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Pauwelyn M, Ingelaere S, Hoffmann R, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, de Waroux JBLP, Vandenberk B, Willems R. Implantable cardiac defibrillators in octogenarians. J Geriatr Cardiol 2023; 20:23-31. [PMID: 36875166 PMCID: PMC9975482 DOI: 10.26599/1671-5411.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE Implantable cardiac defibrillators (ICD) implantation in the very elderly remains controversial. We aimed to describe the experience and outcome of patients over 80 years old implanted with an ICD in Belgium. METHODS Data were extracted from the national QERMID-ICD registry. All implantations performed in octogenarians between February 2010 and March 2019 were analysed. Data on baseline patient characteristics, type of prevention, device configuration and all-cause mortality were available. To determine predictors of mortality, multivariable Cox proportional hazard regression modelling was performed. RESULTS Nationwide, 704 primo ICD implantations were performed in octogenarians (median age 82, IQR 81-83 years; 83% male and 45% secondary prevention). During a mean follow-up of 3.1 ± 2.3 years, 249 (35%) patients died, of which 76 (11%) within the first year after implantation. In multivariable Cox regression analysis age (HR = 1.15, P = 0.004), oncological history (HR = 2.43, P = 0.027) and secondary prevention (HR = 2.23, P = 0.001) were independently associated with 1-year mortality. A better preserved left ventricular ejection fraction (LVEF) was associated with a better outcome (HR = 0.97, P = 0.002). Regarding overall mortality multivariable analysis withheld age, history of atrial fibrillation, centre volume and oncological history as significant predictors. Higher LVEF was again protective (HR = 0.99, P = 0.008). CONCLUSIONS Primary ICD implantation in octogenarians is not often performed in Belgium. Among this population, 11% died within the first year after ICD implantation. Advanced age, oncological history, secondary prevention and a lower LVEF were associated with an increased one-year mortality. Age, low LVEF, atrial fibrillation, centre volume and oncological history were indicative of higher overall mortality.
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Affiliation(s)
| | - Sebastian Ingelaere
- University Hospitals Leuven, Cardiology, Leuven, Belgium.,KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | | | - Johan Vijgen
- Jessa Ziekenhuis, Department of Cardiology, Hasselt, Belgium
| | | | - Ivan Blankoff
- CHU Charleroi, Department of Cardiology, Charleroi, Belgium
| | | | | | - Bert Vandenberk
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium.,University of Calgary, Libin Cardiovascular Institute, Calgary, Canada
| | - Rik Willems
- University Hospitals Leuven, Cardiology, Leuven, Belgium.,KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
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2
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Blankoff I. Belgian Heart Rhythm Meeting 2022 - Book of Abstracts. Acta Cardiol 2022. [DOI: 10.1080/00015385.2022.2136877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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3
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Gruwez H, Snoeck W, Evens S, Vijgen J, Le Polain De Waroux JB, Vandekerckhove Y, Pison L, Haemers P, Nuyens D, Blankoff I, Mairesse G, Willems R. Results from a nationwide atrial fibrillation screening effort in Belgium. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Atrial Fibrillation (AF) is associated with an increased risk of stroke that can be mitigated with anticoagulation therapy. Opportunistic screening for AF for primary stroke prevention is recommended in subjects above 65. However, the paroxysmal and asymptomatic nature of AF hampers early detection with a single time point screening. Multiple time point measurements are superior to single time point measurements for the detection of AF. New technologies such as photoplethysmography (PPG) enable large scale AF screening with repetitive measurements at low-cost using only a smartphone.
Purpose
To explore an entirely online AF screening program in subjects with an elevated stroke risk.
Methods
The Belgian Heart Rhythm Association launched a digital marketing campaign, to promote AF screening during “The Belgian Week of the Heart Rhythm”. Candidates were referred to an online questionnaire to calculate their CHADS-VASC score. Subjects older than 18 with a CHADS-VASC score of 2 or more were allowed to enter the screening program. AF screening was performed with a PPG-based smartphone application. A 60-second PPG trace is captured by placing a fingertip on the smartphone's camera. The smartphone application analyses the PPG trace with an artificial intelligence software. Subjects were instructed to perform measurement twice daily and while experiencing symptoms over the course of 7 days. Measurements were classified as AF or non-AF by the algorithm and were reviewed by medical technicians.
Results
Of the 12.602 candidates who completed the questionnaire, 6.020 subjects met the inclusion criteria and were offered screening. However, only 2.111 (35%) participated in the screening program. The mean age of participants was 63±11 years, 37.3% was male, median CHADS-VASC was 2 (2–3). 257 participants (12.2%) were previously known with AF. In total 25.362 PPG recordings of 60 seconds were performed of which 258 demonstrated AF. AF was detected in 56 participants (2.7%). This was a new finding in 36 participants (1.7%) meaning that 64.3% of participants demonstrating AF were not previously known with AF. The number needed to screen was 58.6 to detect AF in a population without a history of AF and the number needed to invite was 167.2. Only 20 participants (7.8%) with a history of AF demonstrated AF during the screening program.
