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De Pooter J, Timmers L, Boveda S, Combes S, Knecht S, Almorad A, De Asmundis C, Duytschaever M. Validation of a Machine Learning Algorithm to Identify Pulmonary Vein Isolation during Ablation Procedures for the Treatment of Atrial Fibrillation: Results of the PVISION Study. Europace 2024:euae116. [PMID: 38682165 DOI: 10.1093/europace/euae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND AIMS Pulmonary Vein Isolation (PVI) is the cornerstone of ablation for atrial fibrillation. Confirmation of PVI can be challenging due to far field electrograms and sometimes requires additional pacing maneuvers or mapping. This prospective multicenter study assessed the agreement between a previously trained automated algorithm designed to determine vein isolation status with expert opinion in real-world clinical setting. METHOD Consecutive patients scheduled for PVI were recruited at four centers. The ECGenius electrophysiology recording system (CathVision ApS, Denmark) was connected in parallel with the lab's existing system. Electrograms from a circular mapping catheter were annotated during sinus rhythm at baseline pre-ablation, time of isolation, and post-ablation. The ground truth for isolation status was based on operator opinion. The algorithm was applied to the collected PV signals off-line and compared to expert opinion. The primary endpoint was a sensitivity and specificity exceeding 80%. RESULTS Overall, 498 electrograms (248 at baseline and 250 at PVI) with 5,473 individual PV beats from 89 patients (32 females, 62 ±12 years) were analyzed. The algorithm performance reached an area under curve (AUC) of 92% and met the primary study endpoint with a sensitivity and specificity of 86% and 87%, respectively (p = 0.005; p = 0.004). The algorithm had an accuracy of 87% in classifying the time of isolation. CONCLUSION This study validated an automated algorithm using machine learning (ML) to assess the isolation status of pulmonary veins in patients undergoing PVI with different ablation modalities. The algorithm reached an AUC of 92% with both sensitivity and specificity exceeding the primary study endpoints.
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Affiliation(s)
| | - L Timmers
- Heart Center UZ Ghent, Ghent, Belgium
| | - S Boveda
- Clinique Pasteur, Toulouse, France
| | - S Combes
- Clinique Pasteur, Toulouse, France
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De Pooter J, Ozpak E, Calle S, Peytchev P, Heggermont W, Marchandise S, Provenier F, Francois BART, Anne W, Barbaud C, Gillis K, Vanheuverswyn F, Tung R, Wauters A, Le Olain De Waroux JB. Initial experience of left bundle branch area pacing using stylet-driven pacing leads: a multicenter study. Europace 2022. [DOI: 10.1093/europace/euac053.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left bundle branch area pacing (LBBAP) has been performed exclusively using lumen-less pacing leads (LLL) with fixed helix design. This study is the first to explore in a multicenter population the safety and feasibility of LBBAP using stylet-driven leads (SDL) with extendable helix design.
Methods
This study prospectively enrolled all consecutive patients who underwent LBBAP for anti-bradycardia pacing or heart failure indications at 8 Belgian hospitals. LBBAP was attempted either using SDL or LLL delivered through dedicated delivery sheaths. Implant success, complications, procedural and pacing characteristics were recorded at implant and follow-up.
Results
The study enrolled 412 patients (mean age 74 ± 38 years, 44% female). LBBAP with SDL and LLL was successful in 334/353 (94%) and 52/59 (88%) respectively (p=0.058). Implant success for LBBAP using SDL varied from 93 to 100% among centers. Mean paced QRS duration and stimulus to left ventricular activation time were comparable for SDL and LLL (126 ± 21ms versus 125 ± 22ms, p=0.861 and 74 ± 17 and 75 ± 21ms, p=0.756). SDL LBBAP resulted in low pacing thresholds (0.6 ± 0.4V at 0.4ms), which remained stable at 1, 6 and 12 months of follow-up. Lead revisions for SDL LBBAP occurred in 5(1.4%) patients: 2 dislodgements at day 1, 1 late septal perforation at week 3, 1 Twiddler’s syndrome at 5 months, 1 lead fracture at 6 months.
Conclusion
This multicenter study confirms the safety and feasibility of LBBAP using SDL, which is characterized by high implant success, low complication rate and low and stable pacing thresholds.
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Affiliation(s)
- J De Pooter
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - E Ozpak
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - S Calle
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - P Peytchev
- Olv Hospital Aalst, Heart Center, Aalst, Belgium
| | - W Heggermont
- Olv Hospital Aalst, Heart Center, Aalst, Belgium
| | - S Marchandise
- Cliniques Saint-Luc UCL, Departemnt of Cardiology, Brussels, Belgium
| | | | | | - W Anne
- AZ Delta, Roeselare, Belgium
| | | | | | - F Vanheuverswyn
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - R Tung
- University of Arizona College of Medicine, Phoenix, United States of America
| | - A Wauters
- Clinique St Pierre, Ottignies-Louvain-La-Neuve, Belgium
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Ozpak E, Calle S, Demolder A, Kizilkilic S, Timmermans F, De Pooter J. Electrocardiographic analysis of left bundle branch area pacing induced right ventricular activation delay. Europace 2022. [DOI: 10.1093/europace/euac053.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left bundle branch area pacing (LBBAP) aims to capture the area of left bundle branch, resulting in fast activation of the left ventricle (LV) but delayed right ventricular (RV) activation. During intrinsic cardiac conduction, delayed RV activation results on the electrocardiogram (ECG) in a right bundle branch block (RBBB) pattern and is generally considered benign. As such, LBBAP-induced delayed RV activation is thought not to be harmful. However, to what extent left and right ventricular activation times during LBBAP resembles that of healthy individuals with acquired RBBB is currently not known.
