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Weeda JA, Bokenkamp-Gramann R, Straver BB, Rammeloo L, Hahurij ND, Bertels RA, Haak MC, Te Pas AB, Hazekamp MG, Blom NA, van der Palen RLF. Balloon atrial septostomy for transposition of the great arteries: Safety and experience with the Z-5 balloon catheter. Catheter Cardiovasc Interv 2024; 103:308-316. [PMID: 38091308 DOI: 10.1002/ccd.30932] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Balloon atrial septostomy (BAS) is an emergent and essential cardiac intervention to enhance intercirculatory mixing at atrial level in deoxygenated patients diagnosed with transposition of the great arteries (TGA) and restrictive foramen ovale. The recent recall of several BAS catheters and the changes in the European legal framework for medical devices (MDR 2017/745), has led to an overall scarcity of BAS catheters and raised questions about the use, safety, and experience of the remaining NuMED Z-5 BAS catheter. AIMS To evaluate and describe the practice and safety of the Z-5 BAS catheter, and to compare it to the performance of other BAS catheters. METHODS A retrospective single-center cohort encompassing all BAS procedures performed with the Z-5 BAS catheter in TGA patients between 1999 and 2022. RESULTS A total of 182 BAS procedures were performed in 179 TGA-newborns at Day 1 (IQR 0-5) days after birth, with median weight of 3.4 (IQR 1.2-5.7) kg. The need for BAS was urgent in 90% of patients. The percentage of BAS procedures performed at bedside increased over time from 9.8% (before 2010) to 67% (2017-2022). Major complication rate was 2.2%, consisting of cerebral infarction (1.6%) and hypovolemic shock (0.5%). The rate of minor complications was 9.3%, including temporary periprocedural AV-block (3.8%), femoral vein thrombosis (2.7%), transient intracardiac thrombus (0.5%), and atrial flutter (2.2%). BAS procedures performed at bedside and in the cardiac catheterization laboratory had similar complication rates. CONCLUSIONS BAS using the Z-5 BAS catheter is both feasible and safe at bedside and at the cardiac catheterization laboratory with minimal major complications.
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Affiliation(s)
- Jesse A Weeda
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Regina Bokenkamp-Gramann
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Bart B Straver
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Lukas Rammeloo
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Emma Children's Hospital, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, The Netherlands
| | - Nathan D Hahurij
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Robin A Bertels
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Monique C Haak
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Arjan B Te Pas
- Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mark G Hazekamp
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nico A Blom
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
| | - Roel L F van der Palen
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Center for Congenital Heart Disease Amsterdam-Leiden (CAHAL), Departments of Pediatrics, Divisions of Pediatric Cardiology, Departments of Obstetrics and Fetal Medicine, Departments of Cardiothoracic Surgery, Amsterdam University Medical Center (Amsterdam UMC) and Leiden University Medical Center (LUMC), Amsterdam and Leiden, The Netherlands
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Copier JS, Bootsma M, Ng CA, Wilde AAM, Bertels RA, Bikker H, Christiaans I, van der Crabben SN, Hol JA, Koopmann TT, Knijnenburg J, Lommerse AAJ, van der Smagt JJ, Bezzina CR, Vandenberg JI, Verkerk AO, Barge-Schaapveld DQCM, Lodder EM. Reclassification of a likely pathogenic Dutch founder variant in KCNH2; implications of reduced penetrance. Hum Mol Genet 2023; 32:1072-1082. [PMID: 36269083 PMCID: PMC10026256 DOI: 10.1093/hmg/ddac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Variants in KCNH2, encoding the human ether a-go-go (hERG) channel that is responsible for the rapid component of the cardiac delayed rectifier K+ current (IKr), are causal to long QT syndrome type 2 (LQTS2). We identified eight index patients with a new variant of unknown significance (VUS), KCNH2:c.2717C > T:p.(Ser906Leu). We aimed to elucidate the biophysiological effect of this variant, to enable reclassification and consequent clinical decision-making. METHODS A genotype-phenotype overview of the patients and relatives was created. The biophysiological effects were assessed independently by manual-, and automated calibrated patch clamp. HEK293a cells expressing (i) wild-type (WT) KCNH2, (ii) KCNH2-p.S906L alone (homozygous, Hm) or (iii) KCNH2-p.S906L in combination with WT (1:1) (heterozygous, Hz) were used for manual patching. Automated patch clamp measured the variants function against known benign and pathogenic variants, using Flp-In T-rex HEK293 KCNH2-variant cell lines. RESULTS Incomplete penetrance of LQTS2 in KCNH2:p.(Ser906Leu) carriers was observed. In addition, some patients were heterozygous for other VUSs in CACNA1C, PKP2, RYR2 or AKAP9. The phenotype of carriers of KCNH2:p.(Ser906Leu) ranged from asymptomatic to life-threatening arrhythmic events. Manual patch clamp showed a reduced current density by 69.8 and 60.4% in KCNH2-p.S906L-Hm and KCNH2-p.S906L-Hz, respectively. The time constant of activation was significantly increased with 80.1% in KCNH2-p.S906L-Hm compared with KCNH2-WT. Assessment of KCNH2-p.S906L-Hz by calibrated automatic patch clamp assay showed a reduction in current density by 35.6%. CONCLUSION The reduced current density in the KCNH2-p.S906L-Hz indicates a moderate loss-of-function. Combined with the reduced penetrance and variable phenotype, we conclude that KCNH2:p.(Ser906Leu) is a low penetrant likely pathogenic variant for LQTS2.
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Affiliation(s)
- Jaël S Copier
- Experimental Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 Leiden, The Netherlands
| | - Chai A Ng
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Arthur A M Wilde
- Experimental Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
| | - Robin A Bertels
- Department of Paediatric Cardiology, Leiden University Medical Center, Willem-Alexander Children's Hospital, Albinusdreef 2, 2333 Leiden, Netherlands
| | - Hennie Bikker
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
- Human Genetics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, University Medical Centre Groningen, 9713GZ Groningen, The Netherlands
| | - Saskia N van der Crabben
- Human Genetics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janna A Hol
- Erasmus MC, Clinical Genetics, Doctor Molewaterplein 40, 3015 Rotterdam, The Netherlands
| | - Tamara T Koopmann
- Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands
| | - Jeroen Knijnenburg
- Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands
| | - Aafke A J Lommerse
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 Leiden, The Netherlands
| | - Jasper J van der Smagt
- Clinical Genetics, University Medical Center Utrecht, Lundlaan 6, Utrecht, The Netherlands
| | - Connie R Bezzina
- Experimental Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
| | - Jamie I Vandenberg
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Arie O Verkerk
- Experimental Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
- Medical Biology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Elisabeth M Lodder
- Experimental Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart'
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3
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Copier JS, Bootsma M, Wilde AAM, Bertels RA, Bikker H, Christiaans I, Koopmann TT, Lommerse AAJ, Bezzina CR, Verkerk AO, Barge-Schaapveld DQCM, Lodder EM. Recurrent variant of unknown significance in KCNH2 classified through functional characterisation. Europace 2022. [DOI: 10.1093/europace/euac053.014] [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: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO Talent Scheme)
Background
Variants in KCNH2, the gene encoding the hERG channel and responsible for the cardiac rapid delayed rectifier K+ current (IKr), have been linked to Long QT Syndrome type 2 (LQTS2). The KCNH2-p.S906L variant has been found in eight, small unrelated families with variable clinical pictures and incomplete penetrance of LQTS2.
Purpose
Due to the small size of the families, co-segregation analysis is limited. Functional studies were performed to evaluate the effect of the variant on channel functionality. Thereby assessing if KCNH2-p.S906L leads to functional changes explanatory for the phenotype.
Methods
Clinical data of the patients and family members were collected thereby, creating an overview of the phenotype. The biophysiological properties of the hERG channel were assessed by manual whole-cell patch-clamp, using HEK293a cells expressing (i) the wild type (WT) KCNH2, (ii) KCNH2-p.S906L alone (homozygous, hm) or KCNH2-p.S906L in combination with WT (heterozygous, Hz).
Results
Assessment of the clinical data of the patients and family members shows an incomplete and low penetrance of the LQTS2. All carriers were heterozygous for the variant. In carriers of the KCNH2-p.S906L variant, LQTS2 severity was very variable, ranging from asymptomatic, to life-threatening arrhythmic events. The KCNH2-p.S906L variant reduced current density in a dosage-dependent manner compared to KCNH2-WT. The current density was reduced by 63, and 54% in KCNH2-p.S906L-Hm and KCNH2-p.S906L-Hz, respectively. Changes in gating properties were absent, except for activation kinetics in KCNH2-p.S906L-Hm. In these cells, an increase in the time constant, and a positive shift in voltage dependency of activation were observed.
Conclusions
Both the reduced current density and changes in activation kinetics suggest the variant to result in a moderate loss-of-function of the hERG channel, fitting with the observed LQTS2. These observed functional changes in hERG combined with the reduced penetrance in the affected individuals suggest that this variant in KCNH2 is a risk factor for LQTS2.
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Affiliation(s)
- JS Copier
- Amsterdam UMC, Experimental Cardiology, Amsterdam, Netherlands (The)
| | - M Bootsma
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - AAM Wilde
- Amsterdam UMC, Experimental Cardiology, Amsterdam, Netherlands (The)
| | - RA Bertels
- Leiden University Medical Center, Pediatric Cardiology, Leiden, Netherlands (The)
| | - H Bikker
- Amsterdam UMC, Clinical Genetics, Amsterdam, Netherlands (The)
| | - I Christiaans
- University Medical Center Groningen, Clinical Genetics, Groningen, Netherlands (The)
| | - TT Koopmann
- Leiden University Medical Center, Clinical Genetics, Leiden, Netherlands (The)
| | - AAJ Lommerse
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - CR Bezzina
- Amsterdam UMC, Experimental Cardiology, Amsterdam, Netherlands (The)
| | - AO Verkerk
- Amsterdam UMC, Experimental Cardiology and Medical Biology, Amsterdam, Netherlands (The)
| | | | - EM Lodder
- Amsterdam UMC, Experimental Cardiology, Amsterdam, Netherlands (The)
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4
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Kimura Y, Wallet J, Bertels RA, Jongbloed MRM, Kies P, Egorova AD, Hazekamp MG, Lamb HJ, Blom NA, Zeppenfeld K. Non-invasive identification of slow conducting anatomical isthmuses in patients with tetralogy of Fallot by 3D late gadolinium enhancement cardiovascular magnetic resonance. Europace 2022. [DOI: 10.1093/europace/euac053.551] [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
Patients with repaired tetralogy of Fallot (rTOF) remain at risk of sudden cardiac death due to reentrant sustained monomorphic ventricular tachycardia (SMVT). Slow conducting anatomical isthmuses (SCAI), in particular SCAI3 at the outlet septum, bordered by the pulmonary annulus and the ventricular septal defect patch, are the dominant substrate for SMVT. Electroanatomical mapping (EAM) is the invasive gold standard to identify SCAIs, and transection of SCAI by catheter ablation has been correlated with favorable long-term outcome. Non-invasive identification of SCAI for risk stratification and treatment planning is needed but has not been established yet. Three-dimensional (3D) late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) facilitates accurate visualization of morphologically complex hearts with high-spatial resolution.
Objective
The study thought to determine whether 3D LGE-CMR can identify SCAIs.
Methods
Consecutive patients with rTOF who underwent right ventricular (RV) EAM and 3D LGE-CMR were included. LGE-CMR-derived 3D RV reconstructions were created (ADAS-3D) and merged with 3D RV EAM data. Mapping points were superimposed on the CMR-derived 3D reconstruction allowing for direct comparison of EAM data and local signal intensity (SI). The optimal SI cut-off to identify low bipolar voltage (LBV, BV<1.76mV) was determined by receiver operating characteristic carve. An abnormal AI on LGE-CMR was defined as AI with continuous SI above the obtained cut-off connecting AI borders.
Results
Forty-eight rTOF patients (34±16 years, 58% male) were included. At EAM, 21 patients had normal AI, and 20 and 7 had a SCAI (<0.5m/s) or blocked AI, which was AI3 in all. Patients with SCAI showed low BV of AI3 (median 0.7 [range 0.25-2.59] mV). In 11 patients, 14 SMVTs could be induced, all related to SCAI3.
A total of 9240 points were analyzed, showing a significant correlation between BV and SI (R=0.4, P<0.001). The optimal SI cut-off to identify LBV was 42% of the maximal SI (MSI) (AUC 0.80; sensitivity, 74%; specificity, 78%). Using this cut-off of MSI, a SCAI or blocked AI3 could be correctly identified by LGE-CMR in all 27 patients, and a normal AI3 could be correctly confirmed by LGE-CMR in 14/21 patients with normal EAM findings (Figure). The sensitivity and specificity of 3D LGE-CMR for identifying SCAI or blocked AI3 were 100% and 67%, respectively. Of note, among patients with normal EAM findings, those with abnormal AI3 on LGE-CMR had significantly lower BV of AI3 than those with normal AI3 on LGE-CMR (2.06 [Range, 1.62-2.60] vs. 3.53 [2.22-5.67] mV, P<0.01).
Conclusion
3D LGE-CMR can identify SCAI with 100% sensitivity and may identify diseased AI3 even before critical conduction delay occurs. This technique may allow for non-invasive risk stratification of VT and can refine patient selection for invasive EAM.
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Affiliation(s)
- Y Kimura
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J Wallet
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - RA Bertels
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - MRM Jongbloed
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Kies
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - AD Egorova
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - MG Hazekamp
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - HJ Lamb
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NA Blom
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - K Zeppenfeld
- Leiden University Medical Center, Leiden, Netherlands (The)
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5
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Bruyndonckx L, de Riva Silva M, Blom NA, Bertels RA. An accessory pathway with automaticity and bidirectional conductive capacity. Europace 2021; 23:379. [PMID: 33398335 PMCID: PMC7947569 DOI: 10.1093/europace/euaa379] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luc Bruyndonckx
- Department of Paediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Department of Paediatric Cardiology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.,Department of Paediatric Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Marta de Riva Silva
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
| | - Nico A Blom
- Department of Paediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.,Department of Paediatric Cardiology, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Robin A Bertels
- Department of Paediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
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6
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Etnel JRG, Bons LR, De Heer F, Robbers-Visser D, Van Beynum IM, Straver B, Jongbloed MR, Kiès P, Slieker MG, Van Dijk APJ, Kluin J, Bertels RA, Utens EMWJ, The R, Van Galen E, Mulder BJM, Blom NA, Hazekamp MG, Roos-Hesselink JW, Helbing WA, Bogers AJJC, Takkenberg JJM. Patient information portal for congenital aortic and pulmonary valve disease: a stepped-wedge cluster randomised trial. Open Heart 2021; 8:openhrt-2020-001252. [PMID: 33757975 PMCID: PMC7993296 DOI: 10.1136/openhrt-2020-001252] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In response to an increased need for patient information in congenital heart disease, we previously developed an online, evidence-based information portal for patients with congenital aortic and pulmonary valve disease. To assess its effectiveness, a stepped-wedge cluster randomised trial was conducted. METHODS Adult patients and caregivers of paediatric patients with congenital aortic and/or pulmonary valve disease and/or tetralogy of Fallot who visited the outpatient clinic at any of the four participating centres in the Netherlands between 1 March 2016-1 July 2017 were prospectively included. The intervention (information portal) was introduced in the outpatient clinic according to a stepped-wedge randomised design. One month after outpatient clinic visit, each participant completed a questionnaire on disease-specific knowledge, anxiety, depression, mental quality of life, involvement and opinion/attitude concerning patient information and involvement. RESULTS 343 participants were included (221 control, 122 intervention). Cardiac diagnosis (p=0.873), educational level (p=0.153) and sex (p=0.603) were comparable between the two groups. All outcomes were comparable between groups in the intention-to-treat analyses. However, only 51.6% of subjects in the intervention group (n=63) reported actually visiting the portal. Among these subjects (as-treated), disease-specific knowledge (p=0.041) and mental health (p=0.039) were significantly better than in control subjects, while other baseline and outcome variables were comparable. CONCLUSION Even after being invited by their cardiologists, only half of the participants actually visited the information portal. Only in those participants that actually visited the portal, knowledge of disease and mental health were significantly better. This underlines the importance of effective implementation of online evidence-based patient information portals in clinical practice.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frederiek De Heer
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | - Ingrid M Van Beynum
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,De Bascule, Academic Center for Child Psychiatry, Amsterdam, Netherlands
| | | | - Eugene Van Galen
- Patient Association 'Patiëntenvereniging Aangeboren Hartafwijkingen', Maarssen, Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bertels RA, Kammeraad JAE, Zeelenberg AM, Filippini LH, Knobbe I, Kuipers IM, Blom NA. The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study. Pediatr Cardiol 2021; 42:883-890. [PMID: 33515328 PMCID: PMC8110481 DOI: 10.1007/s00246-021-02556-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (- 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (- 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (- 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.
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Affiliation(s)
- Robin A Bertels
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands.
| | - Janneke A E Kammeraad
- Sophia Children's Hospital-Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Anna M Zeelenberg
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
| | - Luc H Filippini
- Juliana Children's Hospital-HAGA Hospital, Els Borst-Eilersplein 275, The Hague, the Netherlands
| | - Ingmar Knobbe
- VU Medical Center-Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nico A Blom
- Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands
- Emma Children's Hospital-Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands
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Etnel JRG, van Dijk APJ, Kluin J, Bertels RA, Utens EMWJ, van Galen E, Bogers AJJC, Takkenberg JJM. Development of an Online, Evidence-Based Patient Information Portal for Congenital Heart Disease: A Pilot Study. Front Cardiovasc Med 2017; 4:25. [PMID: 28507990 PMCID: PMC5410639 DOI: 10.3389/fcvm.2017.00025] [Citation(s) in RCA: 12] [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] [Received: 12/22/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In response to an increased need for patient information on congenital heart disease in the Netherlands, we initiated a nationwide initiative to develop an online, evidence-based patient information portal, starting with a pilot project aimed at the subgroup of patients with congenital aortic and pulmonary valve disease. METHODS AND RESULTS We developed an information portal that aims to (1) improve patient knowledge and involvement and to subsequently reduce anxiety and decisional conflict and improve mental quality of life and (2) to support physicians in informing and communicating with their patients. The information portal was developed according to the systematic International Patient Decision Aid Standards development process employing Delphi techniques by a multidisciplinary workgroup of pediatric and adult congenital cardiologists, a congenital cardiothoracic surgeon, a psychologist, an epidemiologist, a patient representative, and web and industrial design experts. First, patients and physicians were surveyed and interviewed to assess the current state of patient information and explore their preferences and needs to determine the focus for the development of the information portal. We found that patient knowledge and numeracy are limited, reliable information is scarce, physicians inform patients selectively and patient involvement is suboptimal, and there is a need for more reliable, tailored, and multi-faceted information. Based on the findings of these surveys and interviews, a patient-tailored information portal was designed that presents evidence-based disease- and age-specific medical and psychosocial information about diagnosis, treatment, prognosis, and impact on daily life in a manner that is comprehensible and digestible for patients and that meets the needs expressed by both patients and physicians. The effect of the website on patient outcome is currently being assessed in a multicenter stepped-wedge implementation trial. CONCLUSION The present pilot project succeeded in developing an online, evidence-based information portal that is supported by both patients and physicians. The information portal will be further developed and expanded to include all other major forms of congenital heart disease, translations into other languages, and a public information portal to serve patients' relatives and the general public at large.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,De Bascule, Academic Center for Child Psychiatry, Amsterdam, Netherlands
| | - Eugene van Galen
- Patient Association 'Patiëntenvereniging Aangeboren Hartafwijkingen', Maarssen, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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Bertels RA, Harteveld LM, Filippini LH, Clur SA, Blom NA. Left ventricular dysfunction is associated with frequent premature ventricular complexes and asymptomatic ventricular tachycardia in children. Europace 2017; 19:617-621. [PMID: 28431063 DOI: 10.1093/europace/euw075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/05/2016] [Indexed: 01/08/2023] Open
Abstract
AIMS To assess the risk factors for left ventricular (LV) dysfunction in a paediatric population with idiopathic frequent premature ventricular contractions (PVCs) and asymptomatic ventricular tachycardias (VTs). METHODS AND RESULTS Paediatric patients with the diagnosis of idiopathic frequent PVCs and asymptomatic VTs were retrospectively evaluated. Frequent PVCs were defined as ≥5% on 24 h Holter recording. Left ventricular dysfunction was defined as a shortening fraction of ≤28%. Seventy-two children were identified. Six patients showed LV dysfunction at diagnosis [age 10 ± 7 years, 2 (33%) had symptoms such as syncope, palpitations, fatigue, and dizziness], and 66 showed normal LV function [age 8 ± 6 years, 22 (33%) with symptoms]. Patients with LV dysfunction had a higher percentage of PVCs on Holter recordings (47 ± 16 vs. 16 ± 11%, P = 0.006), higher prevalence of VT [5 (83%) vs. 27 (41%), P = 0.045] and sustained ventricular tachycardia (sVT) [3 (50%) vs. 4 (6%), P = 0.001], and a higher number of couplets [6 (100%) vs. 34 (52%), P = 0.030]. In patients with LV dysfunction, two responded to medication (Classes Ic and II) and five underwent ablation, of which one was unsuccessful. During follow-up, LV function normalized in five of six patients. In patients with a normal function, none developed LV dysfunction during the follow-up. CONCLUSION In children with idiopathic PVCs and asymptomatic VTs, development of LV dysfunction is associated with a higher burden of PVCs, the presence of sVTs, and couplets. Left ventricular dysfunction appears to be reversible if the burden of PVCs is decreased by medication or ablation.
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Affiliation(s)
- R A Bertels
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L M Harteveld
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L H Filippini
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Juliana Children's Hospital, The Hague, The Netherlands
| | - S A Clur
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - N A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Kamperidis V, Katsanos S, Bertels RA, Schalij MJ, Delgado V. Three-dimensional transoesophageal echocardiographic visualization of malignant anomalous left main coronary origin and course causing sudden cardiac death. Eur Heart J Cardiovasc Imaging 2014; 15:1428. [PMID: 25139908 DOI: 10.1093/ehjci/jeu153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Spyridon Katsanos
- Heart Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Heart Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Heart Center, Leiden University Medical Center, Leiden, The Netherlands
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Raymakers GJ, Bertels RA, Bennink GB, Hitchcock JF, Kimpen JL, Meijboom EJ. [Heart transplantation in the Netherlands, an option to be considered for 5 children per year on the average]. Ned Tijdschr Geneeskd 1999; 143:1425-8. [PMID: 10422557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To assess the number of possible candidates for paediatric cardiac transplantation and the number of available donors. DESIGN Retrospective. PATIENTS AND METHODS The population (date of birth 1 January 1980-31 March 1998) of the Department of Paediatric Cardiology of the Wilhelmina Children's Hospital, Utrecht, the Netherlands, was reviewed for possible candidates for cardiac transplantation and the resulting number of candidates was extrapolated to the entire country. Figures of the transplant co-ordination unit of the University Hospital Utrecht over 1993-1997 were obtained, to estimate the number of available donors. Furthermore, an overview was made of the results of paediatric cardiac transplantations reported in centres around the world. RESULTS A total number of 15 possible candidates could be selected over the studied period. Extrapolated to the entire country, about 5 candidates each year could be expected. Per year 5 donor hearts of children (< 12 yr) and 11 hearts of adult donors with a low body weight (40-65 kg) have been available for paediatric cardiac transplantation. Worldwide 5- and 10-year survival rates reach 60% and 50%, respectively, morbidity seems low and the quality of life can be considered reasonably good. CONCLUSION The number of expected recipients corresponds with the number of available donors. Together with the promising results reported in transplant centres around the world, this seems to justify the option of paediatric cardiac transplantation for children with end-stage cardiac disease.
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Affiliation(s)
- G J Raymakers
- Academisch Ziekenhuis/Wilhelmina Kinderziekenhuis, Utrecht
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