Conclusions
AF screening in subjects with an elevated stroke risk is feasible with an entirely online screening program without the need for medical hardware or medical personnel with an acceptable number needed to screen. However, this approach failed to target subjects in the highest age groups and since almost two thirds of the subjects interested in the screening program failed to commence screening, approaches to increase this response (specifically in high-risk groups) needs to be explored.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Gruwez
- University Hospitals (UZ) Leuven, Cardiovascular sciences , Leuven , Belgium
| | - W Snoeck
- University Hospitals (UZ) Leuven , Leuven , Belgium
| | - S Evens
- Qompium NV , Hasselt , Belgium
| | - J Vijgen
- Jessa Hospital, Cardiology , Hasselt , Belgium
| | | | | | - L Pison
- Hospital Oost-Limburg (ZOL), Department of Cardiology , Genk , Belgium
| | - P Haemers
- University Hospitals (UZ) Leuven, Cardiovascular sciences , Leuven , Belgium
| | - D Nuyens
- Hospital Oost-Limburg (ZOL), Department of Cardiology , Genk , Belgium
| | - I Blankoff
- CHU Charleroi, Cardiology , Charleroi , Belgium
| | - G Mairesse
- Clinique Du Sud Luxembourg, Cardiology , Arlon , Belgium
| | - R Willems
- University Hospitals (UZ) Leuven, Cardiovascular sciences , Leuven , Belgium
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4
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Ingelaere S, Hoffmann R, Guler I, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, le Polain de Waroux JB, Vandenberk B, Willems R. Inequality between women and men in ICD implantation. IJC Heart & Vasculature 2022; 41:101075. [PMID: 35782706 PMCID: PMC9240366 DOI: 10.1016/j.ijcha.2022.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
Background The impact of sex on ICD implantation practice and survival remain a topic of controversy. To assess sex-specific differences in ICD implantation practice we compared clinical characteristics and survival in women and men. Methods From a nationwide registry, all new ICD implantations performed between 01/02/2010 and 31/01/2019 in Belgian patients were analyzed retrospectively. Baseline characteristics and survival rates were compared between sexes. To identify predictors of mortality, multivariable Cox regression was performed. Results Only 3096 (20.9%) of 14,787 ICD implantations were performed in women. Within each type of underlying cardiomyopathy, the proportion women were lower than men. The main indication in men was ischemic vs dilated cardiomyopathy in women. Women were overall younger (59.1 ± 15.1 vs 62.6 ± 13.1 years; p < 0.001) and had less comorbidities except for oncological disease. More women functioned in NYHA-class III (33.6% vs 27.9%; p < 0.001) and had a QRS > 150 ms (29.4% vs 24.3%; p < 0.001), consistent with a higher use of CRT-D devices (31.7% vs 25.1%; p < 0.001). Women had more complications, reflected by the need to more re-interventions within 1 year (4.3% vs 2.7%, p < 0.001). After correction for covariates, sex-category was not a significant predictor of mortality (p = 0.055). Conclusion There is a significant sex-disparity in ICD implantation rates, not fully explained by epidemiological differences in the prevalence of cardiomyopathies, which could imply an undertreatment of women. Women differ from men in baseline characteristics at implantation suggesting a selection bias. Further research is necessary to evaluate if women receive equal sudden cardiac death prevention.
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5
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Blankoff I. Belgian Heart Rhythm Meeting 2021: Book of Abstracts. Acta Cardiol 2021. [PMID: 34636288 DOI: 10.1080/00015385.2021.1967633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Sun B, Yao J, Ni M, Wei J, Zhong X, Guo W, Zhang L, Wang R, Belke D, Chen YX, Lieve KVV, Broendberg AK, Roston TM, Blankoff I, Kammeraad JA, von Alvensleben JC, Lazarte J, Vallmitjana A, Bohne LJ, Rose RA, Benitez R, Hove-Madsen L, Napolitano C, Hegele RA, Fill M, Sanatani S, Wilde AAM, Roberts JD, Priori SG, Jensen HK, Chen SRW. Cardiac ryanodine receptor calcium release deficiency syndrome. Sci Transl Med 2021; 13:13/579/eaba7287. [PMID: 33536282 DOI: 10.1126/scitranslmed.aba7287] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/07/2020] [Indexed: 11/02/2022]
Abstract
Cardiac ryanodine receptor (RyR2) gain-of-function mutations cause catecholaminergic polymorphic ventricular tachycardia, a condition characterized by prominent ventricular ectopy in response to catecholamine stress, which can be reproduced on exercise stress testing (EST). However, reports of sudden cardiac death (SCD) have emerged in EST-negative individuals who have loss-of-function (LOF) RyR2 mutations. The clinical relevance of RyR2 LOF mutations including their pathogenic mechanism, diagnosis, and treatment are all unknowns. Here, we performed clinical and genetic evaluations of individuals who suffered from SCD and harbored an LOF RyR2 mutation. We carried out electrophysiological studies using a programed electrical stimulation protocol consisting of a long-burst, long-pause, and short-coupled (LBLPS) ventricular extra-stimulus. Linkage analysis of RyR2 LOF mutations in six families revealed a combined logarithm of the odds ratio for linkage score of 11.479 for a condition associated with SCD with negative EST. A RyR2 LOF mouse model exhibited no catecholamine-provoked ventricular arrhythmias as in humans but did have substantial cardiac electrophysiological remodeling and an increased propensity for early afterdepolarizations. The LBLPS pacing protocol reliably induced ventricular arrhythmias in mice and humans having RyR2 LOF mutations, whose phenotype is otherwise concealed before SCD. Furthermore, treatment with quinidine and flecainide abolished LBLPS-induced ventricular arrhythmias in model mice. Thus, RyR2 LOF mutations underlie a previously unknown disease entity characterized by SCD with normal EST that we have termed RyR2 Ca2+ release deficiency syndrome (CRDS). Our study provides insights into the mechanism of CRDS, reports a specific CRDS diagnostic test, and identifies potentially efficacious anti-CRDS therapies.
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Affiliation(s)
- Bo Sun
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada.,Medical School, Kunming University of Science and Technology, Kunming 650504, China
| | - Jinjing Yao
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Mingke Ni
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Jinhong Wei
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Xiaowei Zhong
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Wenting Guo
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Lin Zhang
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Ruiwu Wang
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Darrell Belke
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Yong-Xiang Chen
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Krystien V V Lieve
- Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam 1105AZ, Netherlands.,European Reference Network 'ERN GUARD-Heart', Amsterdam, Netherlands
| | - Anders K Broendberg
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blv 99, DK-8200 Aarhus N, Denmark
| | - Thomas M Roston
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Ivan Blankoff
- C.H.U. Charleroi, Hôpital Civil Marie Curie Chaussée de Bruxelles 140 6042 Charleroi, Belgium
| | - Janneke A Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johannes C von Alvensleben
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO 80045, USA
| | - Julieta Lazarte
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Alexander Vallmitjana
- Department of Automatic Control, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain
| | - Loryn J Bohne
- Departments of Cardiac Sciences and Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Robert A Rose
- Departments of Cardiac Sciences and Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Raul Benitez
- Department of Automatic Control, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain
| | - Leif Hove-Madsen
- Biomedical Research Institute Barcelona (IIBB-CSIC) and IIB Sant Pau, Hospital de Sant Pau, Barcelona 08025, Spain
| | - Carlo Napolitano
- European Reference Network 'ERN GUARD-Heart', Amsterdam, Netherlands.,Division of Cardiology and Molecular Cardiology, IRCCS Maugeri Foundation-University of Pavia, 27100 Pavia, Italy.,Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5B7, Canada
| | - Michael Fill
- Department of Physiology and Biophysics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Shubhayan Sanatani
- Child and Family Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
| | - Arthur A M Wilde
- Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam 1105AZ, Netherlands. .,European Reference Network 'ERN GUARD-Heart', Amsterdam, Netherlands
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON N6A 5A5, Canada.