Methods
Individuals with incomplete RBBB (iRBBB), complete RBBB (cRBBB) and LBBAP were included. Standard twelve lead electrocardiograms (ECG) were stored and analysed digitally using the MUSE ECG database. QRS duration was measured as global QRS duration. Left and right ventricular activation times were estimated by R-wave peak time in lead V6 (V6RWPT) and R’ peak time in lead V1 (V1RWPT), respectively. Delayed RV activation was further characterized by duration and area of R’ wave in lead V1.
Results
Paced QRS duration during LBBAP (n=86) measured 129±15ms whereas QRS duration of iRBBB (n=422) and cRBBB (n=223) individuals measured 103±8ms and 142±17ms respectively (p<0.001). V6RWPT during LBBAP (47±15ms) was significantly longer than V6RWPT in iRBBB (40±5ms) and cRBBB (39±7ms) (p<0.001). With LBBAP, V1RWPT (83±15ms) became delayed compared to iRBBB (74±9ms, p< 0.001), but remained shorter in comparison to cRBBB (98±17ms, p<0.001). Patients with LBBAP were further characterized by V1 R’ duration and R’ area which were shorter and smaller compared to cRBBB but similar to iRBBB individuals.
Conclusion
LBBAP-induced delayed RV activation resembles electrocardiographically more closely to the delayed RV activation as seen in individuals with incomplete rather than complete RBBB. Left ventricular activation times remain slightly prolonged during LBBAP as compared to RBBB individuals.
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Affiliation(s)
- E Ozpak
- University Hospital Ghent, Gent, Belgium
| | - S Calle
- University Hospital Ghent, Gent, Belgium
| | - A Demolder
- University Hospital Ghent, Gent, Belgium
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Calle S, Timmermans F, De Pooter J. Defining left bundle branch block according to the new 2021 European Society of Cardiology criteria. Neth Heart J 2022; 30:495-498. [PMID: 35503400 PMCID: PMC9613831 DOI: 10.1007/s12471-022-01697-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
Correctly diagnosing left bundle branch block (LBBB) is fundamental, as LBBB occurs frequently in heart failure and may trigger a vicious cycle of progressive left ventricular dysfunction. Moreover, a correct diagnosis of LBBB is pivotal to guide cardiac resynchronisation therapy. Since the LBBB diagnostic criteria were recently updated by the European Society of Cardiology (ESC), we assessed their diagnostic accuracy compared with the previous ESC 2013 definition. We further discuss the complexity of defining LBBB within the context of recent insights into the electromechanical pathophysiology of LBBB.
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Affiliation(s)
- S Calle
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium.
| | - F Timmermans
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium
| | - J De Pooter
- Department of Cardiology, 8-K12, University Hospital Ghent, Ghent, Belgium
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Kellens PJ, De Hauwere A, Peire S, Tournicourt I, Strubbe L, De Pooter J, Bacher K. Integrity of personal radiation protective equipment (PRPE): a 3-year longitudinal follow-up study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Personal radiation protective equipment (PRPE) such as lead aprons, vests, skirts and thyroid shields minimize radiation exposure of operators using ionizing radiation. However, PRPE might be prone to cracks and tears in the attenuating layer of the garments which results in inadequate radiation protection and increased operator dose. Currently, there are no uniform guidelines regarding regular inspection and/or rejection criteria of PRPE.
Purpose
This study aims to investigate the prevalence, qualification and quantification of PRPE integrity during a longitudinal follow-up.
Methods
All PRPE of a large, general hospital was yearly evaluated in the period 2018–2020. The equipment was inspected on a tele-operated X-ray table and cracks and tears were qualified and quantified using an X-ray opaque ruler. Rejection criteria of Lambert & McKeon were applied to accept or reject further use of the PRPE. In brief, all pieces, except for thyroid shields, with a total defect area larger than 670mm2 are rejected. For tears, specifically at the position of the gonads, an extra rejection criterion of 15mm2 is defined. For thyroid shields, the rejection criterion is set to 11mm2.
