1
|
Verheul LM, Groeneveld SA, Stoks J, Hoeksema WF, Cluitmans MJM, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. The Dutch Idiopathic Ventricular Fibrillation Registry: progress report on the quest to identify the unidentifiable. Neth Heart J 2024:10.1007/s12471-024-01870-y. [PMID: 38653923 DOI: 10.1007/s12471-024-01870-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Idiopathic ventricular fibrillation (iVF) is a rare cause of sudden cardiac arrest and, by definition, a diagnosis of exclusion. Due to the rarity of the disease, previous and current studies are limited by their retrospective design and small patient numbers. Even though the incidence of iVF has declined owing to the identification of new disease entities, an important subgroup of patients remains. AIM To expand the existing Dutch iVF Registry into a large nationwide cohort of patients initially diagnosed with iVF, to reveal the underlying cause of iVF in these patients, and to improve arrhythmia management. METHODS The Dutch iVF Registry includes sudden cardiac arrest survivors with an initial diagnosis of iVF. Clinical data and outcomes are collected. Outcomes include subsequent detection of a diagnosis other than 'idiopathic', arrhythmia recurrence and death. Non-invasive electrocardiographic imaging is used to investigate electropathological substrates and triggers of VF. RESULTS To date, 432 patients have been included in the registry (median age at event 40 years (interquartile range 28-52)), 61% male. During a median follow-up of 6 (2-12) years, 38 patients (9%) received a diagnosis other than 'idiopathic'. Eleven iVF patients were characterised with electrocardiographic imaging. CONCLUSION The Dutch iVF Registry is currently the largest of its kind worldwide. In this heterogeneous population of index patients, we aim to identify common functional denominators associated with iVF. With the implementation of non-invasive electrocardiographic imaging and other diagnostic modalities (e.g. echocardiographic deformation, cardiac magnetic resonance), we advance the possibilities to reveal pro-fibrillatory substrates.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Job Stoks
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wiert F Hoeksema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Verheul LM, Hoeksema WF, Groeneveld SA, Mulder BA, Bootsma M, Alings M, Evertz R, Blank AC, Kammeraad JAE, Clur SAB, Yap SC, Postema PG, Wilde AAM, Volders PGA, Hassink RJ. Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry. Heart Rhythm 2024:S1547-5271(24)00276-5. [PMID: 38493994 DOI: 10.1016/j.hrthm.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. OBJECTIVE The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. METHODS The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. RESULTS In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2-12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16-18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. CONCLUSION IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.
Collapse
Affiliation(s)
- Lisa M Verheul
- University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Wiert F Hoeksema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | | | - Bart A Mulder
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Reinder Evertz
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janneke A E Kammeraad
- Erasmus MC-Sophia Children's Hospital, Cardiovascular Institute, Department of Pediatric Cardiology, Rotterdam, The Netherlands
| | - Sally-Ann B Clur
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Sing-Chien Yap
- Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Arthur A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Heart Failure and Arrhythmias, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| | - Paul G A Volders
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"; Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Utrecht, The Netherlands; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart,"
| |
Collapse
|
3
|
Zepeda-Echavarria A, van de Leur RR, Vessies M, de Vries NM, van Sleuwen M, Hassink RJ, Wildbergh TX, van Doorn JL, van der Zee R, Doevendans PA, Jaspers JEN, van Es R. Detection of acute coronary occlusion with a novel mobile electrocardiogram device: a pilot study. Eur Heart J Digit Health 2024; 5:183-191. [PMID: 38505481 PMCID: PMC10944676 DOI: 10.1093/ehjdh/ztae002] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 03/21/2024]
Abstract
Aims Many portable electrocardiogram (ECG) devices have been developed to monitor patients at home, but the majority of these devices are single lead and only intended for rhythm disorders. We developed the miniECG, a smartphone-sized portable device with four dry electrodes capable of recording a high-quality multi-lead ECG by placing the device on the chest. The aim of our study was to investigate the ability of the miniECG to detect occlusive myocardial infarction (OMI) in patients with chest pain. Methods and results Patients presenting with acute chest pain at the emergency department of the University Medical Center Utrecht or Meander Medical Center, between May 2021 and February 2022, were included in the study. The clinical 12-lead ECG and the miniECG before coronary intervention were recorded. The recordings were evaluated by cardiologists and compared the outcome of the coronary angiography, if performed. A total of 369 patients were measured with the miniECG, 46 of whom had OMI. The miniECG detected OMI with a sensitivity and specificity of 65 and 92%, compared with 83 and 90% for the 12-lead ECG. Sensitivity of the miniECG was similar for different culprit vessels. Conclusion The miniECG can record a multi-lead ECG and rule-in ST-segment deviation in patients with occluded or near-occluded coronary arteries from different culprit vessels without many false alarms. Further research is required to add automated analysis to the recordings and to show feasibility to use the miniECG by patients at home.
Collapse
Affiliation(s)
- Alejandra Zepeda-Echavarria
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Melle Vessies
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Nynke M de Vries
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Thierry X Wildbergh
- Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | - J L van Doorn
- Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Joris E N Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
4
|
Verheul LM, Guglielmo M, Groeneveld SA, Kirkels FP, Scrocco C, Cramer MJ, Bootsma M, Kapel GFL, Alings M, Evertz R, Mulder BA, Prakken NHJ, Balt JC, Volders PGA, Hirsch A, Yap SC, Postema PG, Nijveldt R, Velthuis BK, Behr ER, Wilde AAM, Hassink RJ. Mitral Annular Disjunction in Idiopathic Ventricular Fibrillation Patients: Just a Bystander or a Potential Cause? Eur Heart J Cardiovasc Imaging 2024:jeae054. [PMID: 38412329 DOI: 10.1093/ehjci/jeae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/25/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
AIMS Previously, we demonstrated that inferolateral mitral annular disjunction (MAD) is more prevalent in patients with idiopathic ventricular fibrillation (IVF) than in healthy controls. In the present study, we advanced the insights into the prevalence and ventricular arrhythmogenicity by inferolateral MAD in an even larger IVF cohort. METHODS AND RESULTS This retrospective multicentre study included 185 IVF patients (median age 39 [27, 52] years, 40% female). Cardiac magnetic resonance images were analysed for mitral valve and annular abnormalities and late gadolinium enhancement. Clinical characteristics were compared between patients with and without MAD. MAD in any of the 4 locations was present in 112 (61%) IVF patients and inferolateral MAD was identified in 24 (13%) IVF patients. Mitral valve prolapse (MVP) was found in 13 (7%) IVF patients. MVP was more prevalent in patients with inferolateral MAD compared with patients without inferolateral MAD(42% vs. 2%, p < 0.001). Proarrhythmic characteristics in terms of a high burden of premature ventricular complexes (PVC) and non-sustained ventricular tachycardia (VT) were more prevalent in patients with inferolateral MAD compared to patients without inferolateral MAD (67% vs. 23%, p < 0.001 and 63% vs 41%, p = 0.046, respectively). Appropriate implantable cardioverter defibrillator therapy during follow-up was comparable for IVF patients with or without inferolateral MAD (13% vs. 18%, p = 0.579). CONCLUSION A high prevalence of inferolateral MAD and MVP is a consistent finding in this large IVF cohort. The presence of inferolateral MAD is associated with a higher PVC burden and non-sustained VTs. Further research is needed to explain this potential interplay.
Collapse
Affiliation(s)
- L M Verheul
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Guglielmo
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A Groeneveld
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F P Kirkels
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - C Scrocco
- Cardiology Research Section, St. George University of London, Cranmer Terrace, London, SW17 0RE and St George's University Hospitals NHS Foundation Trust, London, SW17 0QT United Kingdom
| | - M J Cramer
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M Bootsma
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - G F L Kapel
- Medisch Spectrum Twente, Koningstraat 1, 7512 KZ, Enschede, The Netherlands
| | - M Alings
- Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - R Evertz
- Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen
| | - B A Mulder
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J C Balt
- St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - P G A Volders
- Maastricht University Medical Center+, Peter Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" (http://guardheart.ern-net.eu)
| | - A Hirsch
- Erasmus MC, Cardiovascular Institute, Thorax Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - S C Yap
- Erasmus MC, Cardiovascular Institute, Thorax Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - P G Postema
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
| | - R Nijveldt
- Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen
| | - B K Velthuis
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E R Behr
- Cardiology Research Section, St. George University of London, Cranmer Terrace, London, SW17 0RE and St George's University Hospitals NHS Foundation Trust, London, SW17 0QT United Kingdom
| | - A A M Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
| | - R J Hassink
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Member of the European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart" ( http://guardheart.ern-net.eu)
| |
Collapse
|
5
|
van de Leur RR, van Sleuwen MTGM, Zwetsloot PPM, van der Harst P, Doevendans PA, Hassink RJ, van Es R. Automatic triage of twelve-lead electrocardiograms using deep convolutional neural networks: a first implementation study. Eur Heart J Digit Health 2024; 5:89-96. [PMID: 38264701 PMCID: PMC10802816 DOI: 10.1093/ehjdh/ztad070] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 01/25/2024]
Abstract
Aims Expert knowledge to correctly interpret electrocardiograms (ECGs) is not always readily available. An artificial intelligence (AI)-based triage algorithm (DELTAnet), able to support physicians in ECG prioritization, could help reduce current logistic burden of overreading ECGs and improve time to treatment for acute and life-threatening disorders. However, the effect of clinical implementation of such AI algorithms is rarely investigated. Methods and results Adult patients at non-cardiology departments who underwent ECG testing as a part of routine clinical care were included in this prospective cohort study. DELTAnet was used to classify 12-lead ECGs into one of the following triage classes: normal, abnormal not acute, subacute, and acute. Performance was compared with triage classes based on the final clinical diagnosis. Moreover, the associations between predicted classes and clinical outcomes were investigated. A total of 1061 patients and ECGs were included. Performance was good with a mean concordance statistic of 0.96 (95% confidence interval 0.95-0.97) when comparing DELTAnet with the clinical triage classes. Moreover, zero ECGs that required a change in policy or referral to the cardiologist were missed and there was a limited number of cases predicted as acute that did not require follow-up (2.6%). Conclusion This study is the first to prospectively investigate the impact of clinical implementation of an ECG-based AI triage algorithm. It shows that DELTAnet is efficacious and safe to be used in clinical practice for triage of 12-lead ECGs in non-cardiology hospital departments.
