24 results on '"Westra SW"'
Search Results
2. Optimization of a care pathway before atrial fibrillation ablation with the integration of translational research into routine clinical care
- Author
-
Verhaert, D, primary, Linz, D, additional, Wassink, GW, additional, Weijs, B, additional, Philippens, S, additional, Luermans, JGLM, additional, Westra, SW, additional, Schotten, U, additional, Vernooy, K, additional, and Den Uijl, DW, additional
- Published
- 2022
- Full Text
- View/download PDF
3. Images in clinical medicine. Angioedema of the tongue.
- Author
-
Westra SW and de Jager CPC
- Published
- 2006
4. Clinical signs of the transition of syncope into hypoxic coma: a case report.
- Author
-
van Dijk JG, van Rossum IA, van Waning JI, Westra SW, and Thijs RD
- Subjects
- Humans, Syncope etiology, Syncope diagnosis, Hypoxia etiology, Coma etiology, Syncope, Vasovagal
- Published
- 2023
- Full Text
- View/download PDF
5. A new efficient and integrated pathway for patient evaluation prior to atrial fibrillation ablation.
- Author
-
Verhaert DVM, Linz D, Wassink GF, Weijs B, Philippens S, Luermans JGLM, Westra SW, Schotten U, Vernooy K, and den Uijl DW
- Subjects
- Humans, Treatment Outcome, Data Collection, Atrial Fibrillation surgery, Catheter Ablation methods
- Abstract
Aims: In this quality improvement project, a care pathway for patients considered for atrial fibrillation (AF) ablation was optimized with the goals to improve the patient journey and simultaneously integrate prospective data collection into the clinical process., Methods and Results: The Lean Six Sigma approach was used to map the pre-existing process, identify constraints, and formulate countermeasures. The percentage of patients going through the full pre-ablation preparation that eventually underwent AF ablation, number of hospital visits and consultations, pathway compliance, and completeness of scientific data were measured before and after pathway optimization. Constraints in the process were (i) lack of standardized processes, (ii) inefficient use of resources, (iii) lack of multidisciplinary integration, (iv) lack of research integration, and (v) suboptimal communication. The impact of the corresponding countermeasures (defining a uniform process, incorporating 'go/no-go' moment, introducing a 'one-stop-shop', integrating prospective data collection, and improving communication) was studied for 33 patients before and 26 patients after pathway optimization. After optimization, the percentage of patients receiving a full pre-ablation preparation that eventually underwent AF ablation increased from 59% to 94% (P < 0.01). Fewer hospital visits (3.2 ± 1.2 vs. 2.3 ± 0.8, P = 0.01) and electrophysiologist consultations (1.8 ± 0.7 vs. 1.0 ± 0.3, P < 0.01) were required after pathway optimization. Pathway compliance and complete collection of scientific data increased significantly (3% vs. 73%, P < 0.01 and 15% vs. 73%, P < 0.01, respectively)., Conclusion: The optimization project resulted in a more efficient evaluation of patients considered for AF ablation. The new more efficient process includes prospective data collection and facilitates easy conduct of research studies focused on improvements of patient outcomes., Competing Interests: Conflicts of interest: G.F.W. is an employee of Medtronic Integrated Health Solutions. The other authors have no conflicts of interest to declare., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
- Full Text
- View/download PDF
6. Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study.
- Author
-
Betz K, Verhaert DVM, Gawalko M, Hermans ANL, Habibi Z, Pluymaekers NAHA, van der Velden RMJ, Homberg M, Philippens S, Hereijgers MJM, Vorstermans B, Simons SO, den Uijl DW, Chaldoupi SM, Luermans JGLM, Westra SW, Lankveld T, van Steenwijk RP, Hol B, Schotten U, Vernooy K, Hendriks JM, and Linz D
- Subjects
- Humans, Surveys and Questionnaires, Polysomnography methods, ROC Curve, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Sleep Apnea Syndromes complications, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes epidemiology
- Abstract
Background: Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF., Aim: We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection., Methods: Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea-hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening., Results: Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573-0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m
2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672-0.805) in the overall population., Conclusion: AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies., Trial Registration Number: ISOLATION was registered NCT04342312, 13-04-2020., (© 2023. The Author(s).)- Published