Results
In the 3-year follow-up period, a total of 915 PRPE were evaluated. 43.3% of PRPE showed tears and 29.3% needed to be rejected based on the Lambert & McKeon criteria. More specifically, in 2018, 2019 and 2020, respectively, 17.4%, 16.9% and 21.2% were rejected. In the attached figure, typical examples of visualized defects are represented. The median tear area (interquartile range) was 12 (30) mm2. Remarkably, of 195 newly registered PRPE, 8.7% showed tears in the first year of use of which 88.2% needed to be rejected. In the latter case, the median tear area (interquartile range) was 40 (50) mm2. Information regarding purchase date and size is missing in respectively 45.5% and 50.7% of the cases. Additionally, 13.7% lacked information regarding lead equivalency.
Conclusion
PRPE are prone to tears and cracks. Up to 40% of PRPE showed tears and cracks resulting in nearly 20% rejections. Newly purchased PRPE are not guaranteed to remain free of cracks and tears in the first year of use. These results urge the importance for regular X-ray based integrity analysis of PRPE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P.-J Kellens
- Ghent University, Medical Physics, Ghent, Belgium
| | - A De Hauwere
- Ghent University, Medical Physics, Ghent, Belgium
| | - S Peire
- AZ Sint-Jan Brugge - Oostende AV, Bruges, Belgium
| | | | - L Strubbe
- AZ Sint-Jan Brugge - Oostende AV, Bruges, Belgium
| | - J De Pooter
- University Hospital Ghent, Heart Centre, Ghent, Belgium
| | - K Bacher
- Ghent University, Medical Physics, Ghent, Belgium
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Calle S, Duchenne J, Puvrez A, De Pooter J, Voigt JU, Timmermans F. Strain-based staging classification of left bundle branch block-induced cardiac remodeling predicts reverse remodeling after cardiac resynchronization therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left bundle branch block (LBBB)-induced adverse remodeling is a gradual but largely unknown process, causing a variable degree of left ventricular (LV) dysfunction and response to cardiac resynchronization therapy (CRT). In LBBB patients with septal flash (SF), an electro-mechanical continuum of different speckle-tracking strain patterns was observed, with each pattern tightly correlating with the degree of LV remodeling and dysfunction (1) (Figure 1).
Purpose
In this study, we investigated the relationship between the staged LBBB strain patterns in CRT-eligible patients and their prediction with respect to reverse remodeling and clinical outcome.
Methods
This study enrolled CRT patients from the PREDICT-CRT study population (2). Inclusion criteria were LV ejection fraction (LVEF) ≤35%, QRS duration ≥120 ms, NYHA class II–IV, absence of right ventricular pacing and availability of speckle tracking strain imaging. All patients underwent an echocardiographic examination before and 12 months after CRT implant. LV volumes, strain and dyssynchrony were assessed. Mid-septal longitudinal strain curves were classified into 5 patterns (LBBB-0 through LBBB-4; Figure 1). Primary endpoint was all-cause mortality.
Results
The study involved 250 patients (mean age 64±10 years; 79% men) with a mean LVEF of 26±7%. LBBB was present in 220 (89%) patients and 206 (82%) patients had SF. Prior to CRT implant, a LBBB-0 pattern was observed in 33 (13%), LBBB-1 in 33 (13%), LBBB-2 in 39 (16%), LBBB-3 in 44 (18%) and LBBB-4 in 101 (40%) patients. Patients with LBBB-3 and -4 patterns more frequently had LBBB, lower LVEF, increased mechanical dyssynchrony and more prominent SF (p<0.001 for all) compared with patients with LBBB-0, -1 and -2 patterns. Across the stages, CRT resulted in a gradual volumetric response, ranging from no response in stage LBBB-0 patients (ΔLV end-systolic volume +7±33%; ΔLVEF −2±9%) to super-response in stage LBBB-4 patients (ΔLV end-systolic volume −40±29%; ΔLVEF +15±13%) (p<0.001 for all). Interestingly, following reverse remodeling, the LV function of stage LBBB-2, -3 and -4 patients improved to a similar LVEF of 38% (p=1.000) in this cohort. Patients in stage LBBB-0 had a significantly less favorable five-year outcome compared to those in stage LBBB≥1 (log-rank p=0.003). There was no difference in long-term outcome between stage LBBB-1 to −4 patients (log-rank p=0.510).
Conclusion
Strain-based LBBB staging predicts the extent of LV reverse remodeling in CRT patients. CRT did not translate into improved absolute survival in the more advanced stages, but the observed gradual volumetric response suggests that CRT corrects the LBBB-induced mortality.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- S Calle
- University Hospital Ghent, Gent, Belgium
| | - J Duchenne
- Gasthuisberg University Hospital, Leuven, Belgium
| | - A Puvrez
- Gasthuisberg University Hospital, Leuven, Belgium
| | | | - J U Voigt
- Gasthuisberg University Hospital, Leuven, Belgium
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7
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Aspeslagh B, Calle P, De Pooter J. Wolff Parkinson White and recreational (meth)amphetamine use: a potentially lethal combination. Acta Clin Belg 2021; 76:406-409. [PMID: 32243227 DOI: 10.1080/17843286.2020.1746885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cardiac arrest in Wolff-Parkinson-White (WPW) is a rare event, and although some patients appear to be at greater risk, there is no consensus on clear risk factors. We present a case of a 23-year-old male patient, with a known history of WPW pattern, who suffered an out of hospital ventricular fibrillation after the consumption of rather small dose of (meth)amphetamines. The use of illegal drug can predispose WPW patients to fatal arrhythmia and cardiac arrest. Patients with WPW pattern should be well informed about the risks of (meth)amphetamines and some might be considered for medical therapy or catheter ablation.
