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Vijayaraman P, Trivedi RS, Koneru JN, Sharma PS, De Pooter J, Schaller RD, Cano Ó, Whinnett ZI, Migliore F, Ponnusamy SS, Skeete JR, Zanon F, Heuverswyn FV, Kolominsky J, Pittorru R, Mumtaz M, Ellenbogen KA, Herweg B. Transvenous extraction of conduction system pacing leads: An international multicenter (TECSPAM) study. Heart Rhythm 2024:S1547-5271(24)02381-6. [PMID: 38762819 DOI: 10.1016/j.hrthm.2024.04.054] [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: 03/31/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Conduction system pacing (CSP) by His bundle pacing or left bundle branch area pacing (LBBAP) is incorporated into Heart Rhythm Society guidelines for the management of bradycardia and cardiac resynchronization therapy. Despite increasing adoption with both lumenless leads and stylet-driven leads, concerns regarding the feasibility and safety of the extraction of CSP leads remain. OBJECTIVE The aim of the study was to report on the safety, feasibility, and clinical outcomes of the extraction of CSP leads. METHODS Patients undergoing the extraction of CSP leads from 10 international centers were enrolled in this retrospective study. Data regarding indications, lead location, lead type, extraction tools, procedural success, complications, and reimplantation in the conduction system were collected. RESULTS Overall, 341 patients (age 69 ± 15 years; female 34%; cardiomyopathy 46%; lead dwell time 22 ± 26 months) underwent the extraction of 224 His bundle pacing and 117 LBBAP leads (lumenless leads 321; stylet-driven leads 20). Complete procedural success was achieved in 338 (99%), while clinical success was 100% with retained distal fragments in 3 patients (1%). Among patients with a lead dwell time of >6 months (6-193 months; n = 226), manual extraction was successful in 198 (87%), mechanical tools in 22 (10%), and laser in 6 (3%). Femoral tools were necessary in 3 patients. Minor complications occurred in 7 patients (2.1%). CSP reimplantation was successful in 233 of 244 patients attempted (95%). CONCLUSION The overall success rates of the extraction of CSP leads were very high (although the LBBAP lead dwell time was <3 years), with a low need for extraction tools and minimal complication. Reimplantation in the conduction system is feasible and safe.
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Affiliation(s)
| | | | | | | | | | - Robert D Schaller
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Óscar Cano
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | | | | | | | | | | | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | - Mishal Mumtaz
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | | | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Tampa, Florida
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Liu CF, Prasad KV, Moretta A, Vijayaraman P, Zanon F, Gleva M, De Pooter J, Chinitz LA. Left Bundle Branch Area Pacing using a Stylet-Driven, Retractable-Helix Lead: Short Term Results from a Prospective, Multicenter IDE Trial (The BIO-CONDUCT Study). Heart Rhythm 2024:S1547-5271(24)02547-5. [PMID: 38772432 DOI: 10.1016/j.hrthm.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) has swiftly emerged as a safe and effective alternative to right ventricular (RV) pacing. Limited data exists on the use of retractable-helix, stylet-driven leads (SDL) for LBBAP. OBJECTIVE The objective is to prospectively evaluate performance and safety of the Solia S stylet-driven pacing lead in a rigorously controlled multi-center trial to support U.S. market application. METHODS A multi-center, prospective, non-randomized trial enrolled patients with standard pacing indications. Implant procedural and lead data, including threshold, sensing, impedance, and capture type were collected through 3-months. Primary endpoints were freedom from LBBAP lead-related serious complications through 3-months and LBBAP implant success according to pre-specified criteria. A blinded Clinical Events Committee (CEC) adjudicated all potential endpoint complications. RESULTS A total of 186 patients were included from 14 US sites. LBBAP implants were successful in 95.7% (178/186; 95% CI: 91.7%, 98.1%; p< 0.0001 for comparison to performance goal of 88%). Through the 3-month follow-up, 3 patients experienced a serious LBBAP complication, all lead dislodgements, resulting in a LBBAP lead-related complication-free rate of 98.3%. A total of 13 patients (7.8%) experienced any system-related or procedure-related complication. Mean threshold was 0.89V at 0.4ms, sensing was 10.8mV, and impedance was 608 ohms. CONCLUSION The short-term results from this prospective trial demonstrate both high implant success and freedom from LBBAP lead-related complications utilizing this stylet driven retractable helix lead. This trial supports the safety, use, and effectiveness of SDL for performing contemporary physiologic pacing.
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De Pooter J, Timmers L, Boveda S, Combes S, Knecht S, Almorad A, De Asmundis C, Duytschaever M. Validation of a machine learning algorithm to identify pulmonary vein isolation during ablation procedures for the treatment of atrial fibrillation: results of the PVISION study. Europace 2024; 26:euae116. [PMID: 38682165 PMCID: PMC11089576 DOI: 10.1093/europace/euae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of ablation for atrial fibrillation. Confirmation of PVI can be challenging due to the presence of far-field electrograms (EGMs) and sometimes requires additional pacing manoeuvres or mapping. This prospective multicentre study assessed the agreement between a previously trained automated algorithm designed to determine vein isolation status with expert opinion in a real-world clinical setting. METHODS AND RESULTS Consecutive patients scheduled for PVI were recruited at four centres. The ECGenius electrophysiology (EP) recording system (CathVision ApS, Copenhagen, Denmark) was connected in parallel with the existing system in the laboratory. Electrograms from a circular mapping catheter were annotated during sinus rhythm at baseline pre-ablation, time of isolation, and post-ablation. The ground truth for isolation status was based on operator opinion. The algorithm was applied to the collected PV signals off-line and compared with expert opinion. The primary endpoint was a sensitivity and specificity exceeding 80%. Overall, 498 EGMs (248 at baseline and 250 at PVI) with 5473 individual PV beats from 89 patients (32 females, 62 ± 12 years) were analysed. The algorithm performance reached an area under the curve (AUC) of 92% and met the primary study endpoint with a sensitivity and specificity of 86 and 87%, respectively (P = 0.005; P = 0.004). The algorithm had an accuracy rate of 87% in classifying the time of isolation. CONCLUSION This study validated an automated algorithm using machine learning to assess the isolation status of pulmonary veins in patients undergoing PVI with different ablation modalities. The algorithm reached an AUC of 92%, with both sensitivity and specificity exceeding the primary study endpoints.
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Affiliation(s)
- Jan De Pooter
- Heart Center, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Liesbeth Timmers
- Heart Center, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Demolder A, Nauwynck M, De Pauw M, De Buyzere M, Duytschaever M, Timmermans F, De Pooter J. Prediction of certainty in artificial intelligence-enabled electrocardiography. J Electrocardiol 2024; 83:71-79. [PMID: 38367372 DOI: 10.1016/j.jelectrocard.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/31/2023] [Accepted: 01/28/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The 12‑lead ECG provides an excellent substrate for artificial intelligence (AI) enabled prediction of various cardiovascular diseases. However, a measure of prediction certainty is lacking. OBJECTIVES To assess a novel approach for estimating certainty of AI-ECG predictions. METHODS Two convolutional neural networks (CNN) were developed to predict patient age and sex. Model 1 applied a 5 s sliding time-window, allowing multiple CNN predictions. The consistency of the output values, expressed as interquartile range (IQR), was used to estimate prediction certainty. Model 2 was trained on the full 10s ECG signal, resulting in a single CNN point prediction value. Performance was evaluated on an internal test set and externally validated on the PTB-XL dataset. RESULTS Both CNNs were trained on 269,979 standard 12‑lead ECGs (82,477 patients). Model 1 showed higher accuracy for both age and sex prediction (mean absolute error, MAE 6.9 ± 6.3 years vs. 7.7 ± 6.3 years and AUC 0.946 vs. 0.916, respectively, P < 0.001 for both). The IQR of multiple CNN output values allowed to differentiate between high and low accuracy of ECG based predictions (P < 0.001 for both). Among 10% of patients with narrowest IQR, sex prediction accuracy increased from 65.4% to 99.2%, and MAE of age prediction decreased from 9.7 to 4.1 years compared to the 10% with widest IQR. Accuracy and estimation of prediction certainty of model 1 remained true in the external validation dataset. CONCLUSIONS Sliding window-based approach improves ECG based prediction of age and sex and may aid in addressing the challenge of prediction certainty estimation.
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Affiliation(s)
- Anthony Demolder
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
| | - Maxime Nauwynck
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Marc De Buyzere
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Özpak E, Van Heuverswyn F, Timmermans F, De Pooter J. Lead performance of stylet-driven leads in left bundle branch area pacing: Results from a large single-center cohort and insights from in vitro bench testing. Heart Rhythm 2024:S1547-5271(24)00103-6. [PMID: 38307309 DOI: 10.1016/j.hrthm.2024.01.049] [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: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) requires deep septal lead deployment for left-sided conduction stimulation. Advancing leads toward deep septal positions might add mechanical stress on these leads. Concerns about lead performance and reliability remain an unanswered question. OBJECTIVE The purpose of this study was to analyze lead performance and integrity of stylet-driven pacing leads (SDLs) for LBBAP. METHODS This study assessed lead fracture rates of SDL in a large single-center cohort of adult LBBAP patients. Fluoroscopic analysis of lead bending angulations at the septal insertion point and in vitro bench testing of lead preconditioning were performed to simulate clinical use conditions. Lead performance was compared between LBBAP and conventional right ventricular apical pacing (RVp) sites. RESULTS The study included 325 LBBAP patients (66% male; age 71±15 years). During median follow-up of 18 months, 2 patients (0.6%) experienced conductor fracture between tip housing and ring electrode, whereas no such fractures occurred with RVp patients (n = 149; P = .22). X-ray analysis revealed that high lead bending angulations occurred in 1.3% of the patients. Accelerated bench testing of excessive preconditioned leads showcased a higher probability of early conductor fracture compared to standard preconditioned leads. CONCLUSION The incidence of early conductor failure in LBBAP seems higher than with conventional RVp sites. The most vulnerable lead part seems to be the interelectrode space between the tip housing and ring electrode. Excessive angulation and preconditioning might contribute to early fatigue fracture.