- 2023
- Full Text
- View/download PDF
7. Low 30-Day Mortality After Atrial Fibrillation Ablation: Results From the Netherlands Heart Registration.
- Author
-
Mol D, van der Stoel MD, Balt JC, Bhagwandien RE, Blaauw Y, van Dessel PFHM, van Driel VJHM, Driessen AHG, Elvan A, Hassink RJ, Kemme MJB, Kraaier K, Kuijt WJ, Luermans JGLM, van der Voort PH, Westra SW, de Groot JR, and de Jong JSSG
- Subjects
- Heart, Humans, Netherlands epidemiology, Recurrence, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Pulmonary Veins surgery
- Published
- 2022
- Full Text
- View/download PDF
8. Rationale and Design of the ISOLATION Study: A Multicenter Prospective Cohort Study Identifying Predictors for Successful Atrial Fibrillation Ablation in an Integrated Clinical Care and Research Pathway.
- Author
-
Verhaert DVM, Linz D, Chaldoupi SM, Westra SW, den Uijl DW, Philippens S, Kerperien M, Habibi Z, Vorstermans B, Ter Bekke RMA, Beukema RJ, Evertz R, Hemels MEW, Luermans JGLM, Manusama R, Lankveld TAR, van der Heijden CAJ, Bidar E, Hermans BJM, Zeemering S, Bijvoet GP, Habets J, Holtackers RJ, Mihl C, Nijveldt R, van Empel VPM, Knackstedt C, Simons SO, Buhre WFFA, Tijssen JGP, Isaacs A, Crijns HJGM, Maesen B, Vernooy K, and Schotten U
- Abstract
Introduction: Continuous progress in atrial fibrillation (AF) ablation techniques has led to an increasing number of procedures with improved outcome. However, about 30-50% of patients still experience recurrences within 1 year after their ablation. Comprehensive translational research approaches integrated in clinical care pathways may improve our understanding of the complex pathophysiology of AF and improve patient selection for AF ablation., Objectives: Within the "IntenSive mOlecular and eLectropathological chAracterization of patienTs undergoIng atrial fibrillatiOn ablatioN" (ISOLATION) study, we aim to identify predictors of successful AF ablation in the following domains: (1) clinical factors, (2) AF patterns, (3) anatomical characteristics, (4) electrophysiological characteristics, (5) circulating biomarkers, and (6) genetic background. Herein, the design of the ISOLATION study and the integration of all study procedures into a standardized pathway for patients undergoing AF ablation are described., Methods: ISOLATION (NCT04342312) is a two-center prospective cohort study including 650 patients undergoing AF ablation. Clinical characteristics and routine clinical test results will be collected, as well as results from the following additional diagnostics: determination of body composition, pre-procedural rhythm monitoring, extended surface electrocardiogram, biomarker testing, genetic analysis, and questionnaires. A multimodality model including a combination of established predictors and novel techniques will be developed to predict ablation success., Discussion: In this study, several domains will be examined to identify predictors of successful AF ablation. The results may be used to improve patient selection for invasive AF management and to tailor treatment decisions to individual patients., Competing Interests: CM received consultancy fees for Bayer Healthcare. SS received grants from Boehringer Ingelheim, AstraZeneca and GlaxoSmithKline, honorary fees for presentations from AstraZeneca and Chiesi, consultancy fees from GlaxoSmithKline, payment for advisory boards from Chiesi and GlaxoSmithKline, all outside the submitted work, and payed to his institution. KV was consultant for Medtronic, Abbott, Philips, Biosense Webster. US received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited (United Kingdom), Bayer Healthcare (Germany). US was co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Verhaert, Linz, Chaldoupi, Westra, den Uijl, Philippens, Kerperien, Habibi, Vorstermans, ter Bekke, Beukema, Evertz, Hemels, Luermans, Manusama, Lankveld, van der Heijden, Bidar, Hermans, Zeemering, Bijvoet, Habets, Holtackers, Mihl, Nijveldt, van Empel, Knackstedt, Simons, Buhre, Tijssen, Isaacs, Crijns, Maesen, Vernooy and Schotten.)