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Affiliation(s)
- B. Aspeslagh
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - P. Calle
- Department of Emergency Medicine, AZ Maria Middelares, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J. De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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8
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Strisciuglio T, El Haddad M, Debonnaire P, De Pooter J, Demolder A, Wolf M, Phlips T, Kyriakopoulou M, Almorad A, Knecht S, Tavernier R, Vandekerckhove Y, Duytschaever M. Paroxysmal atrial fibrillation with high vs. low arrhythmia burden: atrial remodelling and ablation outcome. Europace 2021; 22:1189-1196. [PMID: 32601674 DOI: 10.1093/europace/euaa071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The relation between atrial tachyarrhythmia (ATA) burden in paroxysmal atrial fibrillation (AF), atrial remodelling, and efficacy of catheter ablation (CA) is unknown. We investigated whether high vs. low-burden paroxysmal AF patients have distinct clinical characteristics or electro-mechanical properties of the left atrium (LA) and whether burden impacts outcome of CA. METHODS AND RESULTS Atrial tachyarrhythmia burden, defined as the percentage of time spent in ATA, was assessed by insertable cardiac monitors in 105 patients before and after CA. Clinical characteristics and electro-mechanical properties of LA were compared between patients with high vs. low ATA burden. Catheter ablation efficacy was assessed by reduction in ATA burden and 1-year freedom from any ATA. Median ATA burden was 2.7% (highest tertile 9.3%). Clinical characteristics and electrical properties of LA (refractoriness, conduction velocity, low voltage) did not differ between high (≥9.3%) vs. low ATA burden (<9.3%) patients. High ATA burden patients had larger LA diameter (46.5 ± 6 vs. 42.5 ± 6mm, P < 0.01), volume (93.8 ± 22 vs. 80.4 ± 21mL, P = 0.01), and lower LA reservoir and contractile strain (19.7 ± 6 vs. 24.7 ± 6%, P < 0.01; 10.3 ± 3 vs. 12.8 ± 4%, P = 0.01). Catheter ablation reduced ATA burden by 100% (100-100) in both groups (P = 1.0). Freedom from ATA after CA was equally high (83% vs. 89%, P = 0.38). CONCLUSION Paroxysmal AF patients with high ATA burden have altered LA mechanical properties, reflected by larger size and impaired function. Despite mechanical remodelling of the atria, they are excellent responders to CA. Most likely the lack of fibrosis and/or advanced electrical remodelling explain why pulmonary veins remain the dominant trigger for AF in this patient cohort.
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Affiliation(s)
- T Strisciuglio
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - M El Haddad
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - P Debonnaire
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - J De Pooter
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium.,Ghent University Hospital, Heart Center, De Pintelaan 185, 9000 Ghent, Belgium
| | - Anthony Demolder
- Ghent University Hospital, Heart Center, De Pintelaan 185, 9000 Ghent, Belgium
| | - M Wolf
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - T Phlips
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - M Kyriakopoulou
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - A Almorad
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - S Knecht
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - R Tavernier
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Y Vandekerckhove
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital, Ruddershove 10, 8000 Bruges, Belgium.,Ghent University Hospital, Heart Center, De Pintelaan 185, 9000 Ghent, Belgium
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9
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Calle S, Coeman M, Demolder A, Philipsen T, Kayaert P, De Buyzere M, Timmermans F, De Pooter J. Aortic valve implantation-induced conduction block as a framework towards a uniform electrocardiographic definition of left bundle branch block. Neth Heart J 2021; 29:643-653. [PMID: 33929708 PMCID: PMC8630173 DOI: 10.1007/s12471-021-01565-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction New-onset left bundle branch block (LBBB) following transcatheter or surgical aortic valve replacement (LBBBAVI) implies a proximal pathogenesis of LBBB. This study compares electrocardiographic characteristics and concordance with LBBB definitions between LBBBAVI and non-procedure-induced LBBB controls (LBBBcontrol). Methods All LBBBAVI patients at Ghent University Hospital between 2013 and 2019 were enrolled in the study. LBBBAVI patients were matched for age, sex, ischaemic heart disease and ejection fraction to LBBBcontrol patients in a 1:2 ratio. For inclusion, a non-strict LBBB definition was used (QRS duration ≥ 120 ms, QS or rS in V1, absence of Q waves in V5-6). Electrocardiograms were digitally analysed and classified according to three LBBB definitions: European Society of Cardiology (ESC), Strauss and American Heart Association (AHA). Results A total of 177 patients (59 LBBBAVI and 118 LBBBcontrol) were enrolled in the study. LBBBAVI patients had more lateral QRS notching/slurring (100% vs 85%, p = 0.001), included a higher percentage with a QRS duration ≥ 130 ms (98% vs 86%, p = 0.007) and had a less leftward oriented QRS axis (−15° vs −30°, p = 0.013) compared to the LBBBcontrol group. ESC and Strauss criteria were fulfilled in 100% and 95% of LBBBAVI patients, respectively, but only 18% met the AHA criteria. In LBBBcontrol patients, concordance with LBBB definitions was lower than in the LBBBAVI group: ESC 85% (p = 0.001), Strauss 68% (p < 0.001) and AHA 7% (p = 0.035). No differences in electrocardiographic characterisation or concordance with LBBB definitions were observed between LBBBAVI and LBBBcontrol patients with lateral QRS notching/slurring. Conclusion Non-uniformity exists among current LBBB definitions concerning the detection of proximal LBBB. LBBBAVI may provide a framework for more consensus on defining proximal LBBB. Supplementary Information The online version of this article (10.1007/s12471-021-01565-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Calle
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium.