| | - Silvia G Priori
- European Reference Network 'ERN GUARD-Heart', Amsterdam, Netherlands. .,Division of Cardiology and Molecular Cardiology, IRCCS Maugeri Foundation-University of Pavia, 27100 Pavia, Italy.,Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy.,Molecular Cardiology Laboratory, Centro de Investigaciones Cardiovasculares Carlos III, 28029 Madrid, Spain
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blv 99, DK-8200 Aarhus N, Denmark.
| | - S R Wayne Chen
- Libin Cardiovascular Institute of Alberta, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 4Z6, Canada. .,Department of Physiology and Biophysics, Rush University Medical Center, Chicago, IL 60612, USA
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7
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de Vries TAC, Hemels MEW, Cools F, Crijns HJGM, Yperzeele L, Vanacker P, Blankoff I, Lancellotti P, Mairesse GH, de Veer A, Casado Arroyo R, Catez E, de Pauw M, Vanassche T, de Asmundis C, Kirchhof P, De Caterina R, de Groot JR. Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and The Netherlands: insights from the ETNA-AF-Europe study. Acta Cardiol 2021; 76:431-439. [PMID: 33406996 DOI: 10.1080/00015385.2020.1746095] [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: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. METHODS With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15-50 mL/min, weight ≤60 kg, and/or use of strong p-glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). RESULTS Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. CONCLUSION There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. TRIAL REGISTRATION NCT02944019; Date of registration: October 24, 2016.
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Affiliation(s)
- Tim A C de Vries
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
| | - Martin E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank Cools
- Department of Cardiology, General Hospital Klinieken Noord-Antwerpen, Brasschaat, Belgium
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laetitia Yperzeele
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | - Peter Vanacker
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
- Department of Neurology, General Hospital Groeninge, Kortrijk, Belgium
| | - Ivan Blankoff
- Department of Cardiology, Civil Hospital Marie Curie, Charleroi, Belgium
| | | | | | - Anne de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Emmanuel Catez
- Department of Cardiology, Brugmann University Hospital, Brussels, Belgium
| | - Michel de Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Vanassche
- Department of Cardiology, Leuven University Hospital, Leuven, Belgium
| | - Carlo de Asmundis
- Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- The Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Joris R de Groot
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
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8
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de Vries TAC, Hemels MEW, Cools F, Crijns HJGM, Yperzeele L, Vanacker P, Blankoff I, Lancellotti P, Mairesse GH, de Veer A, Casado Arroyo R, Catez E, de Pauw M, Vanassche T, de Asmundis C, Kirchhof P, De Caterina R, de Groot JR. Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and the Netherlands: insights from the ETNA-AF-Europe study. Neth Heart J 2021; 29:158-167. [PMID: 33411231 PMCID: PMC7904979 DOI: 10.1007/s12471-020-01518-7] [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] [Accepted: 10/21/2020] [Indexed: 11/09/2022] Open
Abstract
Background Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. Methods With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15–50 ml/min, weight ≤60 kg, and/or use of strong p‑glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). Results Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. Conclusion There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. Trial registration NCT02944019; Date of registration 24 October 2016 Electronic supplementary material The online version of this article (10.1007/s12471-020-01518-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T A C de Vries
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands. .,Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands.
| | - M E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Cools
- Department of Cardiology, General Hospital Klinieken Noord-Antwerpen, Brasschaat, Belgium
| | - H J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L Yperzeele
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | - P Vanacker
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium.,Department of Neurology, General Hospital Groeninge, Kortrijk, Belgium
| | - I Blankoff
- Department of Cardiology, Civil Hospital Marie Curie, Charleroi, Belgium
| | - P Lancellotti
- Department of Cardiology, University Hospital of Liège, Liège, Belgium
| | - G H Mairesse
- Department of Cardiology, Cliniques du Sud-Luxembourg, Arlon, Belgium
| | - A de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R Casado Arroyo
- Department of Cardiology, Hospital Erasme, Anderlecht, Belgium
| | - E Catez
- Department of Cardiology, Brugmann University Hospital, Brussels, Belgium
| | - M de Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - T Vanassche
- Department of Cardiology, Leuven University Hospital, Leuven, Belgium
| | - C de Asmundis
- Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,The Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - R De Caterina
- Department of Cardiology, University of Pisa, Pisa, Italy
| | - J R de Groot
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
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9
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Hoffmann R, Ingelaere S, Le Polain De Waroux J, Blankoff I, Mairesse G, Vijgen J, Vandekerckhove Y, Willems R. Relationship between mortality after ICD implantation and center volume in Belgium. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0789] [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
Introduction
In Belgium ICD implantation is restricted to 23 centers. A previous analysis of our group based on aggregated results per center showed that 3y mortality varied significantly between centers ranging from 7.5 to 23.4%. Multivariate analysis demonstrated that volume, infection rate and a higher proportion of implantations in primary prevention were predictors of 3y-mortality. These findings needed to be confirmed on a patient level since they could be caused by inter-patient rather than inter-hospital differences.
Methods
The QERMID-ICD database is a retrospective database of all patients implanted with an ICD in Belgium managed by the governmental health care institution (RIZIV/INAMI). Participation is mandatory for reimbursement. We analyzed data of 9896 new implantations performed between 2010 and 2016. Following patient characteristics were available: demographics (gender, NYHA class, primary vs secondary prevention, underlying heart disease, type of device, QRS duration, age and ejection fraction (EF)), comorbidities (atrial fibrillation, diabetes, COPD, neurological disease, oncological disease and renal failure), volume of center (low < median of 65 primo-implantations/year vs high >65 implantations/year) and the average income of the arrondissement in which the patient lived (low income < p25, median p25-p75, high > p75). The primary endpoint was 3y-mortality. Chi-squared test and Mann-Whitney U test with correction for multiple testing were used and multivariate logistic regression was performed to determine the corrected odds ratio for 3-year mortality. Finally, Kaplan-Meier survival analysis was performed.
Results
Low volume centers treated different patients than high volume centers. They implant more primary prevention (66.5 vs. 61.6%), more often patients with ischemic cardiomyopathy (49.8 vs 47.9%), less often arrhythmogenic heart disease (13.2 vs 16.6%) and patients with more co-morbidities and from communities with lower average income. High volume centers used more cardiac resynchronization therapy (26.8 vs 22.5%) despite no difference in QRS width. 1 and 3-y mortality were significantly higher in the low volume centers, respectively 5.6 vs. 4.4% and 16 vs. 11.1%. This was also confirmed in Kaplan Meier survival analysis. In multivariate logistic regression underlying heart disease, income, age, EF, NYHA class, CRT, indication and most comorbidities were significantly associated with mortality, but center volume remained an independent risk factor for 3-y mortality (OR = 0.749 (0.702–0.937), p<0.001).
Conclusion
Patients treated in low and high-volume centers in Belgium are different. However, there remained an association between volume and mortality of centers when controlling for these differences. Further research to elucidate if this association is due to statistical limitations of our analysis, referral bias or differences in quality of care is necessary.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Hoffmann
- University of Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - S Ingelaere
- University of Leuven, Cardiovascular Sciences, Leuven, Belgium
| | | | - I Blankoff
- University Hospital Charleroi, Charleroi, Belgium
| | - G Mairesse
- Clinique Du Sud Luxembourg, Arlon, Belgium
| | - J Vijgen
- Virga Jesse Hospital, Hasselt, Belgium
| | | | - R Willems
- University Hospitals (UZ) Leuven, Leuven, Belgium
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10
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Frontera A, Vlachos K, Kitamura T, Mahida S, Pillois X, Fahy G, Marquie C, Cappato R, Stuart G, Defaye P, Kaski JP, Ector J, Maltret A, Scanu P, Pasquie JL, Deisenhofer I, Blankoff I, Scherr D, Manninger M, Aizawa Y, Koutbi L, Denis A, Pambrun T, Ritter P, Sacher F, Hocini M, Maury P, Jaïs P, Bordachar P, Haïssaguerre M, Derval N. Long-Term Follow-Up of Idiopathic Ventricular Fibrillation in a Pediatric Population: Clinical Characteristics, Management, and Complications. J Am Heart Assoc 2020; 8:e011172. [PMID: 31057083 PMCID: PMC6512137 DOI: 10.1161/jaha.118.011172] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The natural history and long‐term outcome in pediatric patients with idiopathic ventricular fibrillation (IVF) are poorly characterized. We sought to define the clinical characteristics and long‐term outcomes of a pediatric cohort with an initial diagnosis of IVF. Methods and Results Patients were included from an International Registry of IVF (consisting of 496 patients). Inclusion criteria were: (1) VF with no identifiable cause following comprehensive analysis for ischemic, electrical or structural heart disease and (2) age ≤16 years. These included 54 pediatric IVF cases (age 12.7±3.7 years, 59% male) among whom 28 (52%) had a previous history of syncope (median 2 syncopal episodes [interquartile range 1]). Thirty‐six (67%) had VF in situations associated with high adrenergic tone. During a median 109±12 months of follow‐up, 31 patients (57%) had recurrence of ventricular arrhythmias, mainly VF. Two patients developed phenotypic expression of an inherited arrhythmia syndrome during follow‐up (hypertrophic cardiomyopathy and long QT syndrome, respectively). A total of 15 patients had positive genetic testing for inherited arrhythmia syndromes. Ten patients (18%) experienced device‐related complications. Three patients (6%) died, 2 due to VF storm. Conclusions In pediatric patients with IVF, a minority develop a definite clinical phenotype during long‐term follow‐up. Recurrent VF is common in this patient group.
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Affiliation(s)
- Antonio Frontera
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | - Takeshi Kitamura
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Saagar Mahida
- 3 Department of Cardiac Electrophysiology and Inherited Cardiac Diseases Liverpool Heart and Chest Hospital Liverpool United Kingdom
| | - Xavier Pillois
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | | | - Riccardo Cappato
- 6 Humanitas Clinical and Research Center Rozzano, Milan, Italy and Humanitas University, Department of Biomedical Sciences Milan Italy
| | | | | | - Juan Pablo Kaski
- 9 Centre for Inherited Cardiovascular Diseases Great Ormond Street Hospital London United Kingdom.,10 UCL Institute of Cardiovascular Science London United Kingdom
| | - Joris Ector
- 11 University Hospital Gasthuisberg Leuven Belgium
| | - Alice Maltret
- 12 Hôpital Necker Enfants Malades Service de Cardiologie Pédiatrique et Centre de Référence des Maladies Cardiaques Héréditaires Université Paris Descartes Paris France
| | | | | | | | - Ivan Blankoff
- 16 Centre Hospitalier University of Charleroi Belgium
| | - Daniel Scherr
- 17 Division of Cardiology Department of Medicine Medical University of Graz Austria
| | - Martin Manninger
- 17 Division of Cardiology Department of Medicine Medical University of Graz Austria
| | - Yoshifusa Aizawa
- 18 Niigata University Graduate School of Medical and Dental Science Niigata Japan
| | | | - Arnaud Denis
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Thomas Pambrun
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Philippe Ritter
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Frederic Sacher
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
| | - Meleze Hocini
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | | | - Pierre Jaïs
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Pierre Bordachar
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Michel Haïssaguerre
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France.,2 Liryc Institute Bordeaux France
| | - Nicolas Derval
- 1 Electrophysiology Department, Hopital Haut Lévêque Bordeaux France
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11
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Cools F, Wollaert B, Vervoort G, Verstraete S, Voet J, Hermans K, Heyse A, De Wolf A, Hollanders G, Boussy T, Anné W, Vercammen J, Faes D, Beutels M, Mairesse G, Purnode P, Blankoff I, Vandergoten P, Capiau L, Allu J, Bassand JP, Kayani G. Treatment patterns in anticoagulant therapy in patients with newly diagnosed atrial fibrillation in Belgium: results from the GARFIELD-AF registry. Acta Cardiol 2019; 74:309-318. [PMID: 30369290 DOI: 10.1080/00015385.2018.1494089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: AF, anticoagulation, NOACs, changing patterns of prescription. Methods: We describe baseline data and treatment patterns of patients recruited in Belgium in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF). Recruitment began when novel oral anticoagulants (NOACs) were introduced and provides a unique picture of changing treatment patterns over time. 1713 patients with a new (≤6 weeks duration) diagnosis of non-valvular atrial fibrillation (NVAF) and at least one investigator-defined stroke risk factor were recruited between May 2012 and August 2016, and will be prospectively followed for at least 2 years. Results: Overall, anticoagulant use in Belgium was higher than in the rest of Europe: 80.1% of patients received an anticoagulant ± antiplatelet (AP) therapy (14.5% on vitamin K antagonists; 65.6% on NOAC), 10.7% AP therapy and 9.3% no antithrombotic therapy. Over time, we observed an increase in anticoagulant use and a decrease in AP use for stroke prevention. NOAC use in Belgium was the highest of Europe at the study start, with many countries catching up later. In high stroke risk patients (CHA2DS2-VASc ≥2), anticoagulants were used in 84.3%, leaving 15.7% unprotected. In low risk patients (CHA2DS2-VASc 0-1) anticoagulants were overused (58.7%). Factor Xa inhibitors were used more frequently than direct thrombin inhibitors. Conclusion: Guideline adherence on stroke prevention was higher in Belgium than in the rest of Europe, and increased over time. NOAC use in Belgium was the highest of Europe at the study start, with many countries catching up later. Possible reasons are discussed. Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT01090362.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Dirk Faes
- Mariaziekenhuis Noord Limburg, Belgium
| | | | | | | | | | | | | | - Jagan Allu
- Thrombosis Research Institute, London, UK
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12
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Proietti M, Farcomeni A, Goethals P, Scavee C, Vijgen J, Blankoff I, Vandekerckhove Y, Lip GY, Mairesse GH. Cost-effectiveness and screening performance of ECG handheld machine in a population screening programme: The Belgian Heart Rhythm Week screening programme. Eur J Prev Cardiol 2019; 26:964-972. [PMID: 30935219 DOI: 10.1177/2047487319839184] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Overall, 40% of patients with atrial fibrillation are asymptomatic. The usefulness and cost-effectiveness of atrial fibrillation screening programmes are debated. We evaluated whether an atrial fibrillation screening programme with a handheld electrocardiogram (ECG) machine in a population-wide cohort has a high screening yield and is cost-effective. METHODS We used a Markov-model based modelling analysis on 1000 hypothetical individuals who matched the Belgian Heart Rhythm Week screening programme. Subgroup analyses of subjects ≥65 and ≥75 years old were performed. Screening was performed with one-lead ECG handheld machine Omron® HeartScan HCG-801. RESULTS In both overall population and subgroups, the use of the screening procedure diagnosed a consistently higher number of diagnosed atrial fibrillation than not screening. In the base-case scenario, the screening procedure resulted in 106.6 more atrial fibrillation patient-years, resulting in three fewer strokes, 10 more life years and five more quality-adjusted life years (QALYs). The number needed-to-screen (NNS) to avoid one stroke was 361. In subjects ≥65 years old, we found 80.8 more atrial fibrillation patient-years, resulting in three fewer strokes, four more life-years and five more QALYs. The NNS to avoid one stroke was 354. Similar results were obtained in subjects ≥75 years old, with a NNS to avoid one stroke of 371. In the overall population, the incremental cost-effectiveness ratio for any gained QALY showed that the screening procedure was cost-effective in all groups. CONCLUSIONS In a population-wide screening cohort, the use of a handheld ECG machine to identify subjects with newly diagnosed atrial fibrillation was cost-effective in the general population, as well as in subjects ≥65 and subjects ≥75 years old.
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Affiliation(s)
- Marco Proietti
- 1 Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessio Farcomeni
- 2 Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Italy
| | | | | | | | | | | | - Gregory Yh Lip
- 8 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, UK.,9 Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
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13
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Mairesse GH, Le Polain de Waroux JB, Willems R, Aelvoet W, Blankoff I, Vijgen J, Verbeet T. Quality assessment in Belgian arrhythmology: the Belgian heart rhythm association (BeHRA) databases. Acta Cardiol 2019; 74:46-51. [PMID: 29463193 DOI: 10.1080/00015385.2018.1440904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report presents and discusses, on behalf of the Belgian College of Cardiology, the evolution of the peer review process in arrhythmology, focussing on pacemaker implantation. Data from the last 22 years are compared. The national annual increase in implants is around 1%, clinical patient characteristics remained stable over the years while dual chamber pacing was proportionally increasing. Analyses of the normalised sick sinus and complete atrioventricular block ratios revealed a quite homogenous practice between centres and patient district with the only exception of the two more crowded districts. Battery longevity and infection rate were also assessed. With an incidence of 1/1000 device-years follow-up, Belgium remains below accepted European levels.
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Affiliation(s)
- Georges H Mairesse
- a Department of Cardiology , Cliniques du Sud Luxembourg , Arlon , Belgium
| | | | - Rik Willems
- c Department of Cardiology, Katholieke Universiteit Leuven , Leuven , Belgium
| | - Willem Aelvoet
- d Federal Public Service Health Belgium , Brussels , Belgium
| | - Ivan Blankoff
- e Centre Hospitalier Universitaire de Charleroi , Charleroi , Belgium
| | | | - Thierry Verbeet
- g Department of Cardiology, UVC Brugmann , Brussels , Belgium
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14
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Blankoff I, Goethals M, Mairesse GH. Belgian Society of Cardiology Belgian Heart Rhythm Association (BeHRA). Acta Cardiol 2017. [DOI: 10.1080/ac.67.5.2174142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Blankoff I, Goethals M, Mairesse GH. Belgian Society of Cardiology Belgian Heart Rhythm Association (BeHRA). Acta Cardiol 2017. [DOI: 10.1080/ac.69.5.3044888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Blankoff I, Goethal M, Mairesse GH. Belgian Society of Cardiology Belgian Heart Rhythm Association (BeHRA). Acta Cardiol 2017. [DOI: 10.1080/ac.68.5.2994482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Proietti M, Mairesse GH, Goethals P, Scavee C, Vijgen J, Blankoff I, Vandekerckhove Y, Lip GYH. Cerebrovascular disease, associated risk factors and antithrombotic therapy in a population screening cohort: Insights from the Belgian Heart Rhythm Week programme. Eur J Prev Cardiol 2016; 24:328-334. [DOI: 10.1177/2047487316682349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marco Proietti
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, UK
| | | | | | | | | | | | | | - Gregory YH Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
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18
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Conraads VMA, Vanderheyden M, Paelinck B, Verstreken S, Blankoff I, Miljoen H, De Sutter J, Beckers P. The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure patients: a pilot trial. ACTA ACUST UNITED AC 2016; 14:99-106. [PMID: 17301634 DOI: 10.1097/hjr.0b013e32801164b3] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both endurance training (ET) and cardiac resynchronization therapy (CRT) improve quality of life (QOL) and exercise tolerance in patients with advanced chronic heart failure (CHF). DESIGN A randomized intervention trial to study the effect on exercise capacity of ET in addition to CRT in patients with CHF and dyssynchrony. METHODS Seventeen patients (eight men, aged 59+/-9 years) with CHF and dyssynchrony were randomized to CRT with (n=8) or without (n=9) ET and compared with two matched control CHF groups (standard care with ET: n=9, standard care only: n=10). At baseline and after 5 months, exercise tolerance, left ventricular (LV) remodelling, QOL and NT-pro brain natriuretic peptide (NT-proBNP) levels were assessed. RESULTS Peak oxygen consumption (VO2peak), maximal workload (Wattmax), circulatory power, LV ejection fraction, dyssynchrony and QOL improved in both CRT groups. However, the increase in VO2peak (+40% versus +16%, P=0.005), Wattmax (+43% versus +13%, P=0.0005), and circulatory power (+74% versus +32%, P=0.01), was significantly greater in the trained versus the untrained CRT patients. Comparison of the four patient groups confirmed the cumulative effects of CRT plus ET. CONCLUSIONS ET in resynchronized CHF patients is feasible and further enhances exercise tolerance. Patients with severe CHF should be prescribed an exercise training programme after implantation in order to maximize the expected benefit.