- Published
- 2022
- Full Text
- View/download PDF
9. Single procedural outcomes in the setting of percutaneous ablation for persistent atrial fibrillation: a propensity-matched score comparison between different strategies.
- Author
-
Bisignani A, Cecchini F, Mugnai G, Overeinder I, Sieira J, Osório TG, Miraglia V, Monaco C, Sofianos D, Boveda S, Bala G, Ströker E, Paparella G, Westra SW, Brouwer MA, Brugada P, de Asmundis C, and Chierchia GB
- Subjects
- Humans, Propensity Score, Recurrence, Tachycardia surgery, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Cryosurgery methods, Pulmonary Veins surgery
- Abstract
Background: Catheter ablation for persistent atrial fibrillation (persAF) is associated with less favorable outcomes than for paroxysmal AF. To improve success rates, left atrial (LA) substrate modification is frequently performed in addition to pulmonary vein isolation (PVI). The purpose of the study was to compare 4 different ablation approaches using radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB-A) for persAF and to evaluate the respective outcomes on a midterm follow-up of 12 months., Methods: We did a propensity score-matched comparison of 30 patients undergoing PVI + LA posterior wall isolation (LAPWI) with CB-A, 30 patients who underwent PVI + linear ablation (roof and mitral lines) using RFCA, 60 patients with PVI alone using CB-A, and 60 patients who had PVI alone using RFCA. The endpoint was recurrence of documented atrial tachyarrhythmias (ATas) > 30 s at 1-year follow-up., Results: After 12 months, freedom from ATas after a single procedure was 83.3% in the PVI + LAPWI group, 46.7% in the PVI + linear ablation group, 58.3% in the PVI-alone CB-A group, and 61.6% PVI-alone RFCA (p = 0.03). Moreover, freedom from ATas was significantly higher comparing the PVI + LAPWI group with each of the other groups., Conclusions: In this propensity-matched comparison of strategies for persAF, LAPW ablation in addition to PVI with CB-A seems to improve 1-year outcome in comparison to PVI + linear ablation using RFCA and to PVI alone using RFCA or CB-A. Randomized comparisons are eagerly awaited., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
- Full Text
- View/download PDF
10. A VIRTUAL Sleep Apnoea management pathway For the work-up of Atrial fibrillation patients in a digital Remote Infrastructure: VIRTUAL-SAFARI.
- Author
-
Verhaert DVM, Betz K, Gawałko M, Hermans ANL, Pluymaekers NAHA, van der Velden RMJ, Philippens S, Vorstermans B, Simons SO, den Uijl DW, Chaldoupi SM, Luermans JGLM, Westra SW, Lankveld T, Kadhim K, Pepin JL, van Steenwijk RP, Hol B, Schotten U, Sanders P, Vernooy K, Hendriks JM, and Linz D
- Subjects
- Humans, Polysomnography, Sleep, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Catheter Ablation, Sleep Apnea Syndromes complications, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes therapy
- Abstract
Aims: In atrial fibrillation (AF) patients, untreated sleep-disordered breathing (SDB) is associated with lower success rates of rhythm control strategies and as such structured SDB testing is recommended. Herein, we describe the implementation of a virtual SDB management pathway in an AF outpatient clinic and examine the utility and feasibility of this new approach., Methods and Results: Prospectively, consecutive AF patients accepted for AF catheter ablation procedures without previous diagnosis of SDB were digitally referred to a virtual SDB management pathway and instructed to use WatchPAT-ONE (ITAMAR) for one night. Results were automatically transferred to a virtual sleep laboratory, upon which a teleconsultation with a sleep physician was planned. Patient experience was measured using surveys. SDB testing was performed in 119 consecutive patients scheduled for AF catheter ablation procedures. The median time from digital referral to finalization of the sleep study report was 18 [11-24] days. In total, 65 patients (55%) were diagnosed with moderate-to-severe SDB. Patients with SDB were prescribed more cardiovascular drugs and had higher body mass indices (BMI, 29 ± 3.3 vs. 27 ± 4.4kg/m2, P < 0.01). Patients agreed that WatchPAT-ONE was easy to use (91%) and recommended future use of this virtual pathway in AF outpatient clinics (86%). Based on this remote SDB testing, SDB treatment was recommended in the majority of patients., Conclusion: This novel virtual AF management pathway allowed remote SDB testing in AF outpatient clinics with a short time to diagnosis and high patient satisfaction. Structured SDB testing results in a high detection of previously unknown SDB in AF patients scheduled for AF ablation., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
- Full Text
- View/download PDF
11. Persistent phrenic nerve palsy after atrial fibrillation ablation: Follow-up data from The Netherlands Heart Registration.