| | - M Coeman
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - A Demolder
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - T Philipsen
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - P Kayaert
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - M De Buyzere
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - F Timmermans
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - J De Pooter
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
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10
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Calle S, Coeman M, Philipsen T, Kayaert P, Gheeraert P, Timmermans F, De Pooter J. P309Aortic valve implantation-induced bundle branch block as a framework towards a more uniform electrocardiographic definition of left bundle branch block. Europace 2020. [DOI: 10.1093/europace/euaa162.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
The electrocardiographic (ECG) pattern of true left bundle branch block (LBBB) has not been fully clarified and various definitions of LBBB exist. New-onset LBBB after transcatheter (TAVR) or surgical (SAVR) aortic valve replacement implies a proximal pathogenesis of LBBB and thus may provide a reference to characterize and define true LBBB.
PURPOSE
This study compares ECG characteristics in aortic valve implantation-induced LBBB (AVI-LBBB) to a non-procedural-induced LBBB control group (co-LBBB) in order to set a more homogenous definition for true LBBB.
METHODS
The study enrolled all patients with new-onset TAVR- and SAVR-induced LBBB between 2013 and 2019. AVI-LBBB was defined as new-onset persistent LBBB occurring within 24h after TAVR or SAVR. Patients were matched for age, sex, ischemic heart disease and left ventricular systolic function to randomly selected co-LBBB patients in a 1:2 ratio. For inclusion in both groups, a non-strict LBBB definition was used (QRSD ≥120ms, QS or rS in lead V1, absence of Q wave in leads V5-6). ECG characteristics were digitally analysed by the MUSE algorithm and confirmed by two experts. All ECG recordings were classified according to 4 different LBBB definitions: MADIT, European Society of Cardiology (ESC), Strauss and American Heart Association (AHA).
RESULTS
59 patients with AVI-LBBB (34 TAVR, 25 SAVR, median age 82 years, 42% male) were compared to 118 matched co-LBBB patients.
All patients with AVI-LBBB presented with QRS notching/slurring in the lateral leads, whereas this was present in only 85% of the co-LBBB group (p = 0.001). QRS duration (148ms vs 145ms, p = 0.074) and R wave peak time (58ms vs 62ms, p = 0.065) were not significantly different among both groups. AVI-LBBB was characterized by a more rightward QRS axis (-15° vs -30°, p = 0.013). When comparing AVI-LBBB to LBBB controls with QRS notching/slurring, a comparable QRS axis was observed.
Almost all AVI-LBBB patients met the MADIT (98%), ESC (100%) and Strauss (95%) definition. Only 18% of patients met the AHA definition, because of the low combined presence of QRS notching/slurring in all 4 lateral leads (54%) and because only 27% of patients had an R wave peak time >60ms in both leads V5-6.
In the co-LBBB group, adherence to the different definitions was significantly lower compared to the AVI-LBBB group: MADIT 86% (p = 0.007), ESC 85% (p = 0.001), Strauss 68% (p < 0.001) and AHA 7% (p = 0.035). Lower presence of lateral notching/slurring and more patients with smaller QRS duration (QRS duration ≥130ms, 86% vs 98%, p = 0.007) in the co-LBBB group explain these results.
CONCLUSIONS
Discordance exists between various definitions in scoring AVI-LBBB. Our data show that presence of QRS notching/slurring in the lateral leads is a crucial feature of proximal LBBB, rather than QRS duration and R wave peak time. The AVI-LBBB population provides a framework towards a more uniform definition and criteria for assessing true, proximal LBBB.
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Affiliation(s)
- S Calle
- University Hospital Ghent, Gent, Belgium
| | - M Coeman
- University Hospital Ghent, Gent, Belgium
| | | | - P Kayaert
- University Hospital Ghent, Gent, Belgium
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11
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De Coster M, Demolder A, De Meyer V, Vandenbulcke F, Van Heuverswyn F, De Pooter J. P1362Diagnostic accuracy of R-wave detection by insertable cardiac monitors. Europace 2020. [DOI: 10.1093/europace/euaa162.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
OnBehalf
1.Department of Cardiology, Ghent University Hospital, Ghent, Belgium
Introduction
Insertable cardiac monitors (ICM) allow automatic arrhythmia detection but the diagnostic performance can be hampered by poor R-wave sensing leading to false positive recordings.