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19
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Proietti M, Mairesse GH, Goethals P, Scavee C, Vijgen J, Blankoff I, Vandekerckhove Y, Lip GYH. A population screening programme for atrial fibrillation: a report from the Belgian Heart Rhythm Week screening programme. Europace 2016; 18:1779-1786. [PMID: 27170000 DOI: 10.1093/europace/euw069] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/25/2015] [Accepted: 02/23/2016] [Indexed: 11/13/2022] Open
Abstract
AIMS Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The aim of this national screening study was to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF in Belgian general population using an ECG handheld machine and its feasibility to identify new AF cases. METHODS AND RESULTS We analysed data obtained from 5 years of the 'Belgian Heart Rhythm Week' screening programme. All subjects were screened using a one-lead ECG handheld machine. Among 65 747 subjects screened, AF was recorded in 911, with an overall prevalence of 1.4% [95% confidence interval (CI) 1.2-1.6%]. High thrombo-embolic risk, as assessed by CHA2DS2-VASc score ≥2, was recorded in 69% of AF subjects. In subjects with high thrombo-embolic risk, only 5.4% were treated with oral anticoagulant (OAC) and 5.8% were treated with OAC and antiplatelet drugs. Among recorded AF cases, the use of the ECG handheld machine allowed identification of 603 new AF patients (1.1%, 95% CI 0.9-1.3%). Factors associated with incident AF were chronic heart failure (P < 0.001), age (P < 0.001), diabetes mellitus (P < 0.001), previous stroke (P < 0.001), vascular disease (P < 0.001), and male sex (P < 0.001). CONCLUSION In this Belgian national screening programme, prevalence of AF was 1.4%. The use of an ECG handheld machine is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this common arrhythmia.
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Affiliation(s)
- Marco Proietti
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
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20
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Haine SE, Miljoen HP, Blankoff I, Vrints CJ. Atrioventricular dissociation due to pheochromocytoma in a young adult. Clin Cardiol 2010; 33:E65-7. [PMID: 20865751 DOI: 10.1002/clc.20645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/18/2009] [Indexed: 12/27/2022] Open
Abstract
Atrioventricular dissociation can be a manifestation of an underlying noncardiac disease.We present a patient who underwent pacemaker implantation because of intermittent atrioventricular dissociation and medically untreatable supraventricular arrhythmias, which could not be induced by electrophysiological testing. The arrhythmias proved to be due to a pheochromocytoma. After left adrenalectomy, both the supraventricular arrhythmias and the atrioventricular dissociation disappeared. Adequate recognition and treatment of pheochromocytoma can reverse atrioventricular dissociation and may avoid unnecessary procedures such as electrophysiological testing and pacemaker implantation.
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21
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Haine SE, Miljoen HP, Blankoff I, Vrints CJ. Mianserin and Ventricular Tachycardia: Case Report and Review of the Literature. Cardiology 2006; 106:195-8. [PMID: 16675906 DOI: 10.1159/000093025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 02/23/2006] [Indexed: 11/19/2022]
Abstract
Mianserin is a drug frequently used to treat depression and sleep disturbances. Despite documented effects on various cardiac tissues in animal studies, mianserin has a very safe clinical profile. Only one case of ventricular arrhythmias in a patient treated with mianserin has been reported. This patient had a severe cardiac history. Our case is to our knowledge the first report on ventricular arrhythmias in a patient treated with mianserin without previous or present cardiac disease. After discontinuation of mianserin the arrhythmias disappeared within days. The literature on mianserin toxicity is reviewed.
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Affiliation(s)
- S E Haine
- Cardiology, University Hospital of Antwerp, Antwerp, Belgium.
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22
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Affiliation(s)
- H. Ector
- University Hospital Gasthuisberg, Department of Cardiology, Leuven, Belgium
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23
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Basiouny T, de Chillou C, Fareh S, Kirkorian G, Messier M, Sadoul N, Chevalier P, Magnin-Poull I, Blankoff I, Chen J, Touboul P, Aliot E. Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways. J Cardiovasc Electrophysiol 1999; 10:1340-9. [PMID: 10515558 DOI: 10.1111/j.1540-8167.1999.tb00189.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the accuracy and limitations of published algorithms using the 12-lead ECG to localize AV accessory pathways (APs). METHODS AND RESULTS The 11 relevant algorithms found in the literature (MEDLINE database and major scientific sessions) were tested on a series of 266 consecutive patients who successfully underwent radiofrequency catheter ablation of a single overt AV AP. The positive predictive values (PPV) of the algorithms in applicable patients were significantly lower for algorithms with > 6 accessory location sites (40.6% +/- 10.9% vs 61.2% +/- 8.0%; P < 0.03) and show a tendency for algorithms not relying on delta wave polarity but on QRS polarity only (36.6% +/- 11.2% vs 52.3% +/- 13.1%; P = 0.09). The PPV in applicable patients is related to the AP location (P < 0.001) and ranked from the highest to the lowest as follows: left lateral (mean PPV = 86.3%), posteroseptal (mean PPV = 65.2%), right anteroseptal (mean PPV = 45.2%), and right posterolateral (mean PPV = 23.4%). CONCLUSION Our study suggests that the accuracy of algorithms relying on the 12-lead ECG depends on AP locations as defined in the algorithms and on the number of AP sites. The accuracy tends to be lower when delta wave polarity is not included in the algorithm's architecture. This should be considered when using these algorithms or when building new ones.
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Affiliation(s)
- T Basiouny
- Service de Cardiologie, Hôpital Central, Nancy, France
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24
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Sadoul N, Blankoff I, de Chillou C, Beurrier D, Messier M, Bizeau O, Magnin I, Dodinot B, Aliot E. Effects of radiofrequency catheter ablation on patients with permanent pacemakers. J Interv Card Electrophysiol 1997; 1:227-33. [PMID: 9869976 DOI: 10.1023/a:1009721023732] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this study was to assess the effects of radiofrequency energy application on implanted pacemaker functions. Radiofrequency (RF) catheter ablation may cause pacemaker dysfunction due to electromagnetic interferences. The effects of RF on pacemaker behavior were studied in a series of 38 pacemakers, implanted 18 +/- 26 months prior to a RF procedure using either a right ventricular approach (AV node ablation, n = 35) or a left ventricular approach (left concealed accessory pathway ablation, n = 1; VT ablation, n = 2). The 38 patients (mean age 65 +/- 9 years) included 20 men and 18 women. Before energy applications, the 23 different pacemaker models were programmed to the VVI mode at the lowest available rate. The continuous surface ECG was recorded throughout the procedure. Thorough testing of the devices was performed before and after each RF delivery. Unusual pacemaker responses occurred in 20 of the 38 cases studied (53%). The impact of RF delivery was unpredictable, and variable dysfunctions were observed at different times for a given patient or could vary for a given model. Unusual pacemaker responses included pacemaker inhibition (n = 8), untoggled backup mode (n = 3), electromagnetic interference noise mode (n = 3), temporary RF-induced pacemaker tachycardia (n = 2), erratic behavior (n = 1), oversensing of RF onset and offset (n = 8), and transient loss of ventricular capture, (n = 1). Postablation, most devices automatically toggled back to full functionality. The three devices in the untoggled backup mode had to be reprogrammed to obtain normal operations. At the end of the procedure, pacing thresholds remained unchanged in all but one patient, in whom the increase in ventricular threshold was due to a nicked lead. In conclusion, implanted pacemakers frequently exhibit transient, unpredictable responses to RF energy application. Although all pacemaker functions were restored postablation, some devices had to be reset manually. The anomalies observed during the RF application argue for the simultaneous use of an external pacemaker in pacing-dependent patients.
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Affiliation(s)
- N Sadoul
- Service de Cardiologie, CHU de Nancy, France
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de Chillou C, Sadoul N, Bizeau O, Feldmann L, Gazakuré E, Ismaïl M, Magnin-Poull I, Blankoff I, Aliot E. Prognostic value of thrombolysis, coronary artery patency, signal-averaged electrocardiography, left ventricular ejection fraction, and Holter electrocardiographic monitoring for life-threatening ventricular arrhythmias after a first acute myocardial infarction. Am J Cardiol 1997; 80:852-8. [PMID: 9381997 DOI: 10.1016/s0002-9149(97)00535-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Prognostic studies after acute myocardial infarction (AMI) have mainly been performed in the prethrombolytic era. Despite the fact that modern management of AMI has reduced mortality rates, the occurrence of malignant ventricular arrhythmias in the late phase of AMI remains an important issue. We prospectively studied 244 consecutive patients (97 treated with thrombolytics) who survived a first AMI. All patients underwent time domain signal-averaged electrocardiography (vector magnitude: measurements of total QRS duration, terminal low [<40 microV] amplitude signal duration, and root-mean-square voltage of the last 40 ms of the QRS complex), Holter electrocardiographic monitoring, and cardiac catheterization. Late life-threatening ventricular arrhythmias were recorded. Eighteen arrhythmic events occurred during a mean follow-up period of 57 +/- 18 months. Three independent factors were associated with a higher risk of arrhythmic events: (1) left ventricular ejection fraction (odds ratio 1.9/0.10 decrease), (2) terminal low-amplitude signal duration (odds ratio 1.5/5 ms increase), and (3) absence of thrombolytic therapy (odds ratio 3.9). Low-amplitude signal duration sensitivity for sudden cardiac death was low (30%). Left ventricular ejection fraction had the highest positive predictive value for sudden cardiac death (10%). Thus, thrombolysis decreases both the incidence of ventricular tachycardia and sudden cardiac death with a higher reopening rate of the infarct-related vessel. Signal averaging predicts the occurrence of ventricular tachycardia and an impaired left ventricular ejection fraction predicts the occurrence of sudden cardiac death.
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Affiliation(s)
- C de Chillou
- Service de Cardiologie, Hôpital Central, Nancy, France
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Copie X, Hnatkova K, Blankoff I, Staunton A, Camm AJ, Malik M. [Risk of mortality after myocardial infarction: value of heart rate, its variability and left ventricular ejection fraction]. Arch Mal Coeur Vaiss 1996; 89:865-71. [PMID: 8869248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Heart rate variability is a useful parameter for risk stratification after myocardial infarction. However, the relationship between heart rate itself and its variability has not been adequately studied. The authors compared the average RR interval of 24 hours recorded by Holter monitoring with the variability of heart rate and of left ventricular ejection fraction to assess the risk of death after myocardial infarction. A total of 579 patients was followed up for 2 years after acute myocardial infarction. During this period, there were 54 deaths, 42 of cardiac origin, 26 being classified as sudden death. The positive predictive value of left ventricular ejection fraction was lower than those of mean RR interval and the variability of heart rate for overall mortality, cardiac mortality and sudden death. The three indices were essentially equivalent for the prediction of non-sudden cardiac death. The positive predictive value of heart rate variability was better than the mean RR interval for sensitivities < 40%, for all cause mortality. However, for sensitivities > 40%, the two parameters were equivalent or slightly in favour of the mean heart rate over 24 hours. The authors conclude that the mean RR interval over 24 hours is an important prognostic index after myocardial infarction. This index is more powerful than left ventricular ejection fraction and comparable to heart rate variability.
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Affiliation(s)
- X Copie
- Département de cardiologie, hôpital Broussais, Paris
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27
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Copie X, Blankoff I, Hnatkova K, Fei L, Camm AJ, Malik M. [Influence of the duration of recording in the reproducibility of the signal averaged electrocardiogram]. Arch Mal Coeur Vaiss 1996; 89:723-7. [PMID: 8760658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors studied the possibility of improving the reproducibility of the signal averaged ECG by increasing the number of averaged QRS complexes. One hundred patients were included in the study. In each cases, 400 QRS complexes were recorded on twice, consecutively, in strictly identical conditions. During each recording, the total duration of the amplified and averaged QRS complex (tQRS), the duration of the terminal signal below 40 microV (LAS) and the root mean square of the amplitude of the last 40 ms (RMS) were determined for 100, 200, 300 and 400 recorded QRS complexes. The presence of late potentials was defined as the positivity of two of the following criteria: tQRS > 114 ms, LAS > 38 ms, RMS < 20 microV. The number of contradictory diagnostic conclusions between two successive recordings of the same duration decreased progressively with the number of averaged QRS complexes: 10 for 100 QRS, 10 for 200 QRS, 9 for 300 QRS and 6 for 400 QRS complexes, but this improvement was not statistically significant. The absolute differences of tQRS and RMS between two successive recordings of the same duration were statistically different for the four durations of recording (p = 0.05) and there was a tendency towards statistical significance for LAS (p = 0.09). The best quantitative reproducibility of the 3 parameters was obtained with the recording of 300 QRS complexes. In conclusion, the reproducibility of the signal averaged ECG is improved when the number of average QRS complexes is increased. The authors' results suggests that reproducibility this is optimal with the amplification and averaging of 300 QRS complexes.
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Affiliation(s)
- X Copie
- Service de cardiologie (Pr Guize), hôpital Broussais, Paris
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Sopher SM, Murgatroyd FD, Slade AK, Blankoff I, Rowland E, Ward DE, Camm AJ. Low energy internal cardioversion of atrial fibrillation resistant to transthoracic shocks. Heart 1996; 75:635-8. [PMID: 8697172 PMCID: PMC484392 DOI: 10.1136/hrt.75.6.635] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the efficacy of internal cardioversion using low energy shocks delivered with a biatrial electrode configuration in chronic atrial fibrillation resistant to transthoracic shocks. METHODS Low energy internal cardioversion was attempted in 11 patients who had been in atrial fibrillation for 233 (SD 193) days and had failed to cardiovert with transthoracic shocks of 360 J in both apex-base and anterior-posterior positions. Synchronised biphasic shocks of up to 400 V (approximately 6 J) were delivered, usually with intravenous sedation only, between high surface area electrodes in the right atrium and the left atrium (coronary sinus in nine, left pulmonary artery in one, left atrium via patent foramen ovale in one). RESULTS Sinus rhythm was restored in 8/11 patients. The mean leading edge voltage of successful shocks was 363 (46) V [4.9 (1.2) J]. Higher energy shocks induced transient bradycardia [time to first R wave 1955 (218) ms]. No proarrhythmia or other acute complications were observed. CONCLUSIONS Low energy internal cardioversion of atrial fibrillation can restore sinus rhythm in patients in whom conventional transthoracic shocks have failed.
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Copie X, Blankoff I, Fei L, Murgatroyd FD, Hnatkova K, Malik M, Camm AJ. [Reproducibility of signal-averaged electrocardiography]. Arch Mal Coeur Vaiss 1996; 89:325-30. [PMID: 8734185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The reproducibility of the parameters defining the presence of late potentials on the signal-averaged electrocardiogram is one of the limiting factors of the method. The authors studied the coefficients of correlation and reproducibility of these parameters in patients with coronary artery disease. In addition, they tried to determine which parameter was most often responsible for changing a diagnostic conclusion (i.e., presence or absence of late potentials). Two signal-averaged ECGs were recorded one after the other in 127 patients. The presence of late potentials was defined as the presence of a least two of the following criteria: total amplified and averaged QRS duration (tQRS) > 114 ms: duration of the last signal of under 40 microV (LAS) > 38 ms, and root mean square of the amplitude of the last 40 ms (RMS) < 20 microV. The correlation coefficients were 0.98, 0.96 and 0.94 for the duration of tQRS, LAS and RMS respectively (p < 0.0001). The coefficients of reproducibility were 7.0 ms. 7.0 ms and 16.1 microV respectively. Late potentials were present in 22% of patients. A change in diagnosis between the first and second recording was observed in 10 subjects (8% of the population). A combined change in LAS and RMS was responsible for 6 of these revised diagnoses, a change in LAS alone in 2 cases, of the RMS alone in 1 case and the tQRS alone in 1 case. In patients with coronary artery disease, the immediate reproducibility of the diagnosis of late potentials is affected by changes in LAS and RMS. The tQRS is only rarely responsible for a change in diagnosis. This study suggests that the result of the signal-averaged ECG should be interpreted with caution when the LAS or RMS are near their threshold values.
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Affiliation(s)
- X Copie
- Service de cardiologie A, hôpital Broussais, Paris
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Murgatroyd FD, Xie B, Copie X, Blankoff I, Camm AJ, Malik M. Identification of atrial fibrillation episodes in ambulatory electrocardiographic recordings: validation of a method for obtaining labeled R-R interval files. Pacing Clin Electrophysiol 1995; 18:1315-20. [PMID: 7659586 DOI: 10.1111/j.1540-8159.1995.tb06972.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Current systems for analyzing ambulatory electrocardiograms (ECGs) are unable to distinguish precisely between sinus rhythm and atrial fibrillation (AF) episodes, and are unable to produce RR interval listings that distinguish AF from sinus rhythm on a beat-to-beat basis. We describe a method for obtaining such a computerized listing ("Composite Rhythm" file) from ambulatory recordings containing episodes of AF. The file lists the rhythm of each beat, its real time, and the QRS complex morphology. A visual inspection is made of a full printout of the recording to identify the precise time of onset and termination of each episode of AF. These times are entered into a computer and identified with the corresponding beats on a conventional RR interval file generated by Holter analysis. The method was validated using 1-hour segments from 20 ambulatory ECGs containing 145 episodes of AF. These were visually identified by four independent observers with a mean sensitivity of 99.1%. The first beat of AF was identified concordantly in 96% of episodes, with a discrepancy of < or = 3 beats in the other episodes. The times of 200 selected QRS complexes were then entered into the computer by each observer; 91.1% of these complexes were identified exactly and 100% were identified to within one beat. The Composite Rhythm files have several potential applications for testing AF detection algorithms and studying the mode of onset of AF.
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Affiliation(s)
- F D Murgatroyd
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom
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