Collapse
Affiliation(s)
- Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Meike T G M van Sleuwen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Peter-Paul M Zwetsloot
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| |
Collapse
|
6
|
Verheul LM, van der Ree MH, Groeneveld SA, Mulder BA, Christiaans I, Kapel GFL, Alings M, Bootsma M, Barge-Schaapveld DQCM, Balt JC, Yap SC, Krapels IPC, Ter Bekke RMA, Volders PGA, van der Crabben SN, Postema PG, Wilde AAM, Dooijes D, Baas AF, Hassink RJ. The genetic basis of apparently idiopathic ventricular fibrillation: a retrospective overview. Europace 2023; 25:euad336. [PMID: 37967257 PMCID: PMC10665040 DOI: 10.1093/europace/euad336] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIMS During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. The aim of this study was to evaluate genetic testing and its results in idiopathic VF patients. METHODS AND RESULTS We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry. Genetic testing was performed in 379 (91%) patients [median age at event 39 years (27-51), 60% male]. Single-gene testing was performed in 87 patients (23%) and was initiated more often in patients with idiopathic VF before 2010. Panel testing was performed in 292 patients (77%). The majority of causal (likely) pathogenic variants (LP/P, n = 56, 15%) entailed the DPP6 risk haplotype (n = 39, 70%). Moreover, 10 LP/P variants were found in cardiomyopathy genes (FLNC, MYL2, MYH7, PLN (two), TTN (four), RBM20), and 7 LP/P variants were identified in genes associated with cardiac arrhythmias (KCNQ1, SCN5A (2), RYR2 (four)). For eight patients (2%), identification of an LP/P variant resulted in a change of diagnosis. In 113 patients (30%), a VUS was identified. Broad panel testing resulted in a higher incidence of VUS in comparison to single-gene testing (38% vs. 3%, P < 0.001). CONCLUSION Almost all patients from the registry underwent, albeit not broad, genetic testing. The genetic yield of causal LP/P variants in idiopathic VF patients is 5%, increasing to 15% when including DPP6. In specific cases, the LP/P variant is the underlying diagnosis. A gene panel specifically for idiopathic VF patients is proposed.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Martijn H van der Ree
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Imke Christiaans
- Department of Human Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs F L Kapel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ingrid P C Krapels
- Department of Human Genetics, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Saskia N van der Crabben
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Dennis Dooijes
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annette F Baas
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| |
Collapse
|
7
|
Bergeman AT, Hoeksema WF, van der Ree MH, Boersma LVA, Yap SC, Verheul LM, Hassink RJ, van der Crabben SN, Volders PGA, van der Werf C, Wilde AAM, Postema PG. Outcomes in Dutch DPP6 risk haplotype for familial idiopathic ventricular fibrillation: a focused update. Neth Heart J 2023:10.1007/s12471-023-01792-1. [PMID: 37498467 PMCID: PMC10400734 DOI: 10.1007/s12471-023-01792-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The genetic risk haplotype DPP6 has been linked to familial idiopathic ventricular fibrillation (IVF), but the associated long-term outcomes are unknown. METHODS DPP6 risk haplotype-positive family members (DPP6 cases) and their risk haplotype-negative relatives (DPP6 controls) were included. Clinical follow-up data were collected through March 2023. Implantable cardioverter-defibrillator (ICD) indication was divided in primary or secondary prevention. Cumulative survival and event rates were calculated. RESULTS We included 327 DPP6 cases and 315 DPP6 controls. Median follow-up time was 9 years (interquartile range: 4-12). Of the DPP6 cases, 129 (39%) reached the composite endpoint of appropriate ICD shock, sudden cardiac arrest or death, at a median age of 45 years (range: 15-97). Median overall survival was 83 years and 87 years for DPP6 cases and DPP6 controls, respectively (p < 0.001). In DPP6 cases, median overall survival was shorter for males (74 years) than females (85 years) (p < 0.001). Of the DPP6 cases, 97 (30%) died, at a median age of 50 years. With a prophylactic ICD implantation advise based on risk haplotype, sex and age, 137 (42%) of DPP6 cases received an ICD, for primary prevention (n = 109) or secondary prevention (n = 28). In the primary prevention subgroup, 10 patients experienced a total of 34 appropriate ICD shocks, and there were no deaths during follow-up. DPP6 cases with a secondary prevention ICD experienced a total of 231 appropriate ICD shocks. CONCLUSION Patients with the DPP6 risk haplotype, particularly males, are at an increased risk of IVF and sudden cardiac death. Using a risk stratification approach based on risk haplotype, sex and age, a substantial proportion of patients with a primary prevention ICD experienced appropriate ICD shocks, showing the benefit of prophylactic ICD implantation with this strategy.
Collapse
Affiliation(s)
- Auke T Bergeman
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wiert F Hoeksema
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Martijn H van der Ree
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lisa M Verheul
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saskia N van der Crabben
- Department of Human Genetics, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Christian van der Werf
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| |
Collapse
|
8
|
Zepeda-Echavarria A, van de Leur RR, van Sleuwen M, Hassink RJ, Wildbergh TX, Doevendans PA, Jaspers J, van Es R. Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review. JMIR Cardio 2023; 7:e44003. [PMID: 37418308 PMCID: PMC10362423 DOI: 10.2196/44003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/02/2022] [Revised: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. OBJECTIVE This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. METHODS We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. RESULTS From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. CONCLUSIONS ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities.
Collapse
Affiliation(s)
- Alejandra Zepeda-Echavarria
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
- HeartEye BV, Delft, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Joris Jaspers
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
9
|
Bogerd R, Silkens MEWM, Keuken DG, Hassink RJ, Henriques JPS, Lombarts KMJMH. Work-Related Well-Being Among Dutch Cardiologists - A National Survey. Curr Probl Cardiol 2023; 48:101538. [PMID: 36529230 DOI: 10.1016/j.cpcardiol.2022.101538] [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] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
This is the first study to provide a holistic examination of cardiologists' well-being, investigating positive and negative dimensions, and its determinants. We conducted a national, multicenter, self-administered web-based questionnaire. We used frequencies to depict scores on three well-being indicators (professional fulfillment, work exhaustion and interpersonal disengagement) and performed three multiple regression analyses to elucidate their determinants. Cardiologists' mean scores (scale 1 to 5) were 3.85 (SD = 0.62) for professional fulfillment, 2.25 (SD = 0.97) for work exhaustion and 2.04 (SD = 0.80) for interpersonal disengagement. Workload, work-home interference and team atmosphere predicted the negative dimensions of well-being. Autonomy predicted cardiologists' professional fulfillment. Physician-patient interactions, person-job fit and individual resilience affected both dimensions. Dutch cardiologists score relatively high on professional fulfillment and average on work exhaustion and interpersonal disengagement. In order to foster cardiologists' well-being it is critical to increase energy providing work- and individual aspects.