Purpose
This study assesses the prevalence and predictors of R-wave under- and oversensing among different ICM types.
Methods
Patients implanted with an ICM at the University Hospital of Ghent between January 2017 and August 2018 were included. All ICM tracings recorded at ICM interrogation or transmitted by remote monitoring were reviewed for inadequate R-wave sensing leading to false arrhythmia alerts. Inadequate R wave sensing was defined as undersensing due to sudden reduction in R wave amplitude or oversensing due to the occurrence of artefacts. Patient and implant characteristics were retrieved from the medical record and implant reports.
Results
The study screened 135 patients (age 59 ± 19 years, 44% female) implanted with different ICM types: Reveal XT and LINQ n = 92 (68%), Confirm and Confirm Rx n = 35 (26%), BioMonitor n = 8 (6%). ICM analysis was conducted in 112 patients (83%). Overall, false arrhythmia alerts due to inadequate R wave sensing occurred in 22 (20%) of the patients. Among these 22 patients, false diagnosis of bradycardia or pauses were documented in 64%, false high ventricular rates in 14% and false atrial fibrillation alerts in 22% of the patients. Of interest, in an additional 7 (6%) patients significant changes in R wave sensing occurred, although not causing false arrhythmic alerts. Occurrence of R-wave changes occurred in 19% of Reveal, 17% of Confirm and 50% of BioMonitor ICMs (p = not significant). Occurrence of R-wave changes among the different types of ICMs were not related to age, sex, BMI, time of the day, heart frequency or implant R-wave sensing.
Conclusion
Poor R wave sensing, leading to false arrhythmia detection, occurred in a significant number of ICM, and seems to occur independent of ICM type, patient or implant characteristics.
Abstract Figure.
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Affiliation(s)
| | - A Demolder
- University Hospital Ghent, Gent, Belgium
| | - V De Meyer
- University Hospital Ghent, Gent, Belgium
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12
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Calle S, Coeman M, Kamoen V, De Pooter J, Timmermans F. P782 Septal flash is a prevalent and early dyssynchrony marker in transcatheter aortic valve replacement-induced left bundle branch block. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
New-onset left bundle branch block (LBBB) is a frequent complication after transcutaneous aortic valve replacement (TAVR). LBBB is associated with echocardiographic dyssynchrony in heart failure patients, but this has not been thoroughly investigated in acute LBBB following TAVR.
PURPOSE
This study aims to assess the timing and incidence of echocardiographic dyssynchrony in acute TAVR-induced LBBB patients.
METHODS
The study enrolled all TAVR-induced LBBB patients at our Hospital between January 2013 and May 2019. Presence of LBBB was scored within 72 hours following TAVR. Dyssynchrony was assessed by: 1/ presence of septal flash (SF), 2/ interventricular mechanical delay (IVMD, the difference between left and right ventricular pre-ejection interval using pulsed wave Doppler; cut-off ≥40 ms) and 3/ presence of ‘classical dyssynchronous strain pattern’ assessed with speckle tracking (Figure 1). As a control, these three LBBB-related dyssynchrony markers were assessed and compared to LBBB patients without TAVR (non-TAVR patients) in normal ànd reduced EF, but all having SF.
RESULTS
Out of 134 consecutive TAVR procedures, 30 (22%) were complicated by acute LBBB. SF was present in 72% of TAVR-induced LBBB patients, with a median time from TAVR to SF diagnosis of 24 hours. However, only 1 (5%) of these TAVR patients exhibited a classical dyssynchronous contraction strain pattern (Figure 1), despite presence of SF. Finally, the IVMD values in these TAVR-LBBB patients did not meet the ‘dyssynchrony’ cut-off.
As a control, we compared these dyssynchrony parameters in patients with non-TAVR related LBBB with normal and reduced EF, all exhibiting SF. A classical strain pattern was present in 33% of non-TAVR LBBB patients with preserved left ventricular ejection fraction (LV EF) (p = 0.17), and in 80% of non-TAVR LBBB patients with reduced LV EF ≤30% (p < 0.001). The IVMD in non-TAVR LBBB patients with SF and preserved LV EF was 52 ms (p = 0.002) and 57 ms in non-TAVR LBBB patients with SF and LV EF ≤30% (p = 0.009).
CONCLUSION
SF as dyssynchrony marker develops early after TAVR-induced LBBB and is much more prevalent than the classical strain-based dyssynchrony pattern and IVMD.
Our findings from the control population suggest that progressive LBBB-induced LV remodeling (septal thinning and relative lateral thickening) may be required for a ‘classical dyssynchrony strain pattern’ or significant IVMD to occur in TAVR-LBBB patients, but longitudinal follow-up studies in TAVR-LBBB patients are required as proof-of-concept.