- Author
-
Mol D, Renskers L, Balt JC, Bhagwandien RE, Blaauw Y, van Driel VJHM, Driessen AHG, Elvan A, Folkeringa R, Hassink RJ, Hooft van Huysduynen B, Luermans JGLM, Stevenhagen JY, van der Voort PH, Westra SW, de Groot JR, and de Jong JSSG
- Subjects
- Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Netherlands epidemiology, Paralysis etiology, Phrenic Nerve, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Cryosurgery adverse effects, Cryosurgery methods, Pulmonary Veins surgery
- Abstract
Background: Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24 h. This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study., Methods: In this study, we used data from the Netherlands Heart Registration, comprising data from 9549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7433 procedures, and additional follow-up data were collected for patients who developed persistent PNP., Results: Overall, the mean age was 62 ± 10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25%, respectively for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203 (113-351) and 184 (82-359) days, respectively. Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery., Conclusion: After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP., (© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
12. Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation.
- Author
-
van Vugt SPG, Westra SW, Volleberg RHJA, Hannink G, Nakamura R, de Asmundis C, Chierchia GB, Navarese EP, and Brouwer MA
- Subjects
- Administration, Oral, Anticoagulants adverse effects, Humans, Prospective Studies, Randomized Controlled Trials as Topic, Vitamin K, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Stroke etiology, Stroke prevention & control
- Abstract
Aims: At present, there are no guideline recommendations for minimally interrupted use of non-vitamin K antagonist oral anticoagulants (mi-NOAC) during catheter ablation (CA) for atrial fibrillation (AF). Current evidence is predominantly based on observational studies, with continuous use of vitamin K antagonist in the control arm. This quantitative summary reflects the first high-level evidence on contemporary regimens, with continuous NOAC use (c-NOAC) as the current gold standard., Methods and Results: Meta-analysis (Pubmed, Embase, and Web of Science) on prospective, controlled studies comparing contemporary mi-NOAC (without bridging) with c-NOAC. Net adverse clinical events (major bleeding, thrombo-embolic events) were the primary outcome. In addition, we analysed total bleeding, minor bleeding, and silent cerebral embolism. Eight studies (six randomized, two observational) with 2168 patients were summarized. The primary endpoint occurred in 1.0% (18/1835): 1.1% (11/1005) vs. 0.8% (7/830) for the mi-NOAC and c-NOAC groups, respectively; odds ratio (OR) 1.20 [95% confidence interval (CI) 0.49-2.92, P = 0.64]. The OR for total bleeding on mi-NOAC was 1.26 (95% CI 0.97-1.63, P = 0.07). ORs for minor bleeding and silent cerebral embolism were 1.17 (95% CI 0.80-1.70, P = 0.34) and 2.62 (95% CI 0.54-12.61, P = 0.12), respectively., Conclusion: This synopsis provides a quantitative synthesis of high-level evidence on a contemporary strategy of mi-NOAC in CA for AF, and overall clinical outcomes were not different from continuous NOAC use. Despite preprocedural interruption, there was no sign of lower bleeding rates. Additional higher volume datasets are warranted for more precise treatment effect estimations of this everyday alternative anticoagulation strategy in AF ablation., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2021
- Full Text
- View/download PDF
13. Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique.
- Author
-
Mol D, Houterman S, Balt JC, Bhagwandien RE, Blaauw Y, Delnoy PH, van Driel VJ, Driessen AH, Folkeringa RJ, Hassink RJ, van Huysduynen BH, Luermans JG, Ouss AJ, Stevenhagen YJ, van Veghel D, Westra SW, de Jong JS, and de Groot JR
- Subjects
- Female, Humans, Male, Netherlands epidemiology, Recurrence, Treatment Outcome, Ablation Techniques, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Cryosurgery adverse effects, Pulmonary Veins surgery
- Abstract
Aims: Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1-3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation., Methods and Results: The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98-4.45) and 2.02 (95% CI 1.03-4.00) respectively., Conclusion: The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
- Full Text
- View/download PDF
14. Computerized Analysis of the Ventricular Fibrillation Waveform Allows Identification of Myocardial Infarction: A Proof-of-Concept Study for Smart Defibrillator Applications in Cardiac Arrest.