Collapse
Affiliation(s)
- Rosa Bogerd
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Professional Performance and Compassionate Care Research Group, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Milou E W M Silkens
- Centre for Healthcare Innovation Research, Department of Health Services Research & Management, City University of London, London, UK
| | - Debby G Keuken
- Netherlands Society of Cardiology, Utrecht, the Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Department of Cardiology, Utrecht, the Netherlands
| | - José P S Henriques
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Kiki M J M H Lombarts
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Professional Performance and Compassionate Care Research Group, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Grehn M, Mandija S, Miszczyk M, Krug D, Tomasik B, Stickney KE, Alcantara P, Alongi F, Anselmino M, Aranda RS, Balgobind BV, Boda-Heggemann J, Boldt LH, Bottoni N, Cvek J, Elicin O, De Ferrari GM, Hassink RJ, Hazelaar C, Hindricks G, Hurkmans C, Iotti C, Jadczyk T, Jiravsky O, Jumeau R, Buus Kristiansen S, Levis M, López MA, Martí-Almor J, Mehrhof F, Møller DS, Molon G, Ouss A, Peichl P, Plasek J, Postema PG, Quesada A, Reichlin T, Rordorf R, Rudic B, Saguner AM, Ter Bekke RMA, Torrecilla JL, Troost EGC, Vitolo V, Andratschke N, Zeppenfeld K, Blamek S, Fast M, de Panfilis L, Blanck O, Pruvot E, Verhoeff JJC. STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe. Europace 2023; 25:1284-1295. [PMID: 36879464 PMCID: PMC10105846 DOI: 10.1093/europace/euac238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/18/2022] [Indexed: 03/08/2023] Open
Abstract
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
Collapse
Affiliation(s)
- Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Bartłomiej Tomasik
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland.,Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, M. Sklodowskiel-Curie 3a, Gdansk 80210, Poland
| | - Kristine E Stickney
- Research Support Office, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Pino Alcantara
- Department of Radiation Oncology, Hospital Clínico San Carlos, Faculty of Medicine, University Complutense of Madrid, Profesor Martin Lagos, Madrid 28040, Spain
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, University of Brescia, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy.,Department of Medical Sciences, University of Turin, Via Verdi 8, Torino 10124, Italy
| | - Ricardo Salgado Aranda
- Electrophysiology Unit, Department of Cardiology, Hospital Clínico San Carlos Madrid, Professor Martin Lagos, Madrid 28040, Spain
| | - Brian V Balgobind
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Leif-Hendrik Boldt
- Department of Rhythmology, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicola Bottoni
- Cardiology Arrhythmology Center, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Jakub Cvek
- Department of Oncology, University Hospital and Faculty of Medicine, Listopadu 1790, Ostrava Poruba 70852, Czech Republic
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Colien Hazelaar
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Cinzia Iotti
- Radiation Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ul. Poniatowskiego 15, Katowice 40055, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Otakar Jiravsky
- Cardiocenter, Hospital Agel Trinec Podlesi and Masaryk University, Konska 453, Trinec 73961, Czech Republic
| | - Raphaël Jumeau
- Department of Radio-Oncology, Lausanne University Hospital, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Steen Buus Kristiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Mario Levis
- Department of Oncology, University of Torino, Via Giuseppe Verdi 8, Torino 10124, Italy
| | - Manuel Algara López
- Department of Radiation Oncology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar, Universitat Pompeu Fabra, Institut Hospital del Mar d'Investigacions Mèdiques, Paseo Maritim 25-29, Barcelona 08003, Spain
| | - Felix Mehrhof
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, Via San Zeno in Monte 23, Verona 37129, Italy
| | - Alexandre Ouss
- Department of Cardiology, Catharina Hospital, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 9, Prague 14000, Czech Republic
| | - Jiri Plasek
- Department of Cardiovascular Medicine, University Hospital Ostrava, Listopadu 1790. Ostrava Poruba 70852, Czech Republic
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, Amsterdam 1105AZ, The Netherlands
| | - Aurelio Quesada
- Arrhythmia Unit, Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Camillo Golgi Avenue 5, Pavia 27100, Italy
| | - Boris Rudic
- Department of Medicine I, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
| | - Ardan M Saguner
- Arrhythmia Unit, Department of Cardiology, University Hospital Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands
| | - José López Torrecilla
- Department of Radiation Oncology, Hospital General Valencia, Av Tres Cruces 2, Valencia 46014, Spain
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus. Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, Dresden 01307, Germany.,Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstr. 400, Dresden 01328, Germany
| | - Viviana Vitolo
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Strada Campeggi 53, Pavia PV27100, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Ramistrasse 71, Zurich 8006, Switzerland
| | - Katja Zeppenfeld
- Unit of Clinical Electrophysiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Slawomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Ul. Wybrzeze Armii Krajowej, Gliwice 44102, Poland
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Ludovica de Panfilis
- Bioethics Unit, Azienda Unità Sanitaria Locale-IRCCS, Via Amendola 2, Reggio Emilia 42100, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel 24105, Germany
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 21, Lausanne 1011, Switzerland
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| |
Collapse
|
11
|
Bogerd R, Debets MPM, Keuken DG, Hassink RJ, Henriques JPS, Lombarts KMJMH. The relationship between physicians' self-kindness and professional fulfillment and the mediating role of personal resilience and work-home interference: A cross-sectional study. PLoS One 2023; 18:e0284507. [PMID: 37093877 PMCID: PMC10124859 DOI: 10.1371/journal.pone.0284507] [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] [Received: 11/29/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Professional fulfillment is crucial for physicians' well-being and optimal patient care. Highly demanding work environments, perfectionism and self-critical attitudes jeopardize physicians' professional fulfillment. OBJECTIVE To explore to what extent a kinder attitude towards the self, i.e. self-kindness, was associated with physicians' professional fulfillment and whether this relationship was mediated by personal resilience and work-home interference. METHODS In 2020, cardiologists (n = 374) in the Netherlands participated in a web-based survey. Self-kindness was measured by the self-kindness subscale of the Self-Compassion Scale, personal resilience by the Brief Resilience Scale, work-home interference by the negative Work-Home Interference subscale of the Survey Work-Home Interaction-Nijmegen, and professional fulfillment by the corresponding subscale of the Professional Fulfillment Index. Using Hayes' SPSS macro PROCESS v3.5, the authors tested the parallel mediation model. RESULTS Self-kindness was not directly associated with professional fulfillment (direct effect = .042, p = .36, 95% CI: -0.048, 0.132). Self-kindness was indirectly related to professional fulfillment through individual resilience (indirect effect = .049, 95% CI: .020, 0.086) and work-home interference (indirect effect = .057, 95% CI: .023, 096). CONCLUSIONS This study suggests that improving physicians' self-kindness may enhance professional fulfillment through personal resilience and work-home interference. Our findings may stimulate and remind physicians to be kind towards themselves as it may benefit them and their patients.
Collapse
Affiliation(s)
- Rosa Bogerd
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten P M Debets
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Debby G Keuken
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - José P S Henriques
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Verheul LM, Groeneveld SA, Tuinenburg AE, Hassink RJ. Atrial fibrillation begets ventricular fibrillation when the AV node fails. J Electrocardiol 2023; 76:66-70. [PMID: 36442389 DOI: 10.1016/j.jelectrocard.2022.11.003] [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: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Deterioration of atrial fibrillation into ventricular fibrillation has frequently been described in patients with pre-excitation of the ventricles. We report two cases of atrial fibrillation without pre-excitation leading to rapid ventricular tachycardias and recurrent implantable cardioverter defibrillator therapy in young idiopathic ventricular fibrillation patients.
Collapse
Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
13
|
Wouters PC, van de Leur RR, Vessies MB, van Stipdonk AMW, Ghossein MA, Hassink RJ, Doevendans PA, van der Harst P, Maass AH, Prinzen FW, Vernooy K, Meine M, van Es R. Electrocardiogram-based deep learning improves outcome prediction following cardiac resynchronization therapy. Eur Heart J 2022; 44:680-692. [PMID: 36342291 PMCID: PMC9940988 DOI: 10.1093/eurheartj/ehac617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/23/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS This study aims to identify and visualize electrocardiogram (ECG) features using an explainable deep learning-based algorithm to predict cardiac resynchronization therapy (CRT) outcome. Its performance is compared with current guideline ECG criteria and QRSAREA. METHODS AND RESULTS A deep learning algorithm, trained on 1.1 million ECGs from 251 473 patients, was used to compress the median beat ECG, thereby summarizing most ECG features into only 21 explainable factors (FactorECG). Pre-implantation ECGs of 1306 CRT patients from three academic centres were converted into their respective FactorECG. FactorECG predicted the combined clinical endpoint of death, left ventricular assist device, or heart transplantation [c-statistic 0.69, 95% confidence interval (CI) 0.66-0.72], significantly outperforming QRSAREA and guideline ECG criteria [c-statistic 0.61 (95% CI 0.58-0.64) and 0.57 (95% CI 0.54-0.60), P < 0.001 for both]. The addition of 13 clinical variables was of limited added value for the FactorECG model when compared with QRSAREA (Δ c-statistic 0.03 vs. 0.10). FactorECG identified inferolateral T-wave inversion, smaller right precordial S- and T-wave amplitude, ventricular rate, and increased PR interval and P-wave duration to be important predictors for poor outcome. An online visualization tool was created to provide interactive visualizations (https://crt.ecgx.ai). CONCLUSION Requiring only a standard 12-lead ECG, FactorECG held superior discriminative ability for the prediction of clinical outcome when compared with guideline criteria and QRSAREA, without requiring additional clinical variables. End-to-end automated visualization of ECG features allows for an explainable algorithm, which may facilitate rapid uptake of this personalized decision-making tool in CRT.
Collapse
Affiliation(s)
| | | | - Melle B Vessies
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Mohammed A Ghossein
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Thoraxcentre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
14
|
van de Leur RR, Hassink RJ, van Es R. Variational auto-encoders improve explainability over currently employed heatmap methods for deep learning-based interpretation of the electrocardiogram. Eur Heart J Digit Health 2022; 3:502-504. [PMID: 36710900 PMCID: PMC9779792 DOI: 10.1093/ehjdh/ztac063] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - René van Es
- Corresponding author. Tel: +0031 88 757 3453, Fax: +0031 88 757 3453,
| |
Collapse
|
15
|
Groeneveld SA, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Wilde AAM, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation. J Am Heart Assoc 2022; 11:e025364. [PMID: 35929463 PMCID: PMC9496286 DOI: 10.1161/jaha.121.025364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/27/2022]
Abstract
Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls. Methods and Results In this retrospective, multicenter cohort study, cardiac magnetic resonance images from patients with IVF (ie, negative for ischemia, cardiomyopathy, and channelopathies) and age‐ and sex‐matched control subjects were analyzed for the presence of MAD (≥2 mm) and MVP (>2 mm). In total, 72 patients (mean age 39±14 years, 42% women) and 72 control subjects (mean age 41±11 years, 42% women) were included. MAD in the inferolateral wall was more prevalent in patients with IVF versus healthy controls (7 [11%] versus 1 [1%], P=0.024). MVP was only seen in patients with IVF and not in controls (5 [7%] versus 0 [0%], P=0.016). MAD was observed in both patients with (n=4) and without (n=3) MVP. Conclusions Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
Collapse
Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Feddo P Kirkels
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Maarten J Cramer
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Kristina H Haugaa
- ProCardio Center for Innovation Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway.,University of Oslo Oslo Norway
| | - Pieter G Postema
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Niek H J Prakken
- Department of Radiology University Medical Center Groningen Groningen the Netherlands
| | - Arco J Teske
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Birgitta K Velthuis
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Rutger J Hassink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| |
Collapse
|
16
|
van de Leur RR, Bos MN, Taha K, Sammani A, Yeung MW, van Duijvenboden S, Lambiase PD, Hassink RJ, van der Harst P, Doevendans PA, Gupta DK, van Es R. Improving explainability of deep neural network-based electrocardiogram interpretation using variational auto-encoders . Eur Heart J Digit Health 2022; 3:390-404. [PMID: 36712164 PMCID: PMC9707974 DOI: 10.1093/ehjdh/ztac038] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/16/2022] [Indexed: 02/01/2023]
Abstract
Aims Deep neural networks (DNNs) perform excellently in interpreting electrocardiograms (ECGs), both for conventional ECG interpretation and for novel applications such as detection of reduced ejection fraction (EF). Despite these promising developments, implementation is hampered by the lack of trustworthy techniques to explain the algorithms to clinicians. Especially, currently employed heatmap-based methods have shown to be inaccurate. Methods and results We present a novel pipeline consisting of a variational auto-encoder (VAE) to learn the underlying factors of variation of the median beat ECG morphology (the FactorECG), which are subsequently used in common and interpretable prediction models. As the ECG factors can be made explainable by generating and visualizing ECGs on both the model and individual level, the pipeline provides improved explainability over heatmap-based methods. By training on a database with 1.1 million ECGs, the VAE can compress the ECG into 21 generative ECG factors, most of which are associated with physiologically valid underlying processes. Performance of the explainable pipeline was similar to 'black box' DNNs in conventional ECG interpretation [area under the receiver operating curve (AUROC) 0.94 vs. 0.96], detection of reduced EF (AUROC 0.90 vs. 0.91), and prediction of 1-year mortality (AUROC 0.76 vs. 0.75). Contrary to the 'black box' DNNs, our pipeline provided explainability on which morphological ECG changes were important for prediction. Results were confirmed in a population-based external validation dataset. Conclusions Future studies on DNNs for ECGs should employ pipelines that are explainable to facilitate clinical implementation by gaining confidence in artificial intelligence and making it possible to identify biased models.