Abstract P782 Figure 1
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Affiliation(s)
- S Calle
- University Hospital Ghent, Gent, Belgium
| | - M Coeman
- University Hospital Ghent, Gent, Belgium
| | - V Kamoen
- University Hospital Ghent, Gent, Belgium
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De Pooter J, Calle S, Coeman M, Philipsen T, Gheeraert P, Jordaens L, Kayaert P, Timmermans F, Vanheuverswyn F. 6119Correction of transcatheter aortic valve replacement induced left bundle branch block by His bundle pacing. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left bundle branch block (LBBB) occurs frequently after transcatheter aortic valve replacement (TAVR) and is associated with increased risk of permanent pacemaker implantation, heart failure hospitalization and sudden cardiac death. This pilot study explored the feasibility of TAVR-induced LBBB correction with His bundle pacing (HBP).
Methods
Patients with TAVR -induced LBBB and postoperative need for permanent pacemaker implant were planned for electrophysiology study and HBP. Patients with persistent high degree AV-block were excluded. HBP was performed using the Select Secure pacing lead, delivered through a fixed curve or a deflectable sheath. Successful HBP was defined as correction of LBBB by selective or non-selective HBP with LBBB correction thresholds less than 3.5V at 1.0ms at implant.
Results
The study enrolled 6 patients (mean age 85±2.5 years, 50% male). Mean QRS duration was 152±10ms, PR-interval 212±12ms AH-interval 166±16ms and HV-interval 62±12ms. Successful HBP was achieved in 5/6 (83%) patients. Mean QRS duration decreased from 153±11ms to 88±14ms (p=0.002). At implantation, mean threshold for LBBB correction was 1.6±1.0V (unipolar) and 2.2±1.3V (bipolar) at 1.0ms. Periprocedural, two complete AV-blocks occurred, both spontaneously resolved by the end of the procedure. Thresholds remained stable at 1 month follow up: 1.8±1.0V (unipolar) and 2.3±1.5V (bipolar) at 1.0ms.
Figure 1
Conclusion
Permanent His bundle pacing can safely correct TAVR-induced LBBB in the majority of patients. Further studies are needed to assess potential benefits of His bundle pacing over conventional right ventricular pacing in this population.
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Affiliation(s)
- J De Pooter
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - S Calle
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - M Coeman
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - T Philipsen
- Ghent University Hospital (UZ), Cardiac Surgery, Ghent, Belgium
| | - P Gheeraert
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - L Jordaens
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - P Kayaert
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - F Timmermans
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - F Vanheuverswyn
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
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14
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Van Heuverswyn F, De Buyzere M, Coeman M, De Pooter J, Drieghe B, Duytschaever M, Gevaert S, Kayaert P, Vandekerckhove Y, Voet J, El Haddad M, Gheeraert P. P576The first handheld device for autonomic self-detection of symptomatic acute coronary artery occlusion: feasibility, performance and implications for time-efficient self-triage of outpatients with CAD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Time delay between onset of symptoms and seeking medical attention is a major determinant of mortality and morbidity in patients with acute coronary artery occlusion (ACAO). Response time might be reduced by reliable self-detection of ACAO. Currently no self-applicable device can accurately detect ACAO. We have recently shown that an automatic algorithm based upon a three lead system (RELF method) accurately detects ACAO.
Purpose
In this multicenter observational study we tested the operational feasibility, sensitivity and specificity of our RELF method, built into a mobile handheld device, for detection of ACAO.
Methods
Patients with planned elective percutaneous coronary intervention (PCI), who were able to use a smartphone, were asked to perform random ambulatory self-recordings for at least one week. A similar self-recording was made before angioplasty and at 60 s of balloon occlusion.
Results
The operational feasibility of ambulatory self-recordings in enrolled patients with CAD was 59/64 (92.1%, 95% CI: 83.0–96.6). Of all self-recordings 91.1% (n=4567) were automatically classified as successful within one minute. The mean false positive rate during daily life conditions was 4.19% (95% CI: 3.29–5.10). Amongst 65 balloon occlusions, 63 index-tests at 60 s of occlusion were available. The sensitivity for the target conditions “ACAO”, “ACAO with ECG changes” and “ACAO with ECG changes and ST segment elevation myocardial infarction (STEMI) criteria” was respectively 55/63 (0.87; 95% CI: 0.77–0.93), 54/57 (0.95; 95% CI: 0.86–0.98) and 35/35 (1.00). The figure depicts all (n=3936) ST difference vector (STDVn) measurements obtained during ambulatory postural changes, exercise and coronary artery occlusion with and without ECG changes and/or STEMI criteria. Receiver Operator Curve (ROC) for ACAO at different cut-off values of the magnitude of STDVn was 0.973 (95% CI: 0.956–0.990).
Boxplots of all STDVn test recordings
Conclusions
Self-recording with our RELF device is feasible for the majority of patients with CAD. The sensitivity and specificity for automatic detection of the earliest phase of acute coronary artery occlusion support the concept of our RELF device for patient empowerment to reduce delay and increase survival without overloading emergency services. This is the first clinical study that confirms the proof-of-concept of self-detection of acute coronary artery occlusion in outpatients with CAD.
Acknowledgement/Funding
Ghent University, Industrial Research Fund (IOF reference: F2015/IOF-advanced/084).
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Affiliation(s)
| | | | - M Coeman
- University Hospital Ghent, Gent, Belgium
| | | | - B Drieghe
- University Hospital Ghent, Gent, Belgium
| | | | - S Gevaert
- University Hospital Ghent, Gent, Belgium
| | - P Kayaert
- University Hospital Ghent, Gent, Belgium
| | | | - J Voet
- AZ Nikolaas, Sint-Niklaas, Belgium
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De Prez L, Andersen C, De Pooter J, Palmans H. SP-0237 Clinical application of kQ factors for reference dosimetry in flattening filter free (FFF) photon beams. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30657-7] [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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16
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De Pooter J, El Haddad M, Striscuiglio T, Wolf M, Phlips T, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. P849Recurrence of atrial fibrillation after CLOSE-guided pulmonary vein isolation: observations at repeat ablation and follow-up. Europace 2018. [DOI: 10.1093/europace/euy015.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J De Pooter
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - M El Haddad
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | | | - M Wolf
- St-Jan Hospital, Cardiology, Bruges, Belgium
| | - T Phlips
- St-Jan Hospital, Cardiology, Bruges, Belgium
| | - R Tavernier
- St-Jan Hospital, Cardiology, Bruges, Belgium
| | - S Knecht
- St-Jan Hospital, Cardiology, Bruges, Belgium
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17
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Strisciuglio T, Debonnaire P, El Haddad M, De Pooter J, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. P863Atrial fibrillation burden and left atrial imaging. Europace 2018. [DOI: 10.1093/europace/euy015.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Strisciuglio
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - P Debonnaire
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - M El Haddad
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - J De Pooter
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - R Tavernier
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - S Knecht
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | | | - M Duytschaever
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
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18
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Tavernier R, Strisciuglio T, Van Heuverswyn F, Timmers L, De Pooter J, Knecht S, Duytschaever M, Vandekerckhove Y, Kucher A, Stroobandt R. P1229Different scenarios leading to inappropriate therapy inhibition in single chamber ICD detection programming. Europace 2018. [DOI: 10.1093/europace/euy015.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Tavernier
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - T Strisciuglio
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | | | - L Timmers
- Ghent University Hospital (UZ), Ghent, Belgium
| | - J De Pooter
- Ghent University Hospital (UZ), Ghent, Belgium
| | - S Knecht
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - M Duytschaever
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
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Strisciuglio T, El Haddad M, De Pooter J, Bar-Tal M, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. P1153Atrial voltage and conduction velocity in paroxysmal AF without overt structural heart disease: reference values and impact of contact force. Europace 2018. [DOI: 10.1093/europace/euy015.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Strisciuglio
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - M El Haddad
- Ghent University Hospital (UZ), Heart Center, Ghent, Belgium
| | - J De Pooter
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - M Bar-Tal
- Biosense Webster Inc , Diamond bar, United States of America
| | - R Tavernier
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - S Knecht
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | | | - M Duytschaever
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
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De Pooter J, Elhaddad M, Phlips T, Timmers L, Van Heuverswyn F, Knecht S, Tavernier R, Duytschaever M. P301Comparison of local activation time annotation algorithms in high density mapping of regular atrial tachycardias. Europace 2017. [DOI: 10.1093/ehjci/eux141.029] [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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21
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De Pooter J, El Haddad M, Stroobandt R, De Buyzere M, Timmermans F. P1548Accuracy of computer-calculated and manual QRS duration assessments: clinical implications to select candidates for cardiac resynchronization therapy. Europace 2017. [DOI: 10.1093/ehjci/eux158.174] [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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22
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Bordy J, Andersen C, Ankerhold U, Dedieu V, Delaunay F, De Pooter J, Compell J, Duane S, Kapsch R, Kosunen A, Machula G, Marinelli M, Palmans H, Pimpinella M, Pinto M, Rinati GV, Solc J. An introduction to metrology for radiotherapy using complex radiation fields – HLT09 EMRP Project. Phys Med 2015. [DOI: 10.1016/j.ejmp.2015.10.071] [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: 11/27/2022] Open
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Seravalli E, Houweling A, Van Gellekom M, Kaas J, Kuik M, Loeff E, Raaben T, De Pooter J, de Vries W, Van de Kamer J. SU-E-T-51: A National QA Audit of QA Systems Used for IMRT and VMAT Patient QA. Med Phys 2015. [DOI: 10.1118/1.4924412] [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: 11/07/2022] Open
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24
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De Prez L, De Pooter J, Jansen B. WE-G-17A-06: A Water Calorimeter for Use in MRI Linacs. Med Phys 2014. [DOI: 10.1118/1.4889508] [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: 11/07/2022] Open
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25
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De Pooter J, De Prez L. OC-0506: Ionization chamber response in the presence of magnetic fields ñ the influence of the wall effect. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30611-3] [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]
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