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Affiliation(s)
- Emine Özpak
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
| | | | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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De Pooter J, Bulava A, Gras D, Timmer S, Chin-Pang Chan G, Clementy N, Pathak RK, Healy S, Lüsebrink U, Zanon F. Utility of a guiding catheter for conduction system pacing: An early multicenter experience. Heart Rhythm O2 2024; 5:8-16. [PMID: 38312208 PMCID: PMC10837172 DOI: 10.1016/j.hroo.2023.11.017] [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: 02/06/2024] Open
Abstract
Background Conduction system pacing (CSP), either as His bundle pacing (HBP) or as left bundle branch area pacing (LBBAP), may be superior to right ventricular apical or septal pacing. Objective The study sought to present acute results for a new guiding catheter (Biotronik Selectra 3D) designed for CSP implantations of a retractable screw-in lead (Biotronik Solia S). Methods The primary endpoint of the prospective, international nonrandomized BIO|MASTER.Selectra 3D study was freedom from catheter-related serious adverse device effects (SADEs) within 1 week of lead implantation. Results Of 157 enrolled patients, CSP was achieved in 147 (93.6%) patients. No SADEs occurred within 7 days. LBBAP was achieved in 82 patients (45 as crossover from an HBP attempt) and HBP in 65 (44.2%) patients. In centers considering both HBP and LBBAP, the CSP implantation success approached 99%. Successful CSP implantations lasted on average ∼50 minutes (fluoroscopy ∼6 minutes). Most procedures (87.9%) needed only 1 catheter, even after switch from HBP to LBBAP. The catheter's handling was rated largely positive. In patients without bundle branch block, mean QRS duration increased from 106 ms (intrinsic) to 122 ms (CSP) (P = .001). In patients with bundle branch block, mean QRS duration decreased from 151 ms (intrinsic) to 137 ms (CSP) (P = .004). Conclusion The Selectra 3D catheter is a valuable tool for HBP and LBBAP implantations of the stylet-supported pacemaker leads. When implanters considered both HBP and LBBAP, the success rate was ∼99%. Flexibility to change between different approaches may be advisable in heterogeneous and challenging areas, such as CSP implantations.
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Affiliation(s)
| | - Alan Bulava
- České Budějovice Hospital, Faculty of Health and Social Sciences, Cardiology, University of South Bohemia, České Budějovice, Czech Republic
| | - Daniel Gras
- Hôpital Privé du Confluent, Cardiology, Nantes, France
| | - Stefan Timmer
- Noordwest Ziekenhuisgroep, Cardiology, Alkmaar, the Netherlands
| | | | - Nicolas Clementy
- Centre Hospitalier Régional Universitaire de Tours, Cardiology, Chambray-lès-Tours, France
| | - Rajeev K Pathak
- Canberra Heart Rhythm, Australian National University, Cardiology, Garran, Australian Capital Territory, Australia
| | - Stewart Healy
- Monash Medical Centre, Cardiology, Melbourne, Victoria, Australia
| | - Ulrich Lüsebrink
- Universitätsklinikum Gießen und Marburg, Kardiologie, Marburg, Germany
| | - Francesco Zanon
- Santa Maria della Misericordia, Arrhythmia and Electrophysiology Unit, Rovigo, Italy
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Özpak E, Van Heuverswyn F, Timmermans F, De Pooter J. Feasibility and safety of left bundle branch area pacing in patients with septal hypertrophy. J Cardiovasc Electrophysiol 2023; 34:2255-2261. [PMID: 37717221 DOI: 10.1111/jce.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) aims to provide physiological ventricular activation during pacing. Left ventricular septal hypertrophy (LVSH) might be challenging for LBBAP due to the thickness of the interventricular septum and potential presence of septal scar. This study assesses the feasibility, safety, and outcome of LBBAP in patients with LVSH using primarily stylet-driven leads (SDL). METHODS Adult patients with LVSH who underwent LBBAP between March 2019 and November 2022 were enrolled. Baseline patient characteristics, procedural data and postprocedural results were collected. The feasibility of LBBAP in LVSH patients was compared to a cohort of LBBAP patients with normal septal wall thickness (NST). RESULTS Seventeen LVSH and 133 NST patients underwent LBBAP with successful implantation achieved in 15 LVSH patients (88%). Mean implant depth was 17.2 ± 1.9 mm, with 53% proven left bundle branch (LBB) capture. Paced QRS duration (146 ± 14 ms) and V6 R-wave peak time (V6 RWPT; 79 ± 20 ms) were comparable between patients with and without septal hypertrophy, although patients with NST had higher rates of proven LBB capture (71% vs. 53%). In LVSH pacing thresholds (0.6 ± 0.3 V at 0.4 ms) and R-wave amplitude (13.9 ± 5.6 mV) were favorable and remained stable at follow-up. At 12 months, 87% of patients had stable or improved left ventricular ejection fraction. CONCLUSION The results of the study indicate that LBBAP in patients with LVSH is safe and feasible and no lead-related complications were observed despite a mean implant depth exceeding 15 mm. LBBAP using SDL results in favorable pacing and electrocardiographic characteristics in LVSH patients, comparable to patients with NST.
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Affiliation(s)
- Emine Özpak
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Perino AC, Wang PJ, Lloyd M, Zanon F, Fujiu K, Osman F, Briongos-Figuero S, Sato T, Aksu T, Jastrzebski M, Sideris S, Rao P, Boczar K, Yuan-Ning X, Wu M, Namboodiri N, Garcia R, Kataria V, De Pooter J, Przibille O, Gehi AK, Cano O, Katsouras G, Cai B, Astheimer K, Tanawuttiwat T, Datino T, Rizkallah J, Alasti M, Feld G, Barrio-Lopez MT, Gilmore M, Conti S, Yanagisawa S, Indik JH, Zou J, Saha SA, Rodriguez-Munoz D, Chang KC, Lebedev DS, Leal MA, Haeberlin A, Forno ARJD, Orlov M, Frutos M, Cabanas-Grandio P, Lyne J, Leyva F, Tolosana JM, Ollitrault P, Vergara P, Balla C, Devabhaktuni SR, Forleo G, Letsas KP, Verma A, Moak JP, Shelke AB, Curila K, Cronin EM, Futyma P, Wan EY, Lazzerini PE, Bisbal F, Casella M, Turitto G, Rosenthal L, Bunch TJ, Baszko A, Clementy N, Cha YM, Chen HC, Galand V, Schaller R, Jarman JWE, Harada M, Wei Y, Kusano K, Schmidt C, Hurtado MAA, Naksuk N, Hoshiyama T, Kancharla K, Iida Y, Mizobuchi M, Morin DP, Cay S, Paglino G, Dahme T, Agarwal S, Vijayaraman P, Sharma PS. Worldwide survey on implantation of and outcomes for conduction system pacing with His bundle and left bundle branch area pacing leads. J Interv Card Electrophysiol 2023; 66:1589-1600. [PMID: 36607529 PMCID: PMC9817436 DOI: 10.1007/s10840-022-01417-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.
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Affiliation(s)
- Alexander C Perino
- Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Paul J Wang
- Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | | | - Francesco Zanon
- Santa Maria Della Misericordia General Hospital, Perugia, Italy
| | | | | | | | | | - Tolga Aksu
- Yeditepe University Hospital, Istanbul, Turkey
| | | | | | - Praveen Rao
- Baylor University Medical Center, Dallas, USA
| | | | - Xu Yuan-Ning
- West China Hospital, Sichuan University, Chengdu, China
| | - Michael Wu
- Lifespan Cardiovascular Institute, Brown University, Providence, USA
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | | | - Anil K Gehi
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Oscar Cano
- Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Binni Cai
- Xiamen Cardiovascular Hospital, Xiamen, China
| | | | | | - Tomas Datino
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | | | - Gregory Feld
- University of California San Diego Health System, San Diego, USA
| | | | | | | | | | - Julia H Indik
- University of Arizona College of Medicine, Tucson, USA
| | - Jiangang Zou
- First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial Hospital, Nanjing, China
| | | | | | - Kuan-Cheng Chang
- School of Medicine, China Medical University, Taichung, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - Dmitry S Lebedev
- National Medical Research Center. VA Almazov, Saint Petersburg, Russia
| | - Miguel A Leal
- School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | | | | | | | - Manuel Frutos
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Francisco Leyva
- Aston University, Birmingham, UK
- Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Cristina Balla
- Azienda Ospedaliero Universitaria Di Ferrara, Cona, Italy
| | | | | | | | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada
| | | | | | - Karol Curila
- Cardiocenter, 3Rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Edmond M Cronin
- Lewis Katz School of Medicine at, Temple University, Philadelphia, USA
| | - Piotr Futyma
- Medical College, University of Rzeszów, Rzeszów, Poland
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | | | - Pietro Enea Lazzerini
- University of Siena, Siena, Italy
- Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Felipe Bisbal
- University Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Gioia Turitto
- New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | | | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, USA
| | - Artur Baszko
- Poznań University of Medical Sciences, Poznań, Poland
| | | | | | | | | | - Robert Schaller
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | | | - Yong Wei
- Shanghai General Hospital, Shanghai, China
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | - Yoji Iida
- Kobari General Hospital, Noda, Japan
| | | | | | | | | | - Tillman Dahme
- Universitätsklinikum Ulm (Ulm University Medical Center), Ulm, Germany
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Özpak E, Vriese JD, Van Heuverswyn F, Timmermans F, Burri H, De Pooter J. Pitfalls in programming "LV only" mode in left bundle branch area pacing. J Cardiovasc Electrophysiol 2023; 34:483-486. [PMID: 36598451 DOI: 10.1111/jce.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Emine Özpak
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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De Pooter J. My preferred approach to left bundle branch area pacing: Stylet-driven leads. Heart Rhythm O2 2023; 4:154-156. [PMID: 36873317 PMCID: PMC9975020 DOI: 10.1016/j.hroo.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/28/2022] Open
Affiliation(s)
- Jan De Pooter
- Heart Center, Ghent University Hospital, Ghent, Belgium
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Kellens PJ, De Hauwere A, Gossye T, Peire S, Tournicourt I, Strubbe L, De Pooter J, Bacher K. Integrity of personal radiation protective equipment (PRPE): a 4-year longitudinal follow-up study. Insights Imaging 2022; 13:183. [PMID: 36471171 PMCID: PMC9723036 DOI: 10.1186/s13244-022-01323-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Personal radiation protective equipment (PRPE) such as lead aprons minimises radiation exposure of operators using X-ray systems. However, PRPE might be prone to cracks in the attenuating layer resulting in inadequate radiation protection. This study aims to investigate the prevalence, qualification and quantification of PRPE integrity during a longitudinal follow-up study. METHODS All PRPE of a large, general hospital was evaluated yearly in the period 2018-2021. The equipment was inspected on a tele-operated X-ray table, and tears were qualified and quantified using an X-ray opaque ruler. Rejection criteria of Lambert & McKeon, with an extra rejection criterion of 15 mm2 for individual tears, were applied to accept or reject further use of the PRPE. RESULTS Over the 4-year follow-up period, a total of 1011 pieces of PRPE were evaluated. In total, 47.3% of the PRPE showed tears of which 31% exceeded the mentioned rejection criteria. Remarkably, of the 287 newly registered pieces of PRPE, 6.0% showed tears in the first year of use of which 88.2% needed to be rejected. Also, 48% of the repaired PRPE was rejected again in the consecutive year. CONCLUSIONS PRPE is prone to cracks. Up to 50% of PRPE showed tears and cracks resulting in 31% rejections. Newly purchased PRPE is not guaranteed to remain free of cracks and tears in the first year of use. Repair does not guarantee a long-term solution for prolonging the lifespan. Regular X-ray-based integrity analysis of PRPE is needed to ensure adequate radioprotection for operators using X-ray systems.
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Affiliation(s)
- Pieter-Jan Kellens
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - An De Hauwere
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - Tim Gossye
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
| | - Sven Peire
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Ingrid Tournicourt
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Luc Strubbe
- grid.420036.30000 0004 0626 3792AZ Sint-Jan Brugge - Oostende AV, Brugge, Belgium
| | - Jan De Pooter
- grid.410566.00000 0004 0626 3303Heart Centre, University Hospital Ghent, Ghent, Belgium
| | - Klaus Bacher
- grid.5342.00000 0001 2069 7798Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium
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Kellens PJ, De Hauwere A, Gossye T, Peire S, Tournicourt I, Strubbe L, De Pooter J, Bacher K. INTEGRITY OF PERSONAL RADIATION PROTECTIVE EQUIPMENT (PRPE): A 4-YEAR LONGITUDINAL FOLLOW-UP STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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13
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Calle S, Duchenne J, Beela AS, Stankovic I, Puvrez A, Winter S, Fehske W, Aarones M, De Buyzere M, De Pooter J, Voigt JU, Timmermans F. Clinical and Experimental Evidence for a Strain-Based Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. Circ Cardiovasc Imaging 2022; 15:e014296. [PMID: 36330792 DOI: 10.1161/circimaging.122.014296] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Septal strain patterns measured by echocardiography reflect the severity of left bundle branch block (LBBB)-induced left ventricular (LV) dysfunction. We investigated whether these LBBB strain stages predicted the response to cardiac resynchronization therapy in an observational study and developed a sheep model of LBBB-induced cardiomyopathy. METHODS The clinical study enrolled cardiac resynchronization therapy patients who underwent echocardiographic examination with speckle-tracking strain analysis before cardiac resynchronization therapy implant. In an experimental sheep model with pacing-induced dyssynchrony, LV remodeling and strain were assessed at baseline, at 8 and 16 weeks. Septal strain curves were classified into 5 patterns (LBBB-0 to LBBB-4). RESULTS The clinical study involved 250 patients (age 65 [58; 72] years; 79% men; 89% LBBB) with a median LV ejection fraction of 25 [21; 30]%. Across the stages, cardiac resynchronization therapy resulted in a gradual volumetric response, ranging from no response in LBBB-0 patients (ΔLV end-systolic volume 0 [-12; 15]%) to super-response in LBBB-4 patients (ΔLV end-systolic volume -44 [-64; -18]%) (P<0.001). LBBB-0 patients had a less favorable long-term outcome compared with those in stage LBBB≥1 (log-rank P=0.003). In 13 sheep, acute right ventricular pacing resulted in LBBB-1 (23%) and LBBB-2 (77%) patterns. Over the course of 8-16 weeks, continued pacing resulted in progressive LBBB-induced dysfunction, coincident with a transition to advanced strain patterns (92% LBBB-2 and 8% LBBB-3 at week 8; 75% LBBB-3 and 25% LBBB-4 at week 16) (P=0.023). CONCLUSIONS The strain-based LBBB classification reflects a pathophysiological continuum of LBBB-induced remodeling over time and is associated with the extent of reverse remodeling in observational cardiac resynchronization therapy-eligible patients.
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Affiliation(s)
- Simon Calle
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, the Netherlands (A.S.B.).,Department of Cardiovascular Diseases, Suez Canal University, Egypt (A.S.B.)
| | - Ivan Stankovic
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Serbia (I.S.)
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Stefan Winter
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Wolfgang Fehske
- Department of Cardiology, St. Vinzenz Hospital, Germany (S.W., W.F.)
| | - Marit Aarones
- Department of Medicine, Diakonhjemmet Hospital, Norway (M.A.H.)
| | - Marc De Buyzere
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jan De Pooter
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Belgium (J.D., A.S.B., I.S., A.P., J.-U.V.).,Department of Cardiovascular Diseases, University Hospital Leuven, Belgium (J.D., A.P., J.-U.V.)
| | - Frank Timmermans
- Department of Cardiology, University Hospital Ghent, Belgium (S.C., M.D.B., J.D.P., F.T.)
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14
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Van Heuverswyn F, De Schepper C, De Buyzere M, Coeman M, De Pooter J, Drieghe B, Kayaert P, Timmers L, Gevaert S, Calle S, Kamoen V, Demolder A, El Haddad M, Gheeraert P. Clinical validation of a 13-lead electrocardiogram derived from a self-applicable 3-lead recording for diagnosis of myocardial supply ischaemia and common non-ischaemic electrocardiogram abnormalities at rest. Eur Heart J Digit Health 2022; 3:548-558. [PMID: 36710895 PMCID: PMC9779790 DOI: 10.1093/ehjdh/ztac062] [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] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Indexed: 11/13/2022]
Abstract
Aims In this study, we compare the diagnostic accuracy of a standard 12-lead electrocardiogram (ECG) with a novel 13-lead ECG derived from a self-applicable 3-lead ECG recorded with the right exploratory left foot (RELF) device. The 13th lead is a novel age and sex orthonormalized computed ST (ASO-ST) lead to increase the sensitivity for detecting ischaemia during acute coronary artery occlusion. Methods and results A database of simultaneously recorded 12-lead ECGs and RELF recordings from 110 patients undergoing coronary angioplasty and 30 healthy subjects was used. Five cardiologists scored the learning data set and five other cardiologists scored the validation data set. In addition, the presence of non-ischaemic ECG abnormalities was compared. The accuracy for detection of myocardial supply ischaemia with the derived 12 leads was comparable with that of the standard 12-lead ECG (P = 0.126). By adding the ASO-ST lead, the accuracy increased to 77.4% [95% confidence interval (CI): 72.4-82.3; P < 0.001], which was attributed to a higher sensitivity of 81.9% (95% CI: 74.8-89.1) for the RELF 13-lead ECG compared with a sensitivity of 76.8% (95% CI: 71.9-81.7; P < 0.001) for the 12-lead ECG. There was no significant difference in the diagnosis of non-ischaemic ECG abnormalities, except for Q-waves that were more frequently detected on the standard ECG compared with the derived ECG (25.9 vs. 13.8%; P < 0.001). Conclusion A self-applicable and easy-to-use 3-lead RELF device can compute a 12-lead ECG plus an ischaemia-specific 13th lead that is, compared with the standard 12-lead ECG, more accurate for the visual diagnosis of myocardial supply ischaemia by cardiologists.
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Affiliation(s)
| | - Céline De Schepper
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Marc De Buyzere
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Peter Kayaert
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Liesbeth Timmers
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Simon Calle
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Victor Kamoen
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Anthony Demolder
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Milad El Haddad
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Peter Gheeraert
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium
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15
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Jastrzębski M, Kiełbasa G, Cano O, Curila K, Heckman L, De Pooter J, Chovanec M, Rademakers L, Huybrechts W, Grieco D, Whinnett ZI, Timmer SAJ, Elvan A, Stros P, Moskal P, Burri H, Zanon F, Vernooy K. Left bundle branch area pacing outcomes: the multicentre European MELOS study. Eur Heart J 2022; 43:4161-4173. [PMID: 35979843 PMCID: PMC9584750 DOI: 10.1093/eurheartj/ehac445] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [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: 01/25/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 01/21/2023] Open
Abstract
Aims Permanent transseptal left bundle branch area pacing (LBBAP) is a promising new pacing method for both bradyarrhythmia and heart failure indications. However, data regarding safety, feasibility and capture type are limited to relatively small, usually single centre studies. In this large multicentre international collaboration, outcomes of LBBAP were evaluated. Methods and results This is a registry-based observational study that included patients in whom LBBAP device implantation was attempted at 14 European centres, for any indication. The study comprised 2533 patients (mean age 73.9 years, female 57.6%, heart failure 27.5%). LBBAP lead implantation success rate for bradyarrhythmia and heart failure indications was 92.4% and 82.2%, respectively. The learning curve was steepest for the initial 110 cases and plateaued after 250 cases. Independent predictors of LBBAP lead implantation failure were heart failure, broad baseline QRS and left ventricular end-diastolic diameter. The predominant LBBAP capture type was left bundle fascicular capture (69.5%), followed by left ventricular septal capture (21.5%) and proximal left bundle branch capture (9%). Capture threshold (0.77 V) and sensing (10.6 mV) were stable during mean follow-up of 6.4 months. The complication rate was 11.7%. Complications specific to the ventricular transseptal route of the pacing lead occurred in 209 patients (8.3%). Conclusions LBBAP is feasible as a primary pacing technique for both bradyarrhythmia and heart failure indications. Success rate in heart failure patients and safety need to be improved. For wider use of LBBAP, randomized trials are necessary to assess clinical outcomes.