Collapse
Affiliation(s)
| | | | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Arjan Sammani
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ming Wai Yeung
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1. 9713 GZ Groningen, The Netherlands
| | - Stefan van Duijvenboden
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London Wc1E 6Dd, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London Wc1E 6Dd, UK
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands,Central Military Hospital, Lundlaan 1, 3584 Utrecht, The Netherlands
| | - Deepak K Gupta
- Informatics Institute, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, The Netherlands
| | - René van Es
- Corresponding author. Tel: +31 88 757 3453, Fax: +31 88 757 3453,
| |
Collapse
|
17
|
Sammani A, van de Leur RR, Henkens MTHM, Meine M, Loh P, Hassink RJ, Oberski DL, Heymans SRB, Doevendans PA, Asselbergs FW, Te Riele ASJM, van Es R. Life-threatening ventricular arrhythmia prediction in patients with dilated cardiomyopathy using explainable electrocardiogram-based deep neural networks. Europace 2022; 24:1645-1654. [PMID: 35762524 PMCID: PMC9559909 DOI: 10.1093/europace/euac054] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 12/03/2021] [Accepted: 04/10/2022] [Indexed: 11/17/2022] Open
Abstract
Aims While electrocardiogram (ECG) characteristics have been associated with life-threatening ventricular arrhythmias (LTVA) in dilated cardiomyopathy (DCM), they typically rely on human-derived parameters. Deep neural networks (DNNs) can discover complex ECG patterns, but the interpretation is hampered by their ‘black-box’ characteristics. We aimed to detect DCM patients at risk of LTVA using an inherently explainable DNN. Methods and results In this two-phase study, we first developed a variational autoencoder DNN on more than 1 million 12-lead median beat ECGs, compressing the ECG into 21 different factors (F): FactorECG. Next, we used two cohorts with a combined total of 695 DCM patients and entered these factors in a Cox regression for the composite LTVA outcome, which was defined as sudden cardiac arrest, spontaneous sustained ventricular tachycardia, or implantable cardioverter-defibrillator treated ventricular arrhythmia. Most patients were male (n = 442, 64%) with a median age of 54 years [interquartile range (IQR) 44–62], and median left ventricular ejection fraction of 30% (IQR 23–39). A total of 115 patients (16.5%) reached the study outcome. Factors F8 (prolonged PR-interval and P-wave duration, P < 0.005), F15 (reduced P-wave height, P = 0.04), F25 (increased right bundle branch delay, P = 0.02), F27 (P-wave axis P < 0.005), and F32 (reduced QRS-T voltages P = 0.03) were significantly associated with LTVA. Conclusion Inherently explainable DNNs can detect patients at risk of LTVA which is mainly driven by P-wave abnormalities.
Collapse
Affiliation(s)
- Arjan Sammani
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Michiel T H M Henkens
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Peter Loh
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Department of Methodology and Statistics, Faculty of Social Sciences, Utrecht University and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Netherlands Heart Institute (NLHI), Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Centre Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
18
|
Mol D, van der Stoel MD, Balt JC, Bhagwandien RE, Blaauw Y, van Dessel PFHM, van Driel VJHM, Driessen AHG, Elvan A, Hassink RJ, Kemme MJB, Kraaier K, Kuijt WJ, Luermans JGLM, van der Voort PH, Westra SW, de Groot JR, de Jong JSSG. Low 30-day Mortality after Atrial Fibrillation Ablation; Results from the Netherlands Heart Registration: NHR-AF Mortality Study. Can J Cardiol 2022; 38:1616-1618. [PMID: 35709933 DOI: 10.1016/j.cjca.2022.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/19/2022] Open
Abstract
This study presents the 30-day mortality of patients who underwent atrial fibrillation (AF) ablation between 2013 - 2020 and were registered in the Netherlands Heart Registration. In total, 30,197/30,238 (99.9%) patients were analyzed. Fifteen (0.05%) died within 30 days. Nine deaths were considered procedurally related, four were considered non-procedural related, and in two patients the cause of death was unknown.
Collapse
Affiliation(s)
- Daniel Mol
- OLVG, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam University Medical Centers/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, The Netherlands.
| | | | - Jippe C Balt
- St Antonius, Department of Cardiology, Nieuwegein, The Netherlands
| | - Rohit E Bhagwandien
- Erasmus Medical Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Yuri Blaauw
- University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | | | | | - Antoine H G Driessen
- Amsterdam University Medical Centers/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, The Netherlands
| | - Arif Elvan
- Isala, Department of Cardiology, Zwolle, The Netherlands
| | - Rutger J Hassink
- University Medical Center Utrecht, Department of Cardiology, Utrecht, The Netherlands
| | - Michiel J B Kemme
- Amsterdam University Medical Centers/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, The Netherlands
| | - Karin Kraaier
- Medical Center Leeuwarden, Department of Cardiology, Leeuwarden, The Netherlands
| | | | - Justin G L M Luermans
- Maastricht University Medical Center, Department of Cardiology, Maastricht, The Netherlands
| | - Pepijn H van der Voort
- Catharina Hospital, Department of Cardiology and Cardiac Surgery, Eindhoven, The Netherlands
| | - Sjoerd W Westra
- Radboud University Medical Center, Department of Cardiology, Nijmegen, The Netherlands
| | - Joris R de Groot
- Amsterdam University Medical Centers/University of Amsterdam, Department of Cardiology and Cardiac Surgery, Amsterdam, The Netherlands
| | | |
Collapse
|
19
|
Groeneveld SA, van der Ree MH, Mulder BA, Balt J, Wilde AAM, Postema PG, Hassink RJ. Prevalence of Short-Coupled Ventricular Fibrillation in a Large Cohort of Dutch Patients With Idiopathic Ventricular Fibrillation. Circulation 2022; 145:1437-1439. [PMID: 35500051 DOI: 10.1161/circulationaha.121.057878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (S.A.G., R.J.H.)
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, The Netherlands (B.A.M.)
| | - Jippe Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands (J.B.)
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, The Netherlands (M.H.v.d.R., A.A.M.W., P.G.P.)
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, The Netherlands (S.A.G., R.J.H.)
| |
Collapse
|
20
|
van de Leur R, Bos M, Hassink RJ, Doevendans PA, Gupta D, Van Es R. PO-631-07 A NOVEL METHOD FOR EXPLAINABLE DEEP NEURAL NETWORK-BASED INTERPRETATION OF ELECTROCARDIOGRAMS USING VARIATIONAL AUTO-ENCODERS: THE FACTORECG. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.907] [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: 11/04/2022]
|
21
|
Siegersma KR, van de Leur RR, Onland-Moret NC, Leon DA, Diez-Benavente E, Rozendaal L, Bots ML, Coronel R, Appelman Y, Hofstra L, van der Harst P, Doevendans PA, Hassink RJ, den Ruijter HM, van Es R. Deep neural networks reveal novel sex-specific electrocardiographic features relevant for mortality risk. Eur Heart J Digit Health 2022; 3:245-254. [PMID: 36713005 PMCID: PMC9707888 DOI: 10.1093/ehjdh/ztac010] [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] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/04/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023]
Abstract
Aims Incorporation of sex in study design can lead to discoveries in medical research. Deep neural networks (DNNs) accurately predict sex based on the electrocardiogram (ECG) and we hypothesized that misclassification of sex is an important predictor for mortality. Therefore, we first developed and validated a DNN that classified sex based on the ECG and investigated the outcome. Second, we studied ECG drivers of DNN-classified sex and mortality. Methods and results A DNN was trained to classify sex based on 131 673 normal ECGs. The algorithm was validated on internal (68 500 ECGs) and external data sets (3303 and 4457 ECGs). The survival of sex (mis)classified groups was investigated using time-to-event analysis and sex-stratified mediation analysis of ECG features. The DNN successfully distinguished female from male ECGs {internal validation: area under the curve (AUC) 0.96 [95% confidence interval (CI): 0.96, 0.97]; external validations: AUC 0.89 (95% CI: 0.88, 0.90), 0.94 (95% CI: 0.93, 0.94)}. Sex-misclassified individuals (11%) had a 1.4 times higher mortality risk compared with correctly classified peers. The ventricular rate was the strongest mediating ECG variable (41%, 95% CI: 31%, 56%) in males, while the maximum amplitude of the ST segment was strongest in females (18%, 95% CI: 11%, 39%). Short QRS duration was associated with higher mortality risk. Conclusion Deep neural networks accurately classify sex based on ECGs. While the proportion of ECG-based sex misclassifications is low, it is an interesting biomarker. Investigation of the causal pathway between misclassification and mortality uncovered new ECG features that might be associated with mortality. Increased emphasis on sex as a biological variable in artificial intelligence is warranted.