- Author
-
Thannhauser J, Nas J, Rebergen DJ, Westra SW, Smeets JLRM, Van Royen N, Bonnes JL, and Brouwer MA
- Subjects
- Aged, Cardiopulmonary Resuscitation methods, Electric Countershock instrumentation, Electrocardiography methods, Female, Humans, Male, Middle Aged, Netherlands, Prognosis, Proof of Concept Study, Registries, Defibrillators, Implantable, Electric Countershock statistics & numerical data, Heart Arrest etiology, Heart Arrest therapy, Image Processing, Computer-Assisted methods, Myocardial Infarction complications, Myocardial Infarction diagnosis, Ventricular Fibrillation diagnosis, Ventricular Fibrillation etiology
- Abstract
Background In cardiac arrest, computerized analysis of the ventricular fibrillation (VF) waveform provides prognostic information, while its diagnostic potential is subject of study. Animal studies suggest that VF morphology is affected by prior myocardial infarction (MI), and even more by acute MI. This experimental in-human study reports on the discriminative value of VF waveform analysis to identify a prior MI. Outcomes may provide support for in-field studies on acute MI. Methods and Results We conducted a prospective registry of implantable cardioverter defibrillator recipients with defibrillation testing (2010-2014). From 12-lead surface ECG VF recordings, we calculated 10 VF waveform characteristics. First, we studied detection of prior MI with lead II, using one key VF characteristic (amplitude spectrum area [AMSA]). Subsequently, we constructed diagnostic machine learning models: model A, lead II, all VF characteristics; model B, 12-lead, AMSA only; and model C, 12-lead, all VF characteristics. Prior MI was present in 58% (119/206) of patients. The approach using the AMSA of lead II demonstrated a C-statistic of 0.61 (95% CI, 0.54-0.68). Model A performance was not significantly better: 0.66 (95% CI, 0.59-0.73), P =0.09 versus AMSA lead II. Model B yielded a higher C-statistic: 0.75 (95% CI, 0.68-0.81), P <0.001 versus AMSA lead II. Model C did not improve this further: 0.74 (95% CI, 0.67-0.80), P =0.66 versus model B. Conclusions This proof-of-concept study provides the first in-human evidence that MI detection seems feasible using VF waveform analysis. Information from multiple ECG leads rather than from multiple VF characteristics may improve diagnostic accuracy. These results require additional experimental studies and may serve as pilot data for in-field smart defibrillator studies, to try and identify acute MI in the earliest stages of cardiac arrest.
- Published
- 2020
- Full Text
- View/download PDF
15. Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing.
- Author
-
Salden FCWM, Luermans JGLM, Westra SW, Weijs B, Engels EB, Heckman LIB, Lamerichs LJM, Janssen MHG, Clerx KJH, Cornelussen R, Ghosh S, Prinzen FW, and Vernooy K
- Subjects
- Aged, Bundle-Branch Block therapy, Electrocardiography, Electrodes, Female, Fluoroscopy, Heart Failure physiopathology, Heart Septum pathology, Humans, Male, Middle Aged, Prospective Studies, Ventricular Function, Left, Cardiac Resynchronization Therapy methods, Electrophysiological Phenomena, Heart Ventricles physiopathology, Hemodynamics
- Abstract
Background: Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated., Objectives: The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients., Methods: Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax)., Results: As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 ± 22 μVs) and SDAT (to 26 ± 7 ms) than BiV (to 93 ± 26 μVs and 31 ± 7 ms; both p < 0.05) and LVs+RV pacing (to 108 ± 37 μVs; p < 0.05; and 29 ± 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 ± 10% vs. 17 ± 9%, respectively) and larger than during LVs+RV pacing (11 ± 9%; p < 0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing., Conclusions: LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
16. Lead detour.
- Author
-
van den Broek LM, Westra SW, Evertz R, and Boulaksil M
- Published
- 2020
- Full Text
- View/download PDF
17. Second-generation cryoballoon ablation for recurrent atrial fibrillation after an index cryoballoon procedure: a staged strategy with variable balloon size.