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Affiliation(s)
- Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Luuk Heckman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands
| | - Jan De Pooter
- Heart Center, Ghent University Hospital, Ghent, Belgium
| | - Milan Chovanec
- Department of Cardiology, Homolka Hospital, Prague, Czechia
| | - Leonard Rademakers
- Department of Cardiology, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Wim Huybrechts
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Stefan A J Timmer
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Hospital Zwolle, Postbus 10400, 8000 GK Zwolle, the Netherlands
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Jakubowskiego 2, 30-688 Krakow, Poland
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Kevin Vernooy
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia.,Department of Cardiology, Radboud University Medical Centre (RadboudUMC), Nijmegen, the Netherlands
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16
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Bisbal F, Abugattas JP, Trotta O, Gonzalez-Ferrer JJ, Sauri-Ortiz A, Arias MA, Subirana I, Duytshaever M, De Pooter J, Sarrias A, Adeliño R, Alarcón F, Mont L, Pérez-Villacastín J, Osca-Asensi J, Villuendas R, Pachón-Iglesias M, El Haddad M, Bayés-Genís A, de Greef Y. Personalized assessment of the cumulative complication risk of the atrial fibrillation ablation track: The AF-TRACK calculator. Heart Rhythm O2 2022; 3:656-664. [PMID: 36589911 PMCID: PMC9795263 DOI: 10.1016/j.hroo.2022.07.013] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) ablation strategy is associated with a non-negligible risk of complications and often requires repeat procedures (AF ablation track), implying repetitive exposure to procedural risk. Objective The purpose of this study was to develop and validate a model to estimate individualized cumulative risk of complications in patients undergoing the AF ablation track (Atrial Fibrillation TRAck Complication risK [AF-TRACK] calculator). Methods The model was derived from a multicenter cohort including 3762 AF ablation procedures in 2943 patients. A first regression model was fitted to predict the propensity for repeat ablation. The AF-TRACK calculator computed the risk of AF ablation track complications, considering the propensity for repeat ablation. Internal (cross-validation) and external (independent cohort) validation were assessed for discrimination capacity (area under the curve [AUC]) and goodness of fit (Hosmer-Lemeshow [HL] test). Results Complications (N = 111) occurred in 3.7% of patients (2.9% of procedures). Predictors included female sex, heart failure, sleep apnea syndrome, and repeat procedures. The model showed fair discrimination capacity to predict complications (AUC 0.61 [0.55-0.67]) and likelihood of repeat procedure (AUC 0.62 [0.60-0.64]), with good calibration (HL χ2 12.5; P = .13). The model maintained adequate discrimination capacity (AUC 0.67 [0.57-0.77]) and calibration (HL χ2 5.6; P = .23) in the external validation cohort. The validated model was used to create the Web-based AF-TRACK calculator. Conclusion The proposed risk model provides individualized estimates of the cumulative risk of complications of undergoing the AF ablation track. The AF-TRACK calculator is a validated, easy-to-use, Web-based clinical tool to calibrate the risk-to-benefit ratio of this treatment strategy.
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Affiliation(s)
- Felipe Bisbal
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
- Address reprint requests and correspondence: Dr Felipe Bisbal, Heart Institute–Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Spain.
| | | | - Omar Trotta
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | - Isaac Subirana
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | | | | | - Axel Sarrias
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Raquel Adeliño
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Lluís Mont
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Roger Villuendas
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Antoni Bayés-Genís
- Heart Institute–Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Yves de Greef
- ZNA Heart Center, Middelheim, Antwerpen, Belgium
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Ozpak E, Demolder A, Kizilkilic S, Calle S, Timmermans F, De Pooter J. An Electrocardiographic Characterization of Left Bundle Branch Area Pacing-Induced Right Ventricular Activation Delay: A Comparison With Native Right Bundle Branch Block. Front Cardiovasc Med 2022; 9:885201. [PMID: 35757323 PMCID: PMC9218419 DOI: 10.3389/fcvm.2022.885201] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeft bundle branch area pacing (LBBAP) induces delayed RV activation and is thought to be harmless, since the electrocardiographic signature is reminiscent to native RBBB. However, to what extent the delayed RV activation during LBBAP truly resembles that of native RBBB remains unexplored.MethodsThis study included patients with incomplete RBBB (iRBBB), complete RBBB (cRBBB) and patients who underwent LBBAP. Global and right ventricular activation times were estimated by QRS duration and R wave peak time in lead V1 (V1RWPT) respectively. Delayed RV activation was further characterized by duration, amplitude and area of the terminal R wave in V1.ResultsIn patients with LBBAP (n = 86), QRS duration [120 ms (116, 132)] was longer compared to iRBBB patients (n = 422): 104 ms (98, 110), p < 0.001, but shorter compared to cRBBB (n = 223): 138 ms (130, 152), p < 0.001. V1RWPT during LBBAP [84 ms (72, 92)] was longer compared to iRBBB [74 ms (68, 80), p < 0.001], but shorter than cRBBB [96 ms (86, 108), p < 0.001]. LBBAP resulted in V1 R′ durations [42 ms (28, 55)] comparable to iRBBB [42 ms (35, 49), p = 0.49] but shorter than in cRBBB [81 ms (68, 91), p < 0.001]. During LBBAP, the amplitude and area of the V1 R′ wave were more comparable with iRBBB than cRBBB. V1RWPT during LBBAP was determined by baseline conduction disease, but not by LBBAP capture type.ConclusionLBBAP-induced delayed RV activation electrocardiographically most closely mirrors the delayed RV activation as seen with incomplete rather than complete RBBB.
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De Pooter J, Ozpak E, Calle S, Peytchev P, Heggermont W, Marchandise S, Provenier F, Francois B, Anné W, Pollet P, Barbraud C, Gillis K, Timmermans F, Van Heuverswyn F, Tung R, Wauters A, le Polain de Waroux J. Initial experience of left bundle branch area pacing using stylet‐driven pacing leads: a multicenter study. J Cardiovasc Electrophysiol 2022; 33:1540-1549. [DOI: 10.1111/jce.15558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Emine Ozpak
- Heart CenterUniversity Hospital GhentBelgium
| | - Simon Calle
- Heart CenterUniversity Hospital GhentBelgium
| | | | | | - Sebastien Marchandise
- Institut Cardiovasculaire, Cliniques Universitaire Saint‐Luc, UCL LouvainBruxellesBelgium
| | | | | | - Wim Anné
- Dienst Cardiologie AZ DeltaRoeselareBelgium
| | | | - Cynthia Barbraud
- Service Cardiologie, Citadelle Château RougeSainte RosalieLiègeBelgium
| | | | | | | | - Roderick Tung
- Division of Cardiology, The University of Arizona College of Medicine‐PhoenixArizona
| | - Aurélien Wauters
- Institut Cardiovasculaire, Cliniques Universitaire Saint‐Luc, UCL LouvainBruxellesBelgium
- Service de Cardiologie, Clinique Saint PierreOttigniesBelgium
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De Pooter J, Wauters A, Van Heuverswyn F, Le polain de Waroux JB. A Guide to Left Bundle Branch Area Pacing Using Stylet-Driven Pacing Leads. Front Cardiovasc Med 2022; 9:844152. [PMID: 35265691 PMCID: PMC8899462 DOI: 10.3389/fcvm.2022.844152] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Left bundle branch area pacing (LBBAP) has emerged as a novel pacing modality which aims to capture the left bundle branch area and avoids the detrimental effects of right ventricular pacing. Current approaches for LBBAP have been developed using lumen-less pacing leads (LLL). Expanding the tools and leads for LBBAP might contribute to a wider adoption of this technique. Standard stylet-driven pacing leads (SDL) differ from current LLL as they are characterized by a wider lead body diameter, are stylet-supported and often have a non-isodiametric extendable helix design. Although LBBAP can be performed safely with SDL, the implant technique of LBBAP differs compared to LLL. In the current overview we describe in detail how different types of SDL can be used to target a deep septal position and provide a practical guide on how to achieve LBBAP using SDL.
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Affiliation(s)
- Jan De Pooter
- Heart Center, University Hospital Ghent, Ghent, Belgium
- *Correspondence: Jan De Pooter
| | - Aurelien Wauters
- Service de Cardiologie, Clinique Saint Pierre, Ottignies, Belgium
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Defruyt L, De Pooter J, Tavernier R. The electrocardiogram: the great mimicker. Acta Cardiol 2021; 76:800-802. [PMID: 32519932 DOI: 10.1080/00015385.2020.1777744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Loran Defruyt
- Cardiology Department, University Hospital Ghent, Gent, Belgium
| | - Jan De Pooter
- Cardiology Department, University Hospital Ghent, Gent, Belgium
| | - Rene Tavernier
- Cardiology Department, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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Lycke M, Kyriakopoulou M, El Haddad M, Wielandts JY, Hilfiker G, Almorad A, Strisciuglio T, De Pooter J, Wolf M, Unger P, Vandekerckhove Y, Tavernier R, de Waroux JBEP, Duytschaever M, Knecht S. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation. Europace 2021; 23:861-867. [PMID: 33367708 DOI: 10.1093/europace/euaa383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability. METHODS AND RESULTS Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1-3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence. CONCLUSION The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial.
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Affiliation(s)
- Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Maria Kyriakopoulou
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium.,Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Jean-Yves Wielandts
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Gabriela Hilfiker
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Alexandre Almorad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Jan De Pooter
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium.,Department of Cardiology, UZ Gent, Ghent, Belgium
| | - Michael Wolf
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Philippe Unger
- Department of Cardiology, CHU Saint Pierre, Brussels, Belgium
| | - Yves Vandekerckhove
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - René Tavernier
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | | | - Mattias Duytschaever
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, Bruges 8000, Belgium
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22
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Bove T, Alipour Symakani R, Verbeke J, Vral A, El Haddad M, De Wilde H, Stroobandt R, De Pooter J. Study of the time-relationship of the mechano-electrical interaction in an animal model of tetralogy of Fallot: implications for the risk assessment of ventricular arrhythmias. Interact Cardiovasc Thorac Surg 2021; 31:129-137. [PMID: 32243531 DOI: 10.1093/icvts/ivaa047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The long-term outcome of tetralogy of Fallot (TOF) is determined by progressive right ventricular (RV) dysfunction through pulmonary regurgitation (PR) and the risk of malignant arrhythmia. Although mechano-electrical coupling in TOF is well-known, its time effect on the inducibility of arrhythmia remains ill-defined. The goal of this study was to investigate the mechano-electrical properties at different times in animals with chronic PR. METHODS PR was induced by a transannular patch with limited RV scarring in infant pigs. Haemodynamic assessment included biventricular pressure-volume loops after 3 (n = 8) and 6 months (n = 7) compared to controls (n = 5). The electrophysiological study included endocardial monophasic action potential registration, intraventricular conduction velocity and induction of ventricular arrhythmia by burst pacing. RESULTS Progressive RV dilation was achieved at 6 months (RV end-diastolic volume 143 ± 13 ml/m2-RV end-systolic volume 96 ± 7 ml/m2; P < 0.001), in association with depressed RV contractility (preload recruitable stroke work-slope: 19 ± 1 and 11 ± 3 Mw.ml-1.s-1 for control and 6 m; P < 0.001) and left ventricular contractility (preload recruitable stroke work-slope: 60 ± 13 and 40 ± 11 Mw.ml-1.s-1 for control and 6 m; P = 0.005). Concomitant to QRS prolongation, monophasic action potential90-duration and dispersion at the RV and left ventricle were increased at 6 months. Intraventricular conduction was delayed only in the RV at 6 months (1.8 ± 0.2 and 2.4 ± 0.6 m/s for group 6M and the control group; P = 0.035). Sustained ventricular arrhythmias were not inducible. CONCLUSIONS In animals yielding the sequelae of a contemporary operation for TOF, mechano-electrical alterations are progressive and affect predominantly the RV after midterm exposure of PR. Because ventricular arrhythmias were not inducible despite significant RV dilation, the data suggest that the haemodynamic RV deterioration effectively precedes the risk of inducing sustained arrhythmia after TOF repair and opens a window for renewed stratification of contemporary risk factors of ventricular arrhythmias in patients operated on with currently used pulmonary valve- and RV-related techniques.
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Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital Gent, Gent, Belgium.,Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Rahi Alipour Symakani
- Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Jonas Verbeke
- Laboratory of Experimental Cardiac Surgery - Cardio-Circulatory Physiology, Faculty of Medical Sciences, University Gent, Gent, Belgium
| | - Anne Vral
- Radiobiology Research Unit, Faculty of Biomedical Science, University Gent, Gent, Belgium
| | - Milad El Haddad
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
| | - Hans De Wilde
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium.,Department of Pediatric Cardiology, University Hospital Gent, Gent, Belgium
| | - Roland Stroobandt
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
| | - Jan De Pooter
- Department of Interventional Cardiology and Electrophysiology, University Hospital Gent, Gent, Belgium
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23
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De Pooter J, Calle S, Timmermans F, Van Heuverswyn F. Left bundle branch area pacing using stylet‐driven pacing leads with a new delivery sheath: A comparison with lumen‐less leads. J Cardiovasc Electrophysiol 2021; 32:439-448. [DOI: 10.1111/jce.14851] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jan De Pooter
- Heart Center Ghent University Hospital Ghent Belgium
| | - Simon Calle
- Heart Center Ghent University Hospital Ghent Belgium
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24
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Buytaert D, Drieghe B, Van Heuverswyn F, De Pooter J, Gheeraert P, De Wolf D, Taeymans Y, Bacher K. Combining Optimized Image Processing With Dual Axis Rotational Angiography: Toward Low-Dose Invasive Coronary Angiography. J Am Heart Assoc 2020; 9:e014683. [PMID: 32605408 PMCID: PMC7670532 DOI: 10.1161/jaha.119.014683] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Dual axis rotational coronary angiography (DARCA) reduces radiation exposure during coronary angiography on older x‐ray systems. The purpose of the current study is to quantify patient and staff radiation exposure using DARCA on a modality already equipped with dose‐reducing technology. Additionally, we assessed applicability of 1 dose area product to effective dose conversion factor for both DARCA and conventional coronary angiography (CCA) procedures. Methods and Results Twenty patients were examined using DARCA and were compared with 20 age‐, sex‐, and body mass index–matched patients selected from a prior study using CCA on the same x‐ray modality. All irradiation events are simulated using PCXMC (STUK, Finland) to determine organ and effective doses. Moreover, for DARCA each frame is simulated. Staff dose is measured using active personal dosimeters (DoseAware, Philips Healthcare, The Netherlands). With DARCA, median cumulative dose area product is reduced by 57% (ie, 7.41 versus 17.19 Gy·cm2). Effective dose conversion factors of CCA and DARCA are slightly different, yet this difference is not statistically significant. The occupational dose at physician's chest, leg, and collar level are reduced by 60%, 56%, and 16%, respectively, of which the first 2 reached statistical significance. Median effective dose is reduced from 4.75 mSv in CCA to 2.22 mSv in DARCA procedures, where the latter is further reduced to 1.79 mSv when excluding ventriculography. Conclusions During invasive coronary angiography, DARCA reduces radiation exposure even further toward low‐dose values on a system already equipped with advanced image processing and noise reduction algorithms. For both DARCA and CCA procedures, using 1 effective dose conversion factor of 0.30 mSv·Gy−1·cm−2 is feasible.
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Affiliation(s)
- Dimitri Buytaert
- Department of Human Structure and Repair Ghent University Ghent Belgium
| | - Benny Drieghe
- Heart Center Ghent University Hospital Ghent Belgium
| | | | - Jan De Pooter
- Heart Center Ghent University Hospital Ghent Belgium
| | | | - Daniël De Wolf
- Department of Paediatric Cardiology Ghent University Hospital Ghent Belgium
| | - Yves Taeymans
- Heart Center Ghent University Hospital Ghent Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair Ghent University Ghent Belgium
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25
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De Pooter J, Calle S, Bove T, Van Heuverswyn FE, Timmermans F. Perimembranous ventricular septal defect following His bundle lead implantation. J Cardiovasc Electrophysiol 2020; 31:1844-1847. [PMID: 32412109 DOI: 10.1111/jce.14553] [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: 04/09/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Abstract
His bundle pacing (HBP) offers physiologic pacing by placing the pacing lead directly to the His bundle. We present a case in which a HBP lead, implanted at the fragile membranous septum, resulted in a persistent restrictive perimembranous ventricular septal defect (VSD). This complication of HBP has not been reported before but brings new insights in the discussion regarding the optimal position of a pacing lead in the ventricular septum. The fragility of the membranous septum and low rate of spontaneous closure of membranous VSD, might favor lead placement in the muscular septum when aiming for physiologic pacing.
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Affiliation(s)
- Jan De Pooter
- Heart Center, University Hospital Ghent, Ghent, Belgium
| | - Simon Calle
- Heart Center, University Hospital Ghent, Ghent, Belgium
| | - Thierry Bove
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
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26
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De Coster M, Demolder A, De Meyer V, Vandenbulcke F, Van Heuverswyn F, De Pooter J. Diagnostic accuracy of R-wave detection by insertable cardiac monitors. Pacing Clin Electrophysiol 2020; 43:511-517. [PMID: 32259309 DOI: 10.1111/pace.13912] [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] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Insertable cardiac monitors (ICM) allow prolonged rhythm monitoring, but the diagnostic performance can be hampered by false positive arrhythmia alerts related to inadequate R-wave sensing. This study assesses the prevalence and predictors of inadequate R-wave sensing (both over- and undersensing) among different ICM types. METHODS Patients implanted with an ICM at Ghent University Hospital between January 2017 and August 2018 were included. ICM tracings recorded at interrogation or transmitted by remote monitoring were reviewed for inadequate R-wave sensing leading to false arrhythmia alerts. Patient and implant characteristics were retrieved from the medical records and implant reports. RESULTS The study screened 135 patients (age 59 ± 19 years, 44% female) implanted with different ICM types: Reveal LINQ™ and XT (Medtronic): n = 92 (68%), Confirm and Confirm Rx (Abbott): n = 35 (26%), and BioMonitor 2 (Biotronik): n = 8 (6%). ICM tracings were analyzed in 112 patients (83%). False arrhythmia alerts occurred in 22 (20%) patients, most frequently related to undersensing (77%). False diagnosis of bradycardia or pause was documented in 64%, false high ventricular rates in 14%, and false atrial fibrillation alerts in 22%. Occurrence of R-wave changes was not related to patient characteristics or implant R-wave sensing. A trend toward higher number of inadequate R-wave sensing seems to occur with nonparasternal implant sites (P = .074). CONCLUSIONS False arrhythmia alerts due to inadequate R-wave sensing occurred in 20% of ICM patients independent of implant features and patient characteristics.
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Affiliation(s)
- Margot De Coster
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Anthony Demolder
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Veerle De Meyer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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27
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Kyriakopoulou M, Wielandts J, Strisciuglio T, El Haddad M, Pooter JD, Almorad A, Hilfiker G, Phlips T, Unger P, Lycke M, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions. J Cardiovasc Electrophysiol 2020; 31:1091-1098. [DOI: 10.1111/jce.14438] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/10/2020] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Maria Kyriakopoulou
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
- Department of CardiologyUniversite Libre de Bruxelles (ULB)Brussels Belgium
| | | | | | | | | | | | | | - Thomas Phlips
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
| | - Philippe Unger
- Department of CardiologyCHU Saint‐PierreBrussels Belgium
| | - Michelle Lycke
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
| | | | - Rene Tavernier
- Department of CardiologyAZ Sint‐Jan HospitalBruges Belgium
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28
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Coeman M, Kayaert P, Philipsen T, Calle S, Gheeraert P, Gevaert S, Czapla J, Timmers L, Van Heuverswyn F, De Pooter J. Different dynamics of new-onset electrocardiographic changes after balloon- and self-expandable transcatheter aortic valve replacement: Implications for prolonged heart rhythm monitoring. J Electrocardiol 2020; 59:68-73. [DOI: 10.1016/j.jelectrocard.2020.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/27/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022]
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29
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Calle S, Coeman M, Desmet K, De Backer T, De Buyzere M, De Pooter J, Timmermans F. Septal flash is a prevalent and early dyssynchrony marker in transcatheter aortic valve replacement-induced left bundle branch block. Int J Cardiovasc Imaging 2020; 36:1041-1050. [DOI: 10.1007/s10554-020-01791-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
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30
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De Pooter J, Gauthey A, Calle S, Noel A, Kefer J, Marchandise S, Coeman M, Philipsen T, Kayaert P, Gheeraert P, Jordaens L, Timmermans F, Van Heuverswyn F, Bordachar P, le Polain de Waroux JB. Feasibility of His-bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2020; 31:813-821. [PMID: 31990128 DOI: 10.1111/jce.14371] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/10/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB). METHODS Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre-TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0-millisecond pulse width. RESULTS The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S-HBP and NS-HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow-up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred. CONCLUSION Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR-induced LBBB with acceptable pacing thresholds.
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Affiliation(s)
- Jan De Pooter
- Heart Center, Gent University Hospital, Ghent, Belgium
| | - Anaïs Gauthey
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Simon Calle
- Heart Center, Gent University Hospital, Ghent, Belgium
| | - Antoine Noel
- Hospital Du Haut-Leveque, IHU LIRYC, Pessac, France
| | - Joelle Kefer
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien Marchandise
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Tine Philipsen
- Cardiac Surgery, Gent University Hospital, Ghent, Belgium
| | | | | | - Luc Jordaens
- Heart Center, Gent University Hospital, Ghent, Belgium
| | | | | | | | - Jean-Benoît le Polain de Waroux
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
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31
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Calle S, Delens C, Kamoen V, De Pooter J, Timmermans F. Septal flash: At the heart of cardiac dyssynchrony. Trends Cardiovasc Med 2020; 30:115-122. [DOI: 10.1016/j.tcm.2019.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/31/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
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32
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Senesael E, Calle S, Kamoen V, Stroobandt R, De Buyzere M, Timmermans F, De Pooter J. Progression of incomplete toward complete left bundle branch block: A clinical and electrocardiographic analysis. Ann Noninvasive Electrocardiol 2019; 25:e12732. [PMID: 31823461 PMCID: PMC7358832 DOI: 10.1111/anec.12732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/24/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Complete left bundle branch block (cLBBB) is associated with increased cardiovascular mortality and heart failure. On the contrary, the clinical relevance of incomplete left bundle branch block (iLBBB) is less known. This study investigated the profile and outcome of iLBBB patients and assessed the risk of progression to cLBBB. Methods Patients diagnosed with iLBBB between July 2013 and April 2018 were retrospectively included. Subsequently, echo‐ and electrocardiographic examinations at time of iLBBB diagnosis and during follow‐up, as well as progression to non‐strict cLBBB and strict cLBBB, were evaluated. Results The study enrolled 321 patients (33% female, age 74 ± 11 years). During the follow‐up of 21 (8;34) months, 33% of iLBBB patients evolved to non‐strict cLBBB and 27% to strict cLBBB. iLBBB patients who evolved to non‐strict or strict cLBBB were older, had more frequently reduced left ventricular ejection fraction, and had more often QRS notching/slurring in the lateral leads and inferior leads, compared to patients without progression to cLBBB. In multivariate analysis, only QRS notching/slurring in the lateral leads was independently associated with progression to non‐strict cLBBB (odds ratio 4.64, p < .001) and strict cLBBB (odds ratio 9.6, p < .001). iLBBB patients with QRS notching/slurring had a progression rate to non‐strict cLBBB of 52% and 49% to strict cLBBB. Conclusion Among patients with iLBBB, up to one third of the patients progress to cLBBB within a period of 2 years. The presence of QRS notching/slurring in the lateral leads during iLBBB was the strongest predictor for progression toward cLBBB.
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Affiliation(s)
- Ellie Senesael
- Department of Cardiology, University Hospital Gent, Gent, Belgium
| | - Simon Calle
- Department of Cardiology, University Hospital Gent, Gent, Belgium
| | - Victor Kamoen
- Department of Cardiology, University Hospital Gent, Gent, Belgium
| | | | - Marc De Buyzere
- Department of Cardiology, University Hospital Gent, Gent, Belgium
| | - Frank Timmermans
- Department of Cardiology, University Hospital Gent, Gent, Belgium
| | - Jan De Pooter
- Department of Cardiology, University Hospital Gent, Gent, Belgium
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33
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Duytschaever M, De Pooter J, Demolder A, El Haddad M, Phlips T, Strisciuglio T, Debonnaire P, Wolf M, Vandekerckhove Y, Knecht S, Tavernier R. Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: The CLOSE to CURE study. Heart Rhythm 2019; 17:535-543. [PMID: 31707159 DOI: 10.1016/j.hrthm.2019.11.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 09/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few studies evaluated the impact of catheter ablation (CA) on atrial tachyarrhythmia (ATA) burden in paroxysmal atrial fibrillation (AF). OBJECTIVE In the prospective, patient-controlled CLOSE to CURE study, we determined the longer-term impact of optimized CA on ATA burden by using an insertable cardiac monitor (ICM). METHODS A total of 105 patients with paroxysmal AF were implanted with an ICM 65 (interquartile range [IQR] 61-78) days before CA. CA consisted of contact force-guided pulmonary vein isolation targeting an intertag distance of ≤6 mm and a region-specific ablation index. The primary end point was reduction in ICM-detected ATA burden; secondary end points were single-procedure freedom from ATA, quality of life, and adverse events. RESULTS The mean age was 62 ± 8 years; the median CHA2DS2-VASc score was 1 (IQR 1-2); and the median left atrial diameter was 43 (IQR 39-43) mm. After pulmonary vein isolation (1.13 ± 0.39 procedures per patient), median ATA burden decreased from 2.68% (IQR 0.09%-15.02%) at baseline to 0% (IQR 0%-0%) during the first year and to 0% (IQR 0%-0%) during the second year (reduction in ATA burden 100% [IQR 100%-100%]; P < .001). Single-procedure freedom from any ATA was 87% at 1 year and 78% at 2 years. Quality of life improved significantly across all scores. Adverse events occurred in 5 patients (4.8%). CONCLUSION CA has become an effective procedure in paroxysmal AF, with a major impact on ICM-detected ATA burden. Whereas conventional survival analysis suggests a progressive decline in efficacy, we observed that burden reduction is maintained at longer follow-up. These data imply that ATA burden is a more optimal end point for assessing ablation efficacy.
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Affiliation(s)
- Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
| | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Anthony Demolder
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | | | - Michael Wolf
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | - Sebastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Rene Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
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Wolf M, Tavernier R, Zeidan Z, El Haddad M, Vandekerckhove Y, Pooter JD, Phlips T, Strisciuglio T, Almorad A, Kyriakopoulou M, Lycke M, Duytschaever M, Knecht S. Identification of repetitive atrial activation patterns in persistent atrial fibrillation by direct contact high-density electrogram mapping. J Cardiovasc Electrophysiol 2019; 30:2704-2712. [PMID: 31588635 DOI: 10.1111/jce.14214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/19/2019] [Revised: 08/08/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent studies have characterized drivers in persistent atrial fibrillation using automated algorithm detection with panoramic endocardial mapping by means of basket catheters. We aimed to identify repetitive atrial activation patterns (RAAPs) during ongoing atrial fibrillation (AF) based upon automated annotation of unipolar electrograms (EGMs) recorded with a high-density regional endocardial contact mapping catheter. METHODS In 14 persistent AF patients, high-resolution EGMs were recorded for 30 seconds at sequential PentaRay (Biosense Inc) positions covering the entire biatrial surface. All recordings were reviewed off-line with dedicated software allowing automated annotation of the local activation time of the unipolar fibrillatory EGMs (CARTOFINDER; Biosense Inc). RAAPs were defined as a consistent activation pattern (for ≥3 consecutive beats) of either focal activity with centrifugal spread (RAAPfocal ) or rotational activity across the PentaRay splines spanning the AF cycle length (RAAProtational ). RESULTS A total of 498 PentaRay recordings were analyzed (35.6 ± 7.6 per patient). The number of PentaRay recordings displaying RAAP was 9.8 ± 3.1 per patient (range = 3-15), of which 2.4 ± 2.4 RAAProtational (range = 0-7), and 7.4 ± 4.4 RAAPfocal (range = 1-13). 77% of RAAPs portrayed focal firing. The median number of repetitions per 30 second recording was 11 (range = 3-225) per recording. RAAPs were observed both in the right atrium (RA) (35%) and left atrium (LA) (65%), with the majority being near the left PVs/appendage (35% of all RAAPs) and the superior vena cava/right appendage (23% of all RAAPs). CONCLUSION High-resolution, sequential endocardial EGM-based mapping allows identification of RAAPs in persistent AF. In our series, focal firing was the most frequently observed pattern.
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Affiliation(s)
- Michael Wolf
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium.,Department of Cardiology, Hartcentrum ZNA Middelheim, Antwerp, Belgium.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Ziad Zeidan
- Clinical Development - Research and Development, Biosense Webster, Inc, South Diamond Bar, California
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | | | | | - Michelle Lycke
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
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Wolf M, El Haddad M, Fedida J, Taghji P, Van Beeumen K, Strisciuglio T, De Pooter J, Lepièce C, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of left atrial linear ablation using contiguous and optimized radiofrequency lesions: the ALINE study. Europace 2019; 20:f401-f409. [PMID: 29325036 DOI: 10.1093/europace/eux350] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/01/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Achieving block across linear lesions is challenging. We prospectively evaluated radiofrequency (RF) linear ablation at the roof and mitral isthmus (MI) using point-by-point contiguous and optimized RF lesions. Methods and results Forty-one consecutive patients with symptomatic persistent AF underwent stepwise contact force (CF)-guided catheter ablation during ongoing AF. A single linear set of RF lesions was delivered at the roof and posterior MI according to the 'Atrial LINEar' (ALINE) criteria, i.e. point-by-point RF delivery (up to 35 W) respecting strict criteria of contiguity (inter-lesion distance ≤ 6 mm) and indirect lesion depth assessment (ablation index ≥550). We assessed the incidence of bidirectional block across both lines only after restoration of sinus rhythm. After a median RF time of 7 min [interquartile range (IQR) 5-9], first-pass block across roof lines was observed in 38 of 41 (93%) patients. Final bidirectional roof block was achieved in 40 of 41 (98%) patients. First-pass block was observed in 8 of 35 (23%) MI lines, after a median RF time of 8 min (IQR 7-12). Additional endo- and epicardial (54% of patients) RF applications resulted in final bidirectional MI block in 28 of 35 (80%) patients. During a median follow-up of 396 (IQR 310-442) days, 12 patients underwent repeat procedures, with conduction recovery in 4 of 12 and 5 of 10 previously blocked roof lines and MI lines, respectively. No complications occurred. Conclusion Anatomical linear ablation using contiguous and optimized RF lesions results in a high rate of first-pass block at the roof but not at the MI. Due to its complex 3D architecture, the MI frequently requires additional endo- and epicardial RF lesions to be blocked.
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Affiliation(s)
- Michael Wolf
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Joël Fedida
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Philippe Taghji
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Katarina Van Beeumen
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Caroline Lepièce
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Yves Vandekerckhove
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
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Wolf M, El Haddad M, De Wilde V, Phlips T, De Pooter J, Almorad A, Strisciuglio T, Vandekerckhove Y, Tavernier R, Crijns HJ, Knecht S, Duytschaever M. Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications. Heart Rhythm 2019; 16:1013-1020. [DOI: 10.1016/j.hrthm.2019.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Indexed: 12/22/2022]
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Van Heuverswyn F, De Buyzere M, Coeman M, De Pooter J, Drieghe B, Duytschaever M, Gevaert S, Kayaert P, Vandekerckhove Y, Voet J, El Haddad M, Gheeraert P. Feasibility and performance of a device for automatic self-detection of symptomatic acute coronary artery occlusion in outpatients with coronary artery disease: a multicentre observational study. Lancet Digit Health 2019; 1:e90-e99. [PMID: 33323233 DOI: 10.1016/s2589-7500(19)30026-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Time delay between onset of symptoms and seeking medical attention is a major determinant of mortality and morbidity in patients with acute coronary artery occlusion. Response time might be reduced by reliable self-detection. We aimed to formally assess the proof-of-concept and accuracy of self-detection of acute coronary artery occlusion by patients during daily life situations and during the very early stages of acute coronary artery occlusion. METHODS In this multicentre, observational study, we tested the operational feasibility, specificity, and sensitivity of our RELF method, a three-lead detection system with an automatic algorithm built into a mobile handheld device, for detection of acute coronary artery occlusion. Patients were recruited continuously by physician referrals from three Belgian hospitals until the desired sample size was achieved, had been discharged with planned elective percutaneous coronary intervention, and were able to use a smartphone; they were asked to perform random ambulatory self-recordings for at least 1 week. A similar self-recording was made before percutaneous coronary intervention and at 60 s of balloon occlusion. Patients were clinically followed up until 1 month after discharge. We quantitatively assessed the operational feasibility with an automated dichotomous quality check of self-recordings. Performance was assessed by analysing the receiver operator characteristics of the ST difference vector magnitude. This trial is registered with ClinicalTrials.gov, number NCT02983396. FINDINGS From Nov 18, 2016, to April 25, 2018, we enrolled 64 patients into the study, of whom 59 (92%) were eligible for self-applications. 58 (91%) of 64 (95% CI 81·0-95·6) patients were able to perform ambulatory self-recordings. Of all 5011 self-recordings, 4567 (91%) were automatically classified as successful within 1 min. In 65 balloon occlusions, 63 index tests at 60 s of occlusion in 55 patients were available. The mean specificity of daily life recordings was 0·96 (0·95-0·97). The mean false positive rate during daily life conditions was 4·19% (95% CI 3·29-5·10). The sensitivity for the target conditions was 0·87 (55 of 63; 95% CI 0·77-0·93) for acute coronary artery occlusion, 0·95 (54 of 57; 0·86-0·98) for acute coronary artery occlusion with electrocardiogram (ECG) changes, and 1·00 (35 of 35) for acute coronary artery occlusion with ECG changes and ST-segment elevation myocardial infarction criteria (STEMI). The index test was more sensitive to detect a 60 s balloon occlusion than the STEMI criteria on 12-lead ECG (87% vs 56%; p<0·0001). The proportion of total variation in study estimates due to heterogeneity between patients (I2) was low (12·6%). The area under the receiver operator characteristics curve was 0·973 (95% CI 0·956-0·990) for acute coronary artery occlusion at different cutoff values of the magnitude of the ST difference vector. No patients died during the study. INTERPRETATION Self-recording with our RELF device is feasible for most patients with coronary artery disease. The sensitivity and specificity for automatic detection of the earliest phase of acute coronary artery occlusion support the concept of our RELF device for patient empowerment to reduce delay and increase Survival without overloading emergency services. FUNDING Ghent University, Industrial Research Fund.
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Affiliation(s)
| | - Marc De Buyzere
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Coeman
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan De Pooter
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Benny Drieghe
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium; Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Kayaert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Joeri Voet
- Department of Cardiology, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Milad El Haddad
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Peter Gheeraert
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Kyriakopoulou M, Strisciuglio T, El Haddad M, De Pooter J, Almorad A, Van Beeumen K, Unger P, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Evaluation of a simple technique aiming at optimizing point-by-point isolation of the left pulmonary veins: a randomized study. Europace 2019; 21:1185-1192. [DOI: 10.1093/europace/euz115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/02/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We sought to evaluate the efficacy and the safety of a simple technique for stabilizing the ablation catheter during anterior pulmonary vein (PV) encirclement in patients ablated for paroxysmal atrial fibrillation. This consisted of bending the ablation catheter in the left atrium, creating a loop that was cautiously advanced together with the long sheath at the ostium and then within the left superior PV. The curve was then progressively released to reach a stable contact with the anterior part of the left PVs.
Methods and results
Eighty consecutive patients (age 64 ± 11 years, left atrial diameter 43 ± 8 mm) undergoing ‘CLOSE’-guided PV isolation were prospectively randomized into two groups depending on whether the loop technique was used or not. When using the loop technique, the encirclement of the left PVs was shorter [20 min (interquartile range, IQR 17–24) vs. 26 min (IQR 18–33), P < 0.01] with a high rate of first pass isolation [(100%) vs. (97%), P = 0.9] and adenosine proof isolation [(93%) vs. (95%), P = 0.67]. Most specifically, at the anterior part of the left PVs, there were less dislocations [0 (IQR 0–0) vs. 1 (IQR 0–4), P < 0.001], radiofrequency duration was shorter (272 ± 85 s vs. 378 ± 122 s, P < 0.001), force-time integral was higher [524 gs (IQR 427–687) vs. 398 gs (IQR 354–451), P < 0.001], average contact force was higher [20 g (IQR 13–27) vs. 11g (IQR 9–16), P < 0.001], and impedance drop was higher [12 Ω (IQR 9–19) vs. 10 Ω (IQR 7–14), P < 0.001].
Conclusion
This study describes a simple technique to facilitate catheter stability at the anterior part of the left PVs, resulting in more efficient left PV encirclement without compromising safety.
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Affiliation(s)
- Maria Kyriakopoulou
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Universite Libre de Bruxelles (ULB), Brussels, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Alexandre Almorad
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Katarina Van Beeumen
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | | | - Yves Vandekerckhove
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
- Department of Cardiology, UZ Gent, Gent, Belgium
| | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium
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De Pooter J, Strisciuglio T, El Haddad M, Wolf M, Phlips T, Vandekerckhove Y, Tavernier R, Knecht S, Duytschaever M. Pulmonary Vein Reconnection No Longer Occurs in the Majority of Patients After a Single Pulmonary Vein Isolation Procedure. JACC Clin Electrophysiol 2019; 5:295-305. [PMID: 30898231 DOI: 10.1016/j.jacep.2018.11.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/23/2018] [Accepted: 11/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to determine the prevalence of patients with 4 isolated veins at repeat ablation after "CLOSE" -guided pulmonary vein isolation (PVI), a strategy based on delivery of contiguous and optimized radiofrequency lesions. BACKGROUND The likelihood of finding 4 isolated veins at a repeat ablation for atrial fibrillation (AF) recurrence after a first PVI is low. METHODS Patients undergoing repeat ablation for AF recurrence after first CLOSE-guided PVI were included. At repeat: 1) the status of the PV was evaluated; and 2) high-density voltage mapping was performed. In case of pulmonary vein reconnection (PVR), veins were reisolated. In patients with 4 isolated veins, empirical trigger or substrate ablation was performed. RESULTS Of 326 patients undergoing CLOSE-guided PVI for paroxysmal AF, 45 patients underwent repeat ablation for AF recurrence (11 ± 7 months after first PVI). In 28 patients, all veins were still isolated (62%). They showed similar clinical characteristics and similar time from first PVI to AF recurrence (8 ± 7 vs. 6 ± 6 months, respectively, p = 0.453) compared with patients with PVR. In contrast, they were characterized by a higher incidence of low voltage (57% vs. 17%, p = 0.033). Patients with 4 isolated veins, compared with patients treated for PVR, showed a lower 12-month freedom from AF after repeat ablation (61% vs. 88%, p = 0.045). CONCLUSIONS After CLOSE-guided ablation, PVR is no longer the rule in patients with AF recurrence. Patients with AF recurrence and 4 isolated veins present with a similar clinical profile and time to recurrence as patients with PVR.
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Affiliation(s)
- Jan De Pooter
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium; Heart Center, Ghent University Hospital, Ghent, Belgium.
| | | | - Milad El Haddad
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Michael Wolf
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | - Mattias Duytschaever
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium; Heart Center, Ghent University Hospital, Ghent, Belgium
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Stroobandt RX, Duytschaever MF, Strisciuglio T, Van Heuverswyn FE, Timmers L, De Pooter J, Knecht S, Vandekerckhove YR, Kucher A, Tavernier RH. Failure to detect life-threatening arrhythmias in ICDs using single-chamber detection criteria. Pacing Clin Electrophysiol 2019; 42:583-594. [PMID: 30657188 DOI: 10.1111/pace.13610] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near-fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria. METHODS Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life-threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario. RESULTS Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min. CONCLUSION We describe six scenarios leading to failure of ventricular arrhythmia detection in a single-chamber detection setting withholding life-saving therapy. These scenarios are more likely to occur with high-rate programming and long detection times, especially if combined with rate stability and sudden onset.
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Affiliation(s)
| | - Mattias F Duytschaever
- Heart Center, Ghent University Hospital, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - Teresa Strisciuglio
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Jan De Pooter
- Heart Center, Ghent University Hospital, Ghent, Belgium
| | - Sébastien Knecht
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | | | | | - Rene H Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
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Affiliation(s)
- Jan De Pooter
- Ghent University Hospital, Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | - Mattias Duytschaever
- Ghent University Hospital, Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
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De Pooter J, Kamoen V, El Haddad M, Stroobandt R, De Buyzere M, Jordaens L, Timmermans F. Gender differences in electro-mechanical characteristics of left bundle branch block: Potential implications for selection and response of cardiac resynchronization therapy. Int J Cardiol 2018; 257:84-91. [DOI: 10.1016/j.ijcard.2017.10.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/30/2017] [Accepted: 10/16/2017] [Indexed: 12/28/2022]
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De Pooter J, El Haddad M, Kamoen V, Kallupurackal TT, Stroobandt R, De Buyzere M, Timmermans F. Relation between electrical and mechanical dyssynchrony in patients with left bundle branch block: An electro- and vectorcardiographic study. Ann Noninvasive Electrocardiol 2017; 23:e12525. [PMID: 29251398 DOI: 10.1111/anec.12525] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/22/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Current guidelines select patients for cardiac resynchronization therapy (CRT) mainly on electrocardiographic parameters like QRS duration and left bundle branch block (LBBB). However, among those LBBB patients, heterogeneity in mechanical dyssynchrony occurs and might be a reason for nonresponse to CRT. This study assesses the relation between electrocardiographic characteristics and presence of mechanical dyssynchrony among LBBB patients. METHODS The study included patients with true LBBB (including mid-QRS notching) on standard 12-lead electrocardiograms. Left bundle branch block-induced mechanical dyssynchrony was assessed by the presence of septal flash on two-dimensional echocardiography. Previously reported electro- and vectorcardiographic dyssynchrony markers were analyzed: global QRS duration (QRSDLBBB ), left ventricular activation time (QRSDLVAT ), time to intrinsicoid deflection (QRSDID ), and vectorcardiographic QRS areas in the 3D vector loop (QRSA3D ). RESULTS The study enrolled 545 LBBB patients. Septal flash (SF) is present in 52% of patients presenting with true LBBB. Patients with SF are more frequent female, have less ischemic heart disease and smaller left ventricular dimensions. In multivariate analysis longer QRSDLBBB , QRSDLVAT and larger QRSA3D were independently associated with SF. Of all parameters, QRSA3D has the best accuracy to predict SF, although overall accuracy remains moderate (59% sensitivity, 58% specificity). The predictive value of QRSA3D remained constant in both sexes, irrespective of ischemic heart disease, ejection fraction and even when categorizing for QRSDLBBB . CONCLUSION In LBBB patients, large QRS areas correlate better with mechanical dyssynchrony compared to wide QRSD intervals. However, the overall accuracy to predict mechanical dyssynchrony by electrocardiographic dyssynchrony markers, even when using complex vectorcardiographic parameters, remains low.
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Affiliation(s)
- Jan De Pooter
- Ghent University Hospital, Heart Center, Ghent, Belgium
| | | | - Victor Kamoen
- Ghent University Hospital, Heart Center, Ghent, Belgium
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De Pooter J, El Haddad M, Wolf M, Phlips T, Van Heuverswyn F, Timmers L, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias. J Cardiovasc Electrophysiol 2017; 29:177-185. [DOI: 10.1111/jce.13371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/17/2017] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jan De Pooter
- Ghent University Hospital; Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | - Michael Wolf
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | - Thomas Phlips
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | | | - René Tavernier
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | | | - Mattias Duytschaever
- Ghent University Hospital; Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
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De Pooter J, El Haddad M, Stroobandt R, De Buyzere M, Timmermans F. Accuracy of computer-calculated and manual QRS duration assessments: Clinical implications to select candidates for cardiac resynchronization therapy. Int J Cardiol 2017; 236:276-282. [DOI: 10.1016/j.ijcard.2017.01.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 12/28/2022]
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De Pooter J, Phlips T, El Haddad M, Van Heuverswyn F, Timmers L, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. Automated verification of pulmonary vein isolation in radiofrequency- and cryoballoon-guided ablation. Pacing Clin Electrophysiol 2017; 40:779-787. [PMID: 28543788 DOI: 10.1111/pace.13121] [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: 03/19/2017] [Revised: 04/27/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Verification of pulmonary vein isolation (PVI) can be challenging due to the coexistence of pulmonary vein potentials and far-field potentials. This study aimed to prospectively validate a novel algorithm for automated verification of PVI in radiofrequency (RF)-guided and cryoballoon (CB)-guided ablation strategies. METHODS A data set of 620 (RF: 516 EGMs and CB: 104 EGMs) bipolar electrograms (EGM), recorded by circular mapping catheter placed at the left atrium-pulmonary vein (PV) junction, were prospectively analyzed by a two-step algorithm. The algorithm differentiates isolated from nonisolated EGMs based on typology and specific parameters of the bipolar EGMs. EGMs were recorded at baseline and after proven isolation in RF- and CB-guided procedures. Additionally, in the RF group, EGMs during encircling of the PVs were analyzed. RESULTS In the RF and CB group, the algorithm correctly identifies EGMs as isolated or nonisolated with respectively 93% and 96% sensitivity and 86% and 90% specificity. In the RF subgroups of (1) baseline and proven isolated EGMs, (2) EGMs during encircling, and (3) EGMs in redo procedures sensitivity was 96%, 88%, and 100%, respectively, with specificity of 81%, 91%, and 100%. Fourteen out of 14 (100%) reconnected PVs were correctly identified as containing PVPs. Eleven out of 12 (92%) failed freeze attempts were correctly identified as being nonisolated. CONCLUSION We validated a two-step algorithm for automated PVI verification, applicable both for RF- and CB-guided PVI. The algorithm automatically differentiates isolated from nonisolated PVs with high accuracy and without the need for pacing maneuvers.
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Affiliation(s)
- Jan De Pooter
- Ghent University Hospital, Heart Center, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | | | | | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | | | - Mattias Duytschaever
- Ghent University Hospital, Heart Center, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
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De Pooter J, Boersma L, Jordaens L. 136-44: Arrhythmic events in the HoRRACLE's Trial are predicted by slow VT. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i101a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Pooter J, El Haddad M, De Buyzere M, Timmers L, Drieghe B, Timmermans F, Rinaldi A, Stegemann B, Francis D, Vanderheyden M, Sokal A, Sterlinski M, Alfonso Aranda H, Cornelussen R, Jordaens L, Stroobandt RX, Van Heuverswyn F. 89-06: Assessment of vectorcardiographic parameters of the paced QRS complex as prediction of acute hemodynamic response in CRT patients. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Corteville B, De Pooter J, De Backer T, El Haddad M, Stroobandt R, Timmermans F. The electrocardiographic characteristics of septal flash in patients with left bundle branch block. Europace 2016; 19:103-109. [PMID: 26843575 DOI: 10.1093/europace/euv461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/06/2015] [Accepted: 12/29/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS In patients with systolic heart failure and left bundle branch block (LBBB), septal flash (SF) movement has been described by echocardiography. We evaluated the prevalence of SF in LBBB and non-LBBB patients and evaluated whether specific electrocardiographic (ECG) characteristics within LBBB are associated with the presence of SF on echocardiography. METHODS AND RESULTS One hundred and four patients with probable LBBB on standard 12-lead ECG were selected, 40 patients with non-LBBB served as controls. Left bundle branch block and non-LBBB were defined, according to the most recent guidelines. The presence of SF was assessed by echocardiography. Strict LBBB criteria were met in 93.3% of the patients. Septal flash was present in 45.2% of LBBB patients and was not present in non-LBBB patients. This was more prevalent in patients without anterior ischaemic cardiomyopathy (ICMP) compared with those with anterior ICMP (P = 0.008). The duration of QRS was longer in SF patients compared with that of non-SF patients (P < 0.05). The presence of a mid-QRS notching in more than two consecutive leads was a good predictor for the presence of SF (P = 0.01), and when combined with an absent R-wave in lead V1, the presence of SF is very likely (P = 0.001). CONCLUSION Our data show that SF is present in 45.2% of LBBB patients, whereas it was absent in patients with non-LBBB. Patients with SF fulfilled more LBBB criteria compared with LBBB patients without SF. Our findings raise the provocative question of whether the presence of SF identifies patients with 'true LBBB' and whether this echocardiographic finding might be considered as a selection parameter in cardiac resynchronization therapy.
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Affiliation(s)
- Ben Corteville
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
| | - Jan De Pooter
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
| | - Tine De Backer
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
| | - Milad El Haddad
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
| | - Roland Stroobandt
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
| | - Frank Timmermans
- Ghent University Hospital, Heart Center, Department of Cardiology, 8K12 IE, De Pintelaan 185, Ghent 9000, Belgium
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De Pooter J, El Haddad M, Timmers L, Van Heuverswyn F, Jordaens L, Duytschaever M, Stroobandt R. Different Methods to Measure QRS Duration in CRT Patients: Impact on the Predictive Value of QRS Duration Parameters. Ann Noninvasive Electrocardiol 2015; 21:305-15. [PMID: 26391903 DOI: 10.1111/anec.12313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 11/28/2022] Open
Abstract
BACKGROUND Measurements of QRS duration (QRSD) in patients undergoing cardiac resynchronization therapy (CRT) are not standardized. We hypothesized that both the measurement of QRSD and its predictive value on CRT response are sensitive to the method by which QRSD is measured. METHODS Electrocardiograms (ECGs) pre- and post-CRT from 52 CRT patients (66 ± 12 years, 65% male) were retrospectively analyzed. Custom-made software was developed to measure global QRSD (QRSDglobal ) and lead-specific QRSD (QRSDI,II,III,aVR,aVL,aVF,V1,V2,V3,V4,V5,V6 ). QRSD was also assessed automatic by a routinely used ECG device. For each method we measured QRSD pre- and post-CRT and shortening of QRSD (∆QRSD). Response to CRT at 6 months was defined as an improvement of ≥1 class in New York Heart Association classification and an increase by >7.5% in left ventricular ejection fraction. RESULTS The CRT response rate was 77% (n = 40). Different methods to measure QRSD show divergent nominal values before (median range 152-172 ms, P < 0.001) and after CRT (130-152 ms, P < 0.001). The predictive value of QRSD measurements for CRT response also varies significantly according to the method used (range AUC pre-CRT QRSD 0.400-0.580, P < 0.05; AUC post-CRT QRSD 0.447-0.768, P < 0.05; AUC ΔQRSD 0.540-0.858, P < 0.05). Global QRSD measurements revealed lower variability compared to lead-specific QRSD. CONCLUSION Different methods to measure QRSD yield not only different nominal values but also influence the value of QRSD in predicting CRT response. Measuring QRSD by a global method can help to standardize QRSD measurements in future studies.
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Affiliation(s)
- Jan De Pooter
- Ghent University Hospital, Heart Center, Ghent, Belgium
| | | | | | | | - Luc Jordaens
- Ghent University Hospital, Heart Center, Ghent, Belgium
| | - Mattias Duytschaever
- Ghent University Hospital, Heart Center, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
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