Collapse
Affiliation(s)
| | | | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David A Leon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK,International Laboratory for Population and Health, National Research University, Higher School of Economics, Moscow 101000, Russian Federation,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ernest Diez-Benavente
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruben Coronel
- Heart Center, Department of Experimental Cardiology, AMC, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam University Medical Centres, VU University Amsterdam, Amsterdam, The Netherlands
| | - Leonard Hofstra
- Department of Cardiology, Amsterdam University Medical Centres, VU University Amsterdam, Amsterdam, The Netherlands,Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | |
Collapse
|
22
|
Akdag O, Mandija S, van Lier AL, Borman PT, Schakel T, Alberts E, van der Heide O, Hassink RJ, Verhoeff JJ, Mohamed Hoesein FA, Raaymakers BW, Fast MF. Feasibility of cardiac-synchronized quantitative T1 and T2 mapping on a hybrid 1.5 Tesla magnetic resonance imaging and linear accelerator system. Phys Imaging Radiat Oncol 2022; 21:153-159. [PMID: 35287380 PMCID: PMC8917300 DOI: 10.1016/j.phro.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Materials and methods Results Conclusions
Collapse
Affiliation(s)
- Osman Akdag
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Corresponding author.
| | - Stefano Mandija
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostics and Therapy, Center for Image Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Astrid L.H.M.W. van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim T.S. Borman
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Eveline Alberts
- Philips Healthcare, Veenpluis 6 5684 PC Best, The Netherlands
| | - Oscar van der Heide
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Computational Imaging Group for MR Diagnostics and Therapy, Center for Image Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Joost J.C. Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Firdaus A.A. Mohamed Hoesein
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas W. Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Martin F. Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Corresponding author.
| |
Collapse
|
23
|
Cluitmans MJM, Bear LR, Nguyên UC, van Rees B, Stoks J, Ter Bekke RMA, Mihl C, Heijman J, Lau KD, Vigmond E, Bayer J, Belterman CNW, Abell E, Labrousse L, Rogier J, Bernus O, Haïssaguerre M, Hassink RJ, Dubois R, Coronel R, Volders PGA. Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation. Sci Transl Med 2021; 13:eabi9317. [PMID: 34788076 DOI: 10.1126/scitranslmed.abi9317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Matthijs J M Cluitmans
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Philips Research, 5656 AE Eindhoven, Netherlands
| | | | - Uyên C Nguyên
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Bianca van Rees
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Job Stoks
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Rachel M A Ter Bekke
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Department of Radiology, Maastricht University Medical Centre, 6200 MD Maastricht, Netherlands
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Kevin D Lau
- Philips Research, 5656 AE Eindhoven, Netherlands
| | | | | | - Charly N W Belterman
- Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | | | - Louis Labrousse
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Julien Rogier
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Olivier Bernus
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France
| | - Michel Haïssaguerre
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands
| | | | - Ruben Coronel
- IHU LIRYC, 33600 Pessac, France.,Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | - Paul G A Volders
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| |
Collapse
|
24
|
Van De Leur RR, Hompot B, Hassink RJ, Doevendans PA, Van Es R. Interpretable uncertainty estimation for automated triage of 12-lead electrocardiogram using deep convolutional neural networks. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3163] [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
Interpretation of electrocardiograms (ECGs) using artificial intelligence (AI) has shown very promising results recently, such as comprehensive triage of ECGs. Despite this progress, remarkably few of these AI algorithms have been implemented in clinical practice. Mayor challenges before safe widespread implementation is possible, are uncertainty estimation and interpretability. Without these, algorithms are forced to always provide a diagnosis or prediction. When the algorithm has never seen such an ECG before or when it is noisy or contains a difficult or ambiguous case, this could lead to unrecognized erroneous results.
Purpose
We propose a novel deep neural network (DNN) architecture that is able to overcome both the interpretability and uncertainty estimation challenges in automated diagnosis of ECGs.
Methods
A dataset with 320.000 raw 10s 12-lead ECGs was used to train and validate the DNN in separate 90:10 splits. All ECGs were interpreted by a physician and these free-text annotations were translated into 6 categories from normal to acute based on how quickly a cardiologist needs to be consulted.
Using a novel variational autoencoder DNN, the ECG is compressed into a latent space with 64 parameters. In the compressed space, each category has a separate distribution, instead of a single distribution for the whole dataset.
For clinical use, the ECG is represented in the compressed space and the category prior distribution that is the most likely to produce the input ECG representation is the predicted category. The smaller the probability of generating the data point under any of the known categories, the more uncertain the prediction. The compressed space is reduced using principal component analysis (PCA) to visualize where the input is represented in the compressed landscape.
Performance of the uncertainty estimation is assessed in the validation set by ranking the uncertainty in 10 bins from highest to lowest and comparing with the accuracy.
Results
We demonstrate that the accuracy of the algorithm decreases for ECGs where the model is more uncertain about its predictions (Figure 1). Prediction accuracies range from 90% for the ECGs where the algorithm is most certain, to 50% where it is most uncertain. The PCA of the latent space appears to be able to visually represent the categories in the latent space (Figure 2). Moreover, it indicates whether the new ECG belongs to a known category, the algorithm is doubting between categories or the ECG belongs to none of the categories.
Conclusion
The proposed novel method is promising in estimating uncertainty in an interpretable way, which could allow for safer implementation of AI-based ECG interpretation. Further research is needed to improve the baseline performance of the model, to compare to existing methods and to examine the detection of noisy or new ECGs. The interpretability can be further extended to highlight the uncertain regions on the ECGs.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw Figure 1. Uncertainty versus accuracyFigure 2. Representation of ECG
Collapse
Affiliation(s)
- R R Van De Leur
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| | - B Hompot
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| | - R J Hassink
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| | - P A Doevendans
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| | - R Van Es
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| |
Collapse
|
25
|
De Wit LE, van Stiphout F, Groeneveld SA, Hassink RJ, Dekker D. [Psychotropic drugs and QTc prolongation]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2021; 165:D5725. [PMID: 34346615] [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: 06/13/2023]
Abstract
Assessment of the risk for arrhythmias requires knowledge of QTc interval prolonging drugs and baseline clinical risk factors for QTc prolongation. The combination of both determines whether ECG-monitoring is necessary at the start of a psychotropic drug. In this article, we summarize current literature regarding appropriate methods of calculating the QTc interval, risk factors for QTc prolongation and QTc-prolonging psychotropic drugs. The frequency of cardiac monitoring for patients receiving psychotropic drugs should be individually determined, based on the prescribed agent(s) and additional risk factors for TdP. In patients without baseline clinical risk factors for QTc prolongation or cardiac arrhythmias, starting a single psychotropic drug with a low risk profile, ECG-monitoring might not be necessary.
Collapse
Affiliation(s)
- Laura E De Wit
- St. Antonius Ziekenhuis Utrecht, afd. Psychiatrie, Utrecht
| | - Feikje van Stiphout
- Meander Medisch Centrum, sectie Geriatrie/Interne Geneeskunde/MDL, Amersfoort
| | | | | | | |
Collapse
|
26
|
Groeneveld S, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of mitral annulus disjunction and mitral valve prolapse in a multicenter cohort of idiopathic ventricular fibrillation patients. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.083] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation
Background
Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP) and ventricular arrhythmias[1,2]. The prevalence of MAD and MVP in IVF patients in this regard, is not well established.
Purpose
To explore prevalence of MAD and MVP in IVF patients.
Methods
In this retrospective multicenter cohort study, Cardiac Magnetic Resonance images from IVF patients (i.e., negative for ischemia, cardiomyopathy and channelopathies) and matched control subjects were analyzed for MAD (≥2mm) and MVP (>2mm).
Results
In total, 71 IVF patients (mean age 39, 59% male) and 71 controls (mean age 41, 58% male) were included. MAD in the inferolateral wall was more prevalent in IVF patients versus healthy controls (6 [10%] vs. 1 [1%], p = 0.035). MVP was only seen in IVF patients and not in controls (4 [7%] vs. 0 [0%], p = 0.037). MVP was observed both in IVF patients with (n = 3) and without (n = 1) MAD. Patients with MAD did not show papillary muscle fibrosis. Four (67%) patients with MAD showed frequent ventricular ectopy from the basal myocardial region.
Conclusion
Inferolateral MAD and MVP were significantly more prevalent in IVF patients compared to healthy controls (figure). This is in line with previous studies suggesting a correlation between mitral valve disease and IVF. Our findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
Collapse
Affiliation(s)
- S Groeneveld
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - FP Kirkels
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - MJ Cramer
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - R Evertz
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - KH Haugaa
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - PG Postema
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - NHJ Prakken
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - AJ Teske
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - BK Velthuis
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - R Nijveldt
- Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - RJ Hassink
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| |
Collapse
|
27
|
Groeneveld SA, van der Ree MH, Taha K, de Bruin-Bon RHA, Cramer MJ, Teske AJ, Bouma BJ, Amin AS, Wilde AAM, Postema PG, Hassink RJ. Echocardiographic deformation imaging unmasks global and regional mechanical dysfunction in patients with idiopathic ventricular fibrillation: A multicenter case-control study. Heart Rhythm 2021; 18:1666-1672. [PMID: 34058391 DOI: 10.1016/j.hrthm.2021.05.030] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of unidentified origin. New diagnostic tools that can detect subtle abnormalities are needed to diagnose and treat patients with an underlying substrate. OBJECTIVE The purpose of this study was to explore echocardiographic deformation characteristics in IVF patients. METHODS Echocardiograms were analyzed with deformation imaging by 2-dimensional speckle tracking. Global and regional measurements of the left ventricle (LV) and right ventricle (RV) were performed. Regional LV deformation patterns were evaluated for the presence of postsystolic shortening. Regional RV deformation patterns were classified as type I (normal) or type II/III (abnormal). RESULTS In total, 47 IVF patients (mean age 45 years; left ventricular ejection fraction [LVEF] 56%) and 47 healthy controls (mean age 41 years; LVEF 60%) were included. IVF patients showed more global deformation abnormalities as indicated by lower LV global longitudinal strain (18.5% ± 2.6% vs 21.6% ± 1.8%; P <.001) and higher LV mechanical dispersion (41 ± 12 ms vs 26 ± 6 ms; P <.001). In addition, IVF patients showed more regional LV postsystolic shortening compared to healthy controls (50% vs 11%; P <.001). Abnormal RV deformation patterns were observed in 16% of IVF patients and in none of the control subjects (P <.001). CONCLUSION We were able to show both regional and global echocardiographic deformation abnormalities in IVF patients. This study provides evidence that localized myocardial disease is present in a subset of IVF patients.