- Author
-
Westra SW, van Vugt SPG, Sezer S, Evertz R, Hemels ME, Beukema RJ, de Asmundis C, Brouwer MA, and Chierchia GB
- Subjects
- Aged, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation mortality, Cohort Studies, Cryosurgery instrumentation, Cryosurgery mortality, Disease-Free Survival, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Patient Safety, Prospective Studies, Recurrence, Reoperation methods, Risk Assessment, Severity of Illness Index, Survival Rate, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Cryosurgery methods, Pulmonary Veins surgery
- Abstract
Purpose: Currently, information on the optimal approach of redo procedures for paroxysmal atrial fibrillation (PAF) is limited. Radiofrequency ablation is the preferred technique, with reported success rates of 50-70% at 1-2 years, whereas only few reports exist on redo cryoballoon (CB) ablations. We describe outcomes on a systematic approach of repeat procedures with a second-generation cryoballoon (CB-2) after a successful index CB ablation., Methods: Cohort study of 40 consecutive patients with recurrent PAF (55% male), median CHA
2 DS2 -VASc score 1 (IQR 0-3). Per protocol, a staged variable balloon size strategy was followed with a different balloon size during the redo as compared to the index procedure. Minimal follow-up was 12 months (median 17 months [IQR 14-39])., Results: Overall, 120 pulmonary veins (PVs) (75%) showed chronic isolation: 64% (41/64) for first-generation cryoballoon (CB-1) and 82% (79/96) for CB-2 index procedures, respectively (p = 0.01). The overall mean number of reconnected PVs per patient was 1.0 (40/40): 1.4 for CB-1 and 0.7 for CB-2 index procedures (p = 0.008). Phrenic nerve palsies (n = 7) resolved before the end of the procedure. At 1 year, 70% of patients were free of recurrent AF. In multivariate analysis, the only independent predictor of recurrence was the number of prior cardioversions., Conclusions: A systematic approach of repeat procedures with a CB-2 using a different balloon size than during the index CB ablation is safe, with acceptable 1-year outcomes. Future comparative studies on the optimal redo technique and approach are warranted to further improve rhythm control in AF.- Published
- 2019
- Full Text
- View/download PDF
18. Ventricular fibrillation waveform characteristics of the surface ECG: Impact of the left ventricular diameter and mass.
- Author
-
Bonnes JL, Thannhauser J, Nas J, Westra SW, Jansen RMG, Meinsma G, de Boer MJ, Smeets JLRM, Keuper W, and Brouwer MA
- Subjects
- Aged, Cardiopulmonary Resuscitation, Cohort Studies, Electric Countershock, Electrocardiography, Female, Heart Arrest therapy, Humans, Male, Middle Aged, Myocardial Infarction epidemiology, Organ Size, Ventricular Fibrillation physiopathology, Defibrillators, Implantable, Heart Arrest etiology, Heart Ventricles pathology, Myocardial Infarction complications, Ventricular Fibrillation therapy
- Abstract
Background: Despite a promising association between VF waveform characteristics and prognosis after resuscitation, studies with VF-guided treatment have so far not improved outcomes. While driven by the idea that the VF waveform reflects arrest duration, increasing evidence suggests that pre-existent disease-related changes of the myocardium affect ECG-characteristics of VF as well. In this context, we studied the impact of the left ventricular (LV) diameter and mass., Methods: Cohort of 193 ICD-patients with defibrillation testing at the Radboudumc (2010-2014). Surface ECG-recordings (leads I,II,aVF,V1,V3,V6) were analysed to study amplitude and frequency characteristics of the induced VF. Both for LV diameter and mass, patients were categorised in two groups, using echocardiographic data (ASE-guidelines)., Results: In all ECG-leads, dominant and median frequencies were significantly lower in patients with (n=40) than in patients without (n=151) an increased LV diameter. The mean amplitude and amplitude spectrum area (AMSA) did not differ. In contrast, we observed no differences in frequency characteristics in relation to the LV mass, whereas mean amplitude (I,aVF,V3) and AMSA (I,V3) were significantly higher in patients with (n=57) than in patients without (n=120) an increased LV mass., Conclusions: Frequency characteristics of VF were consistently lower in case of an increased LV diameter. Whereas LV mass does not affect the frequency of the VF waveform, amplitudes seem higher with increasing mass. These findings add to the current knowledge of factors that modulate VF characteristics of the surface ECG and provide insight into factors which may be accounted for in future studies on VF-guided resuscitative interventions., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
19. Risk Factors for Inadequate Defibrillation Safety Margins Vary With the Underlying Cardiac Disease: Implications for Selective Testing Strategies.
- Author
-
Bonnes JL, Westra SW, Bouwels LH, DE Boer MJ, Brouwer MA, and Smeets JL
- Subjects
- Adult, Age Factors, Aged, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Chi-Square Distribution, Electric Countershock adverse effects, Female, Humans, Hypertrophy, Left Ventricular complications, Logistic Models, Male, Middle Aged, Myocardial Ischemia diagnosis, Myocardial Ischemia physiopathology, Netherlands, Odds Ratio, Prosthesis Design, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Arrhythmias, Cardiac therapy, Defibrillators, Implantable, Electric Countershock instrumentation, Equipment Safety, Myocardial Ischemia complications, Patient Safety
- Abstract
Introduction: In view of the shift from routine toward no or selective defibrillation testing, optimization of the current risk stratification for inadequate defibrillation safety margins (DSMs) could improve individualized testing decisions. Given the pathophysiological differences in myocardial substrate between ischemic and nonischemic heart disease (IHD/non-IHD) and the accompanying differences in clinical characteristics, we studied inadequate DSMs and their predictors in relation to the underlying etiology., Methods and Results: Cohort of routine defibrillation tests (n = 785) after first implantable cardioverter defibrillator (ICD)-implantations at the Radboud UMC (2005-2014). A defibrillation threshold >25 J was regarded as an inadequate DSM. In total, 4.3% of patients had an inadequate DSM; in IHD 2.5% versus 7.3% in non-IHD (P = 0.002). We identified a group of non-IHD patients at high risk (13-42% inadequate DSM); the remainder of the cohort (>70%) had a risk of only 2% (C-statistic entire cohort 0.74; C-statistic non-IHD 0.82). This was based upon two identified interaction terms: (1) non-IHD and age (aOR 0.94 [95% CI 0.91-0.97]); (2) non-IHD and the indexed left ventricular (LV) internal diastolic diameter (aOR 3.50 [95% CI 2.10-5.82])., Conclusion: The present study on risk stratification for an inadequate DSM not only confirms the importance of making a distinction between IHD and non-IHD, but also shows that risk factors in an entire cohort (LV dilatation, age) may only apply to a subgroup (non-IHD). Appreciation of this concept could favorably affect current risk stratification. If confirmed, our approach may be used to optimize individualized testing decisions in an upcoming era of non-routine testing., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
20. Safety and long-term effects of renal denervation: Rationale and design of the Dutch registry.
- Author
-
Sanders MF, Blankestijn PJ, Voskuil M, Spiering W, Vonken EJ, Rotmans JI, van der Hoeven BL, Daemen J, van den Meiracker AH, Kroon AA, de Haan MW, Das M, Bax M, van der Meer IM, van Overhagen H, van den Born BJ, van Brussel PM, van der Valk PH, Smak Gregoor PJ, Meuwissen M, Gomes ME, Oude Ophuis T, Troe E, Tonino WA, Konings CJ, de Vries PA, van Balen A, Heeg JE, Smit JJ, Elvan A, Steggerda R, Niamut SM, Peels JO, de Swart JB, Wardeh AJ, Groeneveld JH, van der Linden E, Hemmelder MH, Folkeringa R, Stoel MG, Kant GD, Herrman JP, van Wissen S, Deinum J, Westra SW, Aengevaeren WR, Parlevliet KJ, Schramm A, Jessurun GA, Rensing BJ, Winkens MH, Wierema TK, Santegoets E, Lipsic E, Houwerzijl E, Kater M, Allaart CP, Nap A, and Bots ML
- Subjects
- Aged, Antihypertensive Agents therapeutