remodelling in a sheep model. Europace 2011; 13:747-54. [DOI: 10.1093/europace/eur021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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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Adams NG, Adekambi T, Afeltra J, Aguado J, Aires de Sousa M, Akiyoshi K, Al Hasan M, Ala-Kokko T, Albert M, Alfandari S, Allen D, Allerberger F, Almyroudis N, Alp E, Amin R, Anderson-Berry A, Andes DR, Andremont A, Andreu A, Angelakis M, Antachopoulos C, Antoniadou A, Arabatzis M, Arlet G, Arnez M, Arnold C, Asensio A, Asseray N, Ausiello C, Avni T, Ayling R, Baddour L, Baguelin M, Bányai K, Barbour A, Basco LK, Bauer D, Bayston R, Beall B, Becker K, Behr M, Bejon P, Belliot G, Benito-Fernandez J, Benjamin D, Benschop K, Berencsi G, Bergeron MG, Bernard K, Berner R, Beyersmann J, Bille J, Bizzini A, Bjarnsholt T, Blanc D, Blanco J, Blot S, Bohnert J, Boillat N, Bonomo R, Bonten M, Bordon JM, Borel N, Boschiroli ML, Bosilkovski M, Bosso JA, Botelho-Nevers E, Bou G, Bretagne S, Brouqui P, Brun-Buisson C, Brunetto M, Bucher H, Buchheidt D, Buckling A, Bulpa P, Cambau E, Canducci F, Cantón R, Capobianchi M, Carattoli A, Carcopino X, Cardona-Castro N, Carling PC, Carrat F, Castilla J, Castilletti C, Cavaco L, Cavallo R, Ceccherini-Silberstein F, Centrón D, Chappuis F, Charrel R, Chen M, Chevaliez S, Chezzi C, Chomel B, Chowers M, Chryssanthou E, Ciammaruconi A, Ciccozzi M, Cid J, Ciofu O, Cisneros D, Ciufolini MG, Clark C, Clarke SC, Clayton R, Clementi M, Clemons K, Cloeckaert A, Cloud J, Coenye T, Cohen Bacri S, Cohen R, Coia J, Colombo A, Colson P, Concerse P, Cordonnier C, Cormican M, Cornaglia G, Cornely O, Costa S, Cots F, Craxi A, Creti R, Crnich C, Cuenca Estrella M, Cusi MG, d'Ettorre G, da Cruz Lamas C, Daikos G, Dannaoui E, De Barbeyrac B, De Grazia S, de Jager C, de Lamballerie X, de Marco F, del Palacio A, Delpeyroux F, Denamur E, Denis O, Depaquit J, Deplano A, Desenclos JC, Desjeux P, Deutch S, Di Luca D, Dianzani F, Diep B, Diestra K, Dignani C, Dimopoulos G, Divizia M, Doi Y, Dornbusch HJ, Dotis J, Drancourt M, Drevinek P, Dromer F, Dryden M, Dubreuil L, Dubus JC, Dumitrescu O, Dumke R, DuPont H, Edelstein M, Eggimann P, Eis-Huebinger AM, El Atrouni WI, Entenza J, Ergonul O, Espinel-Ingroff A, Esteban J, Etienne J, Fan XG, Fenollar F, Ferrante P, Ferrieri P, Ferry T, Feuchtinger T, Finegold S, Fingerle V, Fitch M, Fitzgerald R, Flori P, Fluit A, Fontana R, Fournier PE, François M, Francois P, Freedman DO, Friedrich A, Gallego L, Gallinella G, Gangneux JP, Gannon V, Garbarg-Chenon A, Garbino J, Garnacho-Montero J, Gatermann S, Gautret P, Gentile G, Gerlich W, Ghannoum M, Ghebremedhin B, Ghigo E, Giamarellos-Bourboulis E, Girgis R, Giske C, Glupczynski Y, Gnarpe J, Gomez-Barrena E, Gorwitz RJ, Gosselin R, Goubau P, Gould E, Gradel K, Gray J, Gregson D, Greub G, Grijalva CG, Groll A, Groschup M, Gutiérrez J, Hackam DG, Hall WA, Hallett R, Hansen S, Harbarth S, Harf-Monteil C, Hasanjani RMR, Hasler P, Hatchette T, Hauser P, He Q, Hedges A, Helbig J, Hennequin C, Herrmann B, Hezode C, Higgins P, Hoesli I, Hoiby N, Hope W, Houvinen P, Hsu LY, Huard R, Humphreys H, Icardi M, Imoehl M, Ivanova K, Iwamoto T, Izopet J, Jackson Y, Jacobsen K, Jang TN, Jasir A, Jaulhac B, Jaureguy F, Jefferies JM, Jehl F, Johnstone J, Joly-Guillou ML, Jonas M, Jones M, Joukhadar C, Kahl B, Kaier K, Kaiser L, Kato H, Katragkou A, Kearns A, Kern W, Kerr K, Kessin R, Kibbler C, Kimberlin D, Kittang B, Klaassen C, Kluytmans J, Ko WC, Koh WJ, Kostrzewa M, Kourbeti I, Krause R, Krcmery V, Krizova P, Kuijper E, Kullberg BJ, Kumar G, Kunin CM, La Scola B, Lagging M, Lagrou K, Lamagni T, Landini P, Landman D, Larsen A, Lass-Floerl C, Laupland K, Lavigne JP, Leblebicioglu H, Lee B, Lee CH, Leggat P, Lehours P, Leibovici L, Leon L, Leonard N, Leone M, Lescure X, Lesprit P, Levy PY, Lew D, Lexau CA, Li SY, Li W, Lieberman D, Lina B, Lina G, Lindsay JA, Livermore D, Lorente L, Lortholary O, Lucet JC, Lund B, Lütticken R, MacLeod C, Madhi S, Maertens J, Maggi F, Maiden M, Maillard JY, Maira-Litran T, Maltezou H, Manian FA, Mantadakis E, Maragakis L, Marcelin AG, Marchaim D, Marchetti O, Marcos M, Markotic A, Martina B, Martínez J, Martinez JL, Marty F, Maurin M, McGee L, Mediannikov O, Meersseman W, Megraud F, Meletiadis J, Mellmann A, Meyer E, Meyer W, Meylan P, Michalopoulos A, Micol R, Midulla F, Mikami Y, Miller RF, Miragaia M, Miriagou V, Mitchell TJ, Miyakis S, Mokrousov I, Monecke S, Mönkemüller K, Monno L, Monod M, Morales G, Moriarty F, Morosini I, Mortensen E, Mubarak K, Mueller B, Mühlemann K, Muñoz Bellido JL, Murray P, Muscillo M, Mylotte J, Naessens A, Nagy E, Nahm MH, Nassif X, Navarro D, Navarro F, Neofytos D, Nes I, Ní Eidhin D, Nicolle L, Niederman MS, Nigro G, Nimmo G, Nordmann P, Nougairède A, Novais A, Nygard K, Oliveira D, Orth D, Ortiz JR, Osherov N, Österblad M, Ostrosky-Zeichner L, Pagano L, Palamara AT, Pallares R, Panagopoulou P, Pandey P, Panepinto J, Pappas G, Parkins M, Parola P, Pasqualotto A, Pasteran F, Paul M, Pawlotsky JM, Peeters M, Peixe L, Pepin J, Peralta G, Pereyre S, Perfect JR, Petinaki E, Petric M, Pettigrew M, Pfaller M, Philipp M, Phillips G, Pichichero M, Pierangeli A, Pierard D, Pigrau C, Pilishvili T, Pinto F, Pistello M, Pitout J, Poirel L, Poli G, Poppert S, Posfay-Barbe K, Pothier P, Poxton I, Poyart C, Pozzetto B, Pujol M, Pulcini C, Punyadeera C, Ramirez M, Ranque S, Raoult D, Rasigade JP, Re MC, Reilly JS, Reinert R, Renaud B, Rice L, Rich S, Richet H, Rigouts L, Riva E, Rizzo C, Robotham J, Rodicio MR, Rodriguez J, Rodriguez-Bano J, Rogier C, Roilides E, Rolain JM, Rooijakkers S, Rooney P, Rossi F, Rotimi V, Rottman M, Roux V, Ruhe J, Russo G, Sadowy E, Sagel U, Said SI, Saijo M, Sak B, Sa-Leao R, Sanders EAM, Sanguinetti M, Sarrazin C, Savelkoul P, Scheifele D, Schmidt WP, Schønheyder H, Schönrich G, Schrenzel J, Schubert S, Schwarz K, Schwarz S, Sefton A, Segondy M, Seifert H, Seng P, Senneville E, Sexton D, Shafer RW, Shalit I, Shankar N, Shata TM, Shields J, Sibley C, Sicinschi L, Siljander T, Simitsopoulou M, Simoons-Smit AM, Sissoko D, Sjögren J, Skiada A, Skoczynska A, Skov R, Slack M, Sogaard M, Sola C, Soriano A, Sotto A, Sougakoff W, Sougakoff W, Souli M, Spelberg B, Spelman D, Spiliopoulou I, Springer B, Stefani S, Stein A, Steinbach WJ, Steinbakk M, Strakova L, Strenger V, Sturm P, Sullivan P, Sutton D, Symmons D, Tacconelli E, Tamalet C, Tang JW, Tang YW, Tattevin P, Thibault V, Thomsen RW, Thuny F, Tong S, Torres C, Townsend R, Tristan A, Trouillet JL, Tsai HC, Tsitsopoulos P, Tuerlinckx D, Tulkens P, Tumbarello M, Tureen J, Turnidge JD, Turriziani O, Tutuian R, Uçkay I, Upton M, Vabret A, Vamvakas EC, van den Boom D, Van Eldere J, van Leeuwen W, van Strijp J, Van Veen S, Vandamme P, Vandenesch F, Vayssier M, Velin D, Venditti M, Venter M, Venuti A, Vergnaud G, Verheij T, Verhofstede C, Viscoli C, Vizza CD, Vogel U, Waller A, Wang YF, Warn P, Warris A, Wauters G, Weidmann M, Weill FX, Weinberger M, Welch D, Wellinghausen N, Wheat J, Widmer A, Wild F, Willems R, Willinger B, Winstanley C, Witte W, Wolff M, Wong F, Wootton M, Wyllie D, Xu W, Yamamoto S, Yaron S, Yildirim I, Zaoutis T, Zazzi M, Zbinden R, Zehender GG, Zemlickova H, Zerbini ML, Zhang L, Zhang Y, Zhao YD, Zhu Z, Zimmerli W. ACKNOWLEDGEMENT OF REVIEWERS. Clin Microbiol Infect 2011. [DOI: 10.1111/j.1469-0691.2010.03428.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sava IG, Heikens E, Kropec A, Theilacker C, Willems R, Huebner J. Enterococcal surface protein contributes to persistence in the host but is not a target of opsonic and protective antibodies in Enterococcus faecium infection. J Med Microbiol 2010; 59:1001-1004. [DOI: 10.1099/jmm.0.020578-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Enterococci are important nosocomial pathogens with multiple intrinsic and acquired resistances to antibiotics. In the past, the majority of infections were caused by Enterococcus faecalis; however, an increase in Enterococcus faecium clinical isolates has been observed in recent years. The enterococcal surface protein (Esp) is expressed on the surface of most E. faecium clinical isolates and has been shown to be involved in biofilm formation. Here, E. faecium E1162 and its previously created insertion-deletion mutant of the esp gene, E. faecium E1162Δesp, were compared in a mouse bacteraemia model. Anti-Esp serum was tested for its capacity to mediate opsonophagocytic killing of E1162 in vitro and to protect against E. faecium bacteraemia. The inactivation of esp attenuated E. faecium virulence with reduced numbers of bacteria recovered from the kidneys in animals infected with the mutant compared to the wild-type strain (P=0.035). Passive immunization with rabbit polyclonal serum raised against the recombinant N-terminal Esp protein did not protect mice against E. faecium bacteraemia (P>0.05). In contrast, mice passively immunized with polyclonal antiserum raised against lipoteichoic acid (LTA) from E. faecalis had lower numbers of E. faecium E1162 in the blood compared to mice immunized with normal rabbit serum. These results suggest that Esp contributes to E. faecium persistence in the host. However, in contrast to LTA, Esp does not seem to be a target for protective antibodies in E. faecium strain E1162 in mouse bacteraemia.
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Affiliation(s)
- I. G. Sava
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - E. Heikens
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A. Kropec
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Theilacker
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - R. Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - J. Huebner
- Division of Infectious Diseases, Department of Medicine, University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany
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Szulik M, Tillekaerts M, Vangeel V, Ganame J, Willems R, Lenarczyk R, Rademakers F, Kalarus Z, Kukulski T, Voigt JU. Assessment of apical rocking: a new, integrative approach for selection of candidates for cardiac resynchronization therapy. Eur J Echocardiogr 2010; 11:863-9. [PMID: 20615904 DOI: 10.1093/ejechocard/jeq081] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Current attempts of improving patient selection in cardiac resynchronization therapy (CRT) are mainly based on echocardiographic timing of myocardial velocity peaks. Regional myocardial function is neglected. Apical transverse motion (ATM) is a new parameter to quantify apical rocking as an integrative surrogate of both temporal and functional inhomogeneities within the left ventricle. In this study, we tested the predictive value of apical rocking for response to CRT. METHODS AND RESULTS Sixty-nine patients eligible for CRT were assessed by echocardiography before and 11 ± 5 months after pacemaker implantation. Response was defined as left ventricular (LV) end-systolic volume decrease >15%. Rocking was quantified (ATM) and visually assessed by four blinded readers. Predictive value for CRT response of both assessments was compared with conventional dyssynchrony parameters. ATM in the four-chamber view plane differentiated best between responders and non-responders (2.2 ± 1.5 vs. 0.06 ± 1.9 mm, P< 0.0001). Quantified ATM predicted reverse remodelling with a sensitivity, specificity, and accuracy of 75, 96, and 83% whereas visual rocking assessment resulted in 89, 75, and 83%, respectively. The accuracy of conventional parameters was significantly lower. CONCLUSION Apical rocking is a new marker to assess LV dyssynchrony and predict CRT response. It is superior to conventional parameters. Even its simple visual assessment may be sufficiently accurate in the clinical setting.
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Affiliation(s)
- Mariola Szulik
- Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
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La Gerche A, Robberecht C, Kuiperi C, Nuyens D, Willems R, de Ravel T, Matthijs G, Heidbüchel H. Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin. Heart 2010; 96:1268-74. [PMID: 20525856 DOI: 10.1136/hrt.2009.189621] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine the prevalence of desmosomal gene mutations in athletes with complex arrhythmias (VA) of right ventricular (RV) origin and structural RV abnormalities to evaluate whether there is sufficient genetic overlap with arrhythmogenic right ventricular cardiomyopathy (ARVC) to consider them the same or different entities. DESIGN Observational cohort SETTING Tertiary hospital referrals PATIENTS Forty-seven consecutive athletes (age 42 (11) years) with complex VA of RV morphology (excluding idiopathic right ventricular outflow tract ventricular tachycardia), who performed 14 (9) h/week of moderate to intense sport practise for 19 (9) years. INTERVENTIONS Clinical evaluation (detailed sports history, multi-modality imaging, electrophysiological study) and sequencing of five candidate desmosomal genes. RESULTS A clinical diagnosis of definite or suspected ARVC by task force criteria (TFC) was met in 24 (51%) and 17 (36%), respectively. ARVC classification was not related to the rate of major arrhythmic events (p=0.28). Pathogenic mutations (four novel) were identified in six athletes (12.8%), which is below published rates for familial ARVC (27-52%). Moreover, only two athletes had a suggestive family history. Severe RV dysfunction was more frequent in mutation carriers (33% vs 2%, p=0.04), but otherwise TFC features were similar to those without mutations. No mutations were found in the 20 athletes performing more than average weekly exercise, yet all met the criteria for definite or suspected ARVC. CONCLUSIONS In this athletic cohort, we found lower than expected rates of desmosomal gene mutations, particularly among those performing the most exercise. This adds further weight to the hypothesis that an ARVC-like phenotype may be acquired through intense exercise without an identifiable genetic predisposition.
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Affiliation(s)
- A La Gerche
- Department of Cardiovascular Medicine, University Hospital, University of Leuven, Belgium
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