Collapse
Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rianne H A de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berto J Bouma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmad S Amin
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
28
|
Vranken JF, van de Leur RR, Gupta DK, Juarez Orozco LE, Hassink RJ, van der Harst P, Doevendans PA, Gulshad S, van Es R. Uncertainty estimation for deep learning-based automated analysis of 12-lead electrocardiograms. Eur Heart J Digit Health 2021; 2:401-415. [PMID: 36713602 PMCID: PMC9707930 DOI: 10.1093/ehjdh/ztab045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 02/01/2023]
Abstract
Aims Automated interpretation of electrocardiograms (ECGs) using deep neural networks (DNNs) has gained much attention recently. While the initial results have been encouraging, limited attention has been paid to whether such results can be trusted, which is paramount for their clinical implementation. This study aims to systematically investigate uncertainty estimation techniques for automated classification of ECGs using DNNs and to gain insight into its utility through a clinical simulation. Methods and results On a total of 526 656 ECGs from three different datasets, six different methods for estimation of aleatoric and epistemic uncertainty were systematically investigated. The methods were evaluated based on ranking, calibration, and robustness against out-of-distribution data. Furthermore, a clinical simulation was performed where increasing uncertainty thresholds were applied to achieve a clinically acceptable performance. Finally, the correspondence between the uncertainty of ECGs and the lack of interpretational agreement between cardiologists was estimated. Results demonstrated the largest benefit when modelling both epistemic and aleatoric uncertainty. Notably, the combination of variational inference with Bayesian decomposition and ensemble with auxiliary output outperformed the other methods. The clinical simulation showed that the accuracy of the algorithm increased as uncertain predictions were referred to the physician. Moreover, high uncertainty in DNN-based ECG classification strongly corresponded with a lower diagnostic agreement in cardiologist's interpretation (P < 0.001). Conclusion Uncertainty estimation is warranted in automated DNN-based ECG classification and its accurate estimation enables intermediate quality control in the clinical implementation of deep learning. This is an important step towards the clinical applicability of automated ECG diagnosis using DNNs.
Collapse
Affiliation(s)
- Jeroen F Vranken
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Deepak K Gupta
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Luis E Juarez Orozco
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Utrecht, The Netherlands,Department of Cardiology, Central Military Hospital, Utrecht, The Netherlands
| | - Sadaf Gulshad
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Corresponding author. Tel: 0031 88 757 3453,
| |
Collapse
|
29
|
Pomp J, van Asselen B, Tersteeg RHA, Vink A, Hassink RJ, van der Kaaij NP, van Aarnhem GEEHL, Verhoeff JJC. Sarcoma of the Heart Treated with Stereotactic MR-Guided Online Adaptive Radiation Therapy. Case Rep Oncol 2021; 14:453-458. [PMID: 33790766 PMCID: PMC7983626 DOI: 10.1159/000513623] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
We present the first case in the literature of a patient with a histology-proven intimal sarcoma of the heart, recurrent after surgery, treated with stereotactic MR-guided online adaptive radiation therapy on an MR-Linac machine. The treatment was feasible and well tolerated. The CT scan 6 months after the last treatment showed stable disease.
Collapse
Affiliation(s)
- Jacquelien Pomp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bram van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robbert H A Tersteeg
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
30
|
Mellor GJ, Blom LJ, Groeneveld SA, Winkel BG, Ensam B, Bargehr J, van Rees B, Scrocco C, Krapels IPC, Volders PGA, Tfelt-Hansen J, Krahn AD, Hassink RJ, Behr ER. Familial Evaluation in Idiopathic Ventricular Fibrillation: Diagnostic Yield and Significance of J Wave Syndromes. Circ Arrhythm Electrophysiol 2021; 14:e009089. [PMID: 33550818 DOI: 10.1161/circep.120.009089] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Greg J Mellor
- Cardiology Department, Royal Papworth Hospital, Cambridge (G.J.M., J.B.)
| | - Lennart J Blom
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Bo G Winkel
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Bode Ensam
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| | - Johannes Bargehr
- Cardiology Department, Royal Papworth Hospital, Cambridge (G.J.M., J.B.).,Division of Cardiovascular Medicine, University of Cambridge, United Kingdom (J.B.)
| | - Bianca van Rees
- Department of Cardiology, Cardiovascular Rsrch Inst Maastricht (CARIM) (B.v.R., P.G.V.A.), Maastricht University Medical Center, the Netherlands
| | - Chiara Scrocco
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| | - Ingrid P C Krapels
- Department of Clinical Genetics (I.P.C.K.), Maastricht University Medical Center, the Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Rsrch Inst Maastricht (CARIM) (B.v.R., P.G.V.A.), Maastricht University Medical Center, the Netherlands
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands (L.J.B., S.A.G., R.J.H.)
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular & Clinical Sciences Rsrch Inst, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
| |
Collapse
|
31
|
van de Leur RR, Taha K, Bos MN, van der Heijden JF, Gupta D, Cramer MJ, Hassink RJ, van der Harst P, Doevendans PA, Asselbergs FW, van Es R. Discovering and Visualizing Disease-Specific Electrocardiogram Features Using Deep Learning: Proof-of-Concept in Phospholamban Gene Mutation Carriers. Circ Arrhythm Electrophysiol 2021; 14:e009056. [PMID: 33401921 PMCID: PMC7892204 DOI: 10.1161/circep.120.009056] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/22/2020] [Accepted: 11/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND ECG interpretation requires expertise and is mostly based on physician recognition of specific patterns, which may be challenging in rare cardiac diseases. Deep neural networks (DNNs) can discover complex features in ECGs and may facilitate the detection of novel features which possibly play a pathophysiological role in relatively unknown diseases. Using a cohort of PLN (phospholamban) p.Arg14del mutation carriers, we aimed to investigate whether a novel DNN-based approach can identify established ECG features, but moreover, we aimed to expand our knowledge on novel ECG features in these patients. METHODS A DNN was developed on 12-lead median beat ECGs of 69 patients and 1380 matched controls and independently evaluated on 17 patients and 340 controls. Differentiating features were visualized using Guided Gradient Class Activation Mapping++. Novel ECG features were tested for their diagnostic value by adding them to a logistic regression model including established ECG features. RESULTS The DNN showed excellent discriminatory performance with a c-statistic of 0.95 (95% CI, 0.91-0.99) and sensitivity and specificity of 0.82 and 0.93, respectively. Visualizations revealed established ECG features (low QRS voltages and T-wave inversions), specified these features (eg, R- and T-wave attenuation in V2/V3) and identified novel PLN-specific ECG features (eg, increased PR-duration). The logistic regression baseline model improved significantly when augmented with the identified features (P<0.001). CONCLUSIONS A DNN-based feature detection approach was able to discover and visualize disease-specific ECG features in PLN mutation carriers and revealed yet unidentified features. This novel approach may help advance diagnostic capabilities in daily practice.
Collapse
Affiliation(s)
- Rutger R. van de Leur
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
- Netherlands Heart Institute, Utrecht (R.R.v.d.L., K.T., P.A.D.)
| | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
- Netherlands Heart Institute, Utrecht (R.R.v.d.L., K.T., P.A.D.)
| | - Max N. Bos
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
- Informatics Institute, University of Amsterdam, the Netherlands (M.N.B., D.G.)
| | - Jeroen F. van der Heijden
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
| | - Deepak Gupta
- Informatics Institute, University of Amsterdam, the Netherlands (M.N.B., D.G.)
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
- Netherlands Heart Institute, Utrecht (R.R.v.d.L., K.T., P.A.D.)
- Central Military Hospital, Utrecht, the Netherlands (P.A.D.)
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (R.R.v.d.L., K.T., M.N.B., J.F.v.d.H., M.J.C., R.J.H., P.v.d.H., P.A.D., F.W.A., R.v.E.)
| |
Collapse
|
32
|
Groeneveld SA, Blom LJ, van der Heijden JF, Loh P, Hassink RJ. Follow-up after hemodynamically not tolerated ventricular tachycardia in patients with midrange reduced to normal ejection fraction: A retrospective single-centre case series. Eur J Clin Invest 2021; 51:e13359. [PMID: 32705678 PMCID: PMC7757240 DOI: 10.1111/eci.13359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The benefit of implantable cardioverter-defibrillator (ICD) implantation in patients with hemodynamically not tolerated ventricular tachycardia (VT) and midrange reduced to normal ejection fraction (LVEF >35%) is currently unclear. The purpose of this study was to investigate follow-up after hemodynamically not tolerated VT in patients with LVEF >35%. In addition, we aimed to find possible predictive factors to identify who will benefit from ICD implantation. METHODS In a retrospective single-centre case series, all patients with hemodynamically not tolerated VT and LVEF >35% that underwent electrophysiological study (EPS) and/or radiofrequency VT ablation were included. RESULTS Forty-two patients (5 women, median age 68 years) with hemodynamically not tolerated VT and LVEF >35% underwent EPS. VT ablation was performed in thirty-one patients, which was considered successful in twenty-three patients. Nineteen patients had an ICD at discharge while 23 patients were discharged without an ICD. The severity of hemodynamic compromise, LVEF and ablation success played an important role in the decision-making for ICD implantation. Six patients (14.3%) had recurrence of VT, all hemodynamically tolerated. CONCLUSIONS In this small case series, patients with hemodynamically not tolerated VT and LVEF >35% had a relatively low recurrence rate and all recurrences were nonfatal. Based on our results, we hypothesize that the severity of hemodynamic compromise, LVEF and ablation success might modify the risk for VA recurrence. A prospective study to determine the prognostic value of these factors in patients with hemodynamically not tolerated VT and LVEF >35% is necessary.
Collapse
Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lennart J Blom
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Peter Loh
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
33
|
van de Leur RR, Boonstra MJ, Bagheri A, Roudijk RW, Sammani A, Taha K, Doevendans PA, van der Harst P, van Dam PM, Hassink RJ, van Es R, Asselbergs FW. Big Data and Artificial Intelligence: Opportunities and Threats in Electrophysiology. Arrhythm Electrophysiol Rev 2020; 9:146-154. [PMID: 33240510 PMCID: PMC7675143 DOI: 10.15420/aer.2020.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 12/23/2022] Open
Abstract
The combination of big data and artificial intelligence (AI) is having an increasing impact on the field of electrophysiology. Algorithms are created to improve the automated diagnosis of clinical ECGs or ambulatory rhythm devices. Furthermore, the use of AI during invasive electrophysiological studies or combining several diagnostic modalities into AI algorithms to aid diagnostics are being investigated. However, the clinical performance and applicability of created algorithms are yet unknown. In this narrative review, opportunities and threats of AI in the field of electrophysiology are described, mainly focusing on ECGs. Current opportunities are discussed with their potential clinical benefits as well as the challenges. Challenges in data acquisition, model performance, (external) validity, clinical implementation, algorithm interpretation as well as the ethical aspects of AI research are discussed. This article aims to guide clinicians in the evaluation of new AI applications for electrophysiology before their clinical implementation.
Collapse
Affiliation(s)
- Rutger R van de Leur
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Machteld J Boonstra
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ayoub Bagheri
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
| | - Rob W Roudijk
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Arjan Sammani
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karim Taha
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Pieter Afm Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands.,Central Military Hospital Utrecht, Ministerie van Defensie, Utrecht, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter M van Dam
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - René van Es
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
34
|
Mol D, Houterman S, Balt JC, Bhagwandien RE, Blaauw Y, Delnoy PPH, van Driel VJ, Driessen AH, Folkeringa RJ, Hassink RJ, van Huysduynen BH, Luermans JG, Ouss AJ, Stevenhagen YJ, van Veghel D, Westra SW, de Jong JS, de Groot JR. Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique. Europace 2020; 23:216-225. [DOI: 10.1093/europace/euaa255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
Abstract
Aims
Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1–3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation.
Methods and results
The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98–4.45) and 2.02 (95% CI 1.03–4.00) respectively.
Conclusion
The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications.
Collapse
Affiliation(s)
- Daniel Mol
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St. Antonius, Nieuwegein, The Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Antoine H Driessen
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Justin G Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexandre J Ouss
- Department of Cardiology and Cardiac Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonas S de Jong
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
35
|
Groeneveld SA, Blom LJ, Hassink RJ. [Sudden death in the young: the importance of autopsy and DNA testing]. Ned Tijdschr Geneeskd 2020; 164:D4342. [PMID: 32608928] [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: 06/11/2023]
Abstract
When a young person suddenly dies, there is a real chance that this was caused by genetic heart disease. Autopsy plays an important role in determining the cause of death, but the autopsy rate in the Netherlands is relatively low. Practical problems and a lack of information on autopsy play a role. It is important to inform the family on the importance of autopsy and DNA testing. If the family refuses autopsy, consent can be given for removal of material for DNA testing. If no autopsy and no DNA test were done, cardiological screening of family members remains highly recommended. New guidelines and procedures for diagnostics after sudden death are very important. For that reason, we developed a step-by-step plan to support healthcare providers. Early detection of genetic heart disease may prevent sudden death of family members, for example, by using preventive medication or internal defibrillators (ICD).
Collapse
|
36
|
van de Leur RR, Blom LJ, Gavves E, Hof IE, van der Heijden JF, Clappers NC, Doevendans PA, Hassink RJ, van Es R. Automatic Triage of 12-Lead ECGs Using Deep Convolutional Neural Networks. J Am Heart Assoc 2020; 9:e015138. [PMID: 32406296 PMCID: PMC7660886 DOI: 10.1161/jaha.119.015138] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND The correct interpretation of the ECG is pivotal for the accurate diagnosis of many cardiac abnormalities, and conventional computerized interpretation has not been able to reach physician‐level accuracy in detecting (acute) cardiac abnormalities. This study aims to develop and validate a deep neural network for comprehensive automated ECG triage in daily practice. METHODS AND RESULTS We developed a 37‐layer convolutional residual deep neural network on a data set of free‐text physician‐annotated 12‐lead ECGs. The deep neural network was trained on a data set with 336.835 recordings from 142.040 patients and validated on an independent validation data set (n=984), annotated by a panel of 5 cardiologists electrophysiologists. The 12‐lead ECGs were acquired in all noncardiology departments of the University Medical Center Utrecht. The algorithm learned to classify these ECGs into the following 4 triage categories: normal, abnormal not acute, subacute, and acute. Discriminative performance is presented with overall and category‐specific concordance statistics, polytomous discrimination indexes, sensitivities, specificities, and positive and negative predictive values. The patients in the validation data set had a mean age of 60.4 years and 54.3% were men. The deep neural network showed excellent overall discrimination with an overall concordance statistic of 0.93 (95% CI, 0.92–0.95) and a polytomous discriminatory index of 0.83 (95% CI, 0.79–0.87). CONCLUSIONS This study demonstrates that an end‐to‐end deep neural network can be accurately trained on unstructured free‐text physician annotations and used to consistently triage 12‐lead ECGs. When further fine‐tuned with other clinical outcomes and externally validated in clinical practice, the demonstrated deep learning–based ECG interpretation can potentially improve time to treatment and decrease healthcare burden.
Collapse
Affiliation(s)
- Rutger R van de Leur
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Lennart J Blom
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Irene E Hof
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Nick C Clappers
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Rutger J Hassink
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - René van Es
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| |
Collapse
|
37
|
Blom LJ, Groeneveld SA, Wulterkens BM, van Rees B, Nguyen UC, Roudijk RW, Cluitmans M, Volders PGA, Hassink RJ. Novel use of repolarization parameters in electrocardiographic imaging to uncover arrhythmogenic substrate. J Electrocardiol 2020; 59:116-121. [PMID: 32062380 DOI: 10.1016/j.jelectrocard.2020.02.003] [Citation(s) in RCA: 5] [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: 11/21/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring repolarization characteristics is challenging and has been reserved for experienced physicians. In electrocardiographic imaging (ECGI), activation-recovery interval (ARI) is used as a measure of local cardiac repolarization duration. We hypothesized that repolarization characteristics, such as local electrogram morphology and local and global dispersion of repolarization timing and duration could be of significance in ECGI. OBJECTIVE To further explore their potential in arrhythmic risk stratification we investigated the use of novel repolarization parameters in ECGI. MATERIALS AND METHODS We developed and compared methods for T-peak and T-end detection in reconstructed potentials. All methods were validated on annotated reconstructed electrograms (EGMs). Characteristics of the reconstructed EGMs and epicardial substrate maps in IVF patients were analyzed by using data recorded during sinus rhythm. The ECGI data were analyzed for EGM morphology, conduction, and repolarization. RESULTS We acquired ECGI data from 8 subjects for this study. In all patients we evaluated four repolarization parameters: Repolarization time, T-wave area, Tpeak-Tend interval, and T-wave alternans. Most prominent findings were steep repolarization time gradients in regions with flat EGMs. These regions were also characterized by low T-wave area and large differences in Tpeak-Tend interval. CONCLUSIONS Measuring novel repolarization parameters in reconstructed electrograms acquired with ECGI is feasible, can be done in a fully automated manner and may provide additional information on underlying arrhythmogenic substrate for risk stratification. Further studies are needed to investigate their potential use and clinical application.
Collapse
Affiliation(s)
- L J Blom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B M Wulterkens
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B van Rees
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - U C Nguyen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R W Roudijk
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - P G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
38
|
Blom LJ, Visser M, Christiaans I, Scholten MF, Bootsma M, van den Berg MP, Yap SC, van der Heijden JF, Doevendans PA, Loh P, Postema PG, Barge-Schaapsveld DQ, Hofman N, Volders PGA, Wilde AA, Hassink RJ. Incidence and predictors of implantable cardioverter-defibrillator therapy and its complications in idiopathic ventricular fibrillation patients. Europace 2019; 21:1519-1526. [DOI: 10.1093/europace/euz151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest. Implantable cardioverter-defibrillator (ICD) implantation is currently the only treatment option. Limited data are available on the prevalence and complications of ICD therapy in these patients. We sought to investigate ICD therapy and its complications in patients with IVF.
Methods and results
Patients were selected from a national registry of IVF patients. Patients in whom no underlying diagnosis was found during follow-up were eligible for inclusion. Recurrence of ventricular arrhythmia (VA) was derived from medical and ICD records, electrogram records of ICD therapies were used to differentiate between appropriate or inappropriate interventions. Independent predictors for appropriate ICD shock were calculated using cox regression. In 217 IVF patients, recurrence of sustained VAs occurred in 66 patients (30%) during a median follow-up period of 6.1 years. Ten patients died (4.6%). Thirty-eight patients (17.5%) experienced inappropriate ICD therapy, and 32 patients (14.7%) had device-related complications. Symptoms before cardiac arrest [hazard ratio (HR): 2.51, 95% confidence interval (CI): 1.48–4.24], signs of conduction disease (HR: 2.27, 95% CI: 1.15–4.47), and carrier of the DPP6 risk haplotype (HR: 3.24, 1.70–6.17) were identified as independent predictors of appropriate shock occurrence.
Conclusion
Implantable cardioverter-defibrillator therapy is an effective treatment in IVF, treating recurrences of potentially lethal VAs in approximately one-third of patients during long-term follow-up. However, device-related complications and inappropriate shocks were also frequent. We found significant predictors for appropriate ICD therapy. This may imply that these patients require additional management to prevent recurrent events.
Collapse
Affiliation(s)
- Lennart J Blom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marloes Visser
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marcoen F Scholten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
- Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Nynke Hofman
- Department of Cardiogenetics, AMC, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
39
|
Blom LJ, Te Riele AS, Vink A, Hauer RN, Hassink RJ. Late evolution of arrhythmogenic cardiomyopathy in patients with initial presentation as idiopathic ventricular fibrillation. HeartRhythm Case Rep 2018; 5:25-30. [PMID: 30693201 PMCID: PMC6342730 DOI: 10.1016/j.hrcr.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Lennart J. Blom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Address reprint requests and correspondence: Dr Lennart J. Blom, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
| | | | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard N.W. Hauer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
40
|
Blom LJ, Volders PGA, Wilde AA, Hassink RJ. Life-long tailoring of diagnosis and management of patients with idiopathic ventricular fibrillation-future perspectives in research. Neth Heart J 2018; 26:367-374. [PMID: 29882040 PMCID: PMC6046665 DOI: 10.1007/s12471-018-1123-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The diagnosis and management of idiopathic ventricular fibrillation is challenging, as it requires extensive diagnostic testing and offers few curative options due to unknown underlying disease. The resulting population is a heterogeneous group of patients with a largely unknown natural history. Structural patient characterisation, follow-up and innovations in diagnostic testing can improve our understanding of the disease mechanisms of idiopathic ventricular fibrillation, detect underlying disease during follow-up and aid in therapeutic management. Recently, initiatives have been launched in the Netherlands to investigate the role of high-resolution non-invasive electrocardiographic imaging and genetic and familial screening in idiopathic ventricular fibrillation.
Collapse
Affiliation(s)
- L J Blom
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands.
| | - P G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - R J Hassink
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
41
|
Visser M, Pereira LCP, Mastenbroek MH, Versteeg H, Hassink RJ. Impaired Mental Health-Related Quality of Life in Patients with Idiopathic Ventricular Fibrillation. Pacing Clin Electrophysiol 2017; 40:578-584. [PMID: 28156009 DOI: 10.1111/pace.13034] [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] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/05/2017] [Accepted: 01/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (iVF) is diagnosed in cardiac arrest survivors without an identifiable cause. Data regarding the health-related quality of life (HRQoL) in iVF patients are lacking. The purpose of this study was to investigate the HRQoL of iVF patients and to compare it to patients with an implantable cardioverter defibrillator (ICD) diagnosed with an underlying disease and healthy subjects. METHODS In 61 iVF patients with an ICD (iVF-ICD) and 59 ICD patients with a diagnosis (diagnosis-ICD), HRQoL was assessed using the 12-item Short-Form Health Survey (SF-12), the EuroQoL-5 dimensions (EQ-5D), the 9-item Patient Health Questionnaire, and the ICD Patient Concerns (ICDC) Questionnaire. In addition, 860 healthy subjects completed the SF-12. RESULTS IVF-ICD showed similar SF-12 physical summary scores compared with diagnosis-ICD patients (50.8 [interquartile range (IQR) = 42.1-53.9] vs 54.1 [IQR = 46.5-58.3]; P = 0.080) and healthy subjects (51.8 [IQR = 45.9-54.1]; P = 0.691). The mental summary score was impaired in iVF-ICD patients compared with diagnosis-ICD patients (45.9 [IQR = 40.7-49.4] vs 54.6 [IQR = 46.0-57.9]; P < 0.001) and healthy subjects (47.7 [IQR = 43.0-50.4]; P = 0.027). Scores on all five EQ-5D domains were similar between iVF-ICD patients and diagnosis-ICD patients, as well as symptoms of severe depression (19% vs 12%; P = 0.101). ICD concerns were similar between iVF-ICD and diagnosis-ICD patients (ICDC-scores 2 vs 2; P = 0.494). CONCLUSIONS Data suggest that there is a reduced mental HRQoL in patients with iVF compared to other cardiac arrest survivors. Screening and treatment of psychological distress should therefore be considered in iVF patients.
Collapse
Affiliation(s)
- Marloes Visser
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands.,Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands
| | | | | | - Henneke Versteeg
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands.,Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands
| |
Collapse
|
42
|
Visser M, Dooijes D, van der Smagt JJ, van der Heijden JF, Doevendans PA, Loh P, Asselbergs FW, Hassink RJ. Next-generation sequencing of a large gene panel in patients initially diagnosed with idiopathic ventricular fibrillation. Heart Rhythm 2017; 14:1035-1040. [PMID: 28087426 DOI: 10.1016/j.hrthm.2017.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) is a rare primary cardiac arrhythmia syndrome that is diagnosed in a resuscitated cardiac arrest victim, with documented ventricular fibrillation, in whom no underlying cause is identified after comprehensive clinical evaluation. In some patients, causative genetic mutations are detected that facilitate patient treatment and follow-up. The feasibility of next-generation sequencing (NGS) has increased with its greater availability and decreasing costs. OBJECTIVE The aim of this study was to assess the diagnostic yield of NGS in patients with IVF. METHODS A total of 33 patients initially diagnosed with IVF were included (mean age 53 ± 15 years; 14(42%) men). In all included patients, NGS of 33 genes and the DPP6 haplotype revealed no pathogenic mutations. Genetic screening comprised NGS of a panel of 179 additional genes. Variants with a minor allele frequency of <0.05% were assessed for pathogenicity by using existing mutation databases and in silico predictive algorithms. RESULTS In 1 of 33 patients, a likely pathogenic mutation was detected. The added yield of genetic testing with NGS of 179 additional genes is 3% in patients with IVF. In 15% of patients, 1 or multiple variants of uncertain clinical significance were detected. CONCLUSION The added yield of genetic screening of extended NGS panels in patients initially diagnosed with IVF is minimal. Routine analysis of large diagnostic NGS panels is therefore not recommended.
Collapse
Affiliation(s)
- Marloes Visser
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands,.
| | - Dennis Dooijes
- Department of Clinical Genetics, University Medical Centre, Utrecht, The Netherlands
| | | | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Peter Loh
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | | | - Rutger J Hassink
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands
| |
Collapse
|
43
|
Visser M, van der Smagt JJ, Loh P, van der Heijden JF, Hassink RJ. A patient with early repolarization syndrome and concurrent Brugada syndrome: Demonstration of a different pathophysiology? Int J Cardiol 2016; 223:58-60. [PMID: 27529593 DOI: 10.1016/j.ijcard.2016.08.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Marloes Visser
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, the Netherlands.
| | | | - Peter Loh
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
| | | | - Rutger J Hassink
- Department of Cardiology, University Medical Centre, Utrecht, the Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, the Netherlands
| |
Collapse
|
44
|
Teunissen C, Clappers N, Kassenberg W, Hassink RJ, van der Heijden JF, Loh P. Time matters: adenosine testing immediately after pulmonary vein isolation does not substitute a waiting period. Europace 2016; 19:1140-1145. [DOI: 10.1093/europace/euw173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/15/2016] [Indexed: 11/12/2022] Open
|
45
|
Visser M, van der Heijden JF, van der Smagt JJ, Doevendans PA, Wilde AA, Loh P, Hassink RJ. Long-Term Outcome of Patients Initially Diagnosed With Idiopathic Ventricular Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004258. [DOI: 10.1161/circep.116.004258] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] [Received: 04/14/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
Background—
Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest. Limited data are available on the long-term outcome of IVF patients.
Methods and Results—
In this retrospective cohort study, 107 consecutive patients with an initial diagnosis of IVF were analyzed (age at index event 40.4 years, 60% male). Missing diagnostic data were acquired during follow-up, including genetic testing, to exclude underlying disease. A specific diagnosis was revealed in 22 of 107 patients (21%) during a median follow-up of 10.2 years. Mortality rate was 9% in IVF patients (8/85). Appropriate implantable cardioverter–defibrillator therapy was delivered in 23 patients (29%) of 78 IVF patients with an implantable cardioverter–defibrillator, with a median of 3 appropriate shocks per patient.
Conclusions—
One fifth of the patients initially diagnosed with IVF reveal a specific diagnosis during long-term follow-up. Additional diagnostic testing, including genetic testing, contributes to the detection of specific diseases. The recurrence rate of ventricular arrhythmias in IVF patients is high. Our data show the importance of thorough follow-up and reassessment of diagnosis in IVF patients.
Collapse
Affiliation(s)
- Marloes Visser
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Jeroen F. van der Heijden
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Jasper J. van der Smagt
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Pieter A. Doevendans
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Arthur A. Wilde
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Peter Loh
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Rutger J. Hassink
- From the Departments of Cardiology (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.) and Clinical Genetics (J.J.v.d.S.), University Medical Centre, Utrecht, The Netherlands; Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| |
Collapse
|
46
|
Visser M, van der Heijden JF, Doevendans PA, Loh P, Wilde AA, Hassink RJ. Idiopathic Ventricular Fibrillation: The Struggle for Definition, Diagnosis, and Follow-Up. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003817. [PMID: 27103090 DOI: 10.1161/circep.115.003817] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marloes Visser
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Jeroen F van der Heijden
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Pieter A Doevendans
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Peter Loh
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Arthur A Wilde
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Rutger J Hassink
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.).
| |
Collapse
|
47
|
Teunissen C, Kassenberg W, van der Heijden JF, Hassink RJ, van Driel VJ, Zuithoff NP, Doevendans PA, Loh P. Five-year efficacy of pulmonary vein antrum isolation as a primary ablation strategy for atrial fibrillation: a single-centre cohort study. Europace 2016; 18:1335-42. [DOI: 10.1093/europace/euv439] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/07/2015] [Indexed: 11/12/2022] Open
|
48
|
Du Pré BC, Van Laake LW, Velthuis BK, de Waal EEC, Buijsrogge MP, Hassink RJ. An exceptionally large coronary artery aneurysm in a formerly healthy young woman. Neth Heart J 2015; 23:609-10. [PMID: 26449243 PMCID: PMC4651965 DOI: 10.1007/s12471-015-0756-8] [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: 11/30/2022] Open
Affiliation(s)
- B C Du Pré
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Van Laake
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - B K Velthuis
- Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - E E C de Waal
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P Buijsrogge
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| |
Collapse
|
49
|
Siegers CEP, Visser M, Loh P, van der Heijden JF, Hassink RJ. Catecholaminergic polymorphic ventricular tachycardia (CPVT) initially diagnosed as idiopathic ventricular fibrillation: the importance of thorough diagnostic work-up and follow-up. Int J Cardiol 2015; 177:e81-3. [PMID: 25456695 DOI: 10.1016/j.ijcard.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
|
50
|
Udo EO, Hassink RJ. Pulmonary vein isolation as a treatment for severe atrial functional mitral regurgitation in a patient with atrial fibrillation. Int J Cardiol 2014; 175:578-9. [PMID: 24874910 DOI: 10.1016/j.ijcard.2014.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 11/16/2022]
Affiliation(s)
- E O Udo
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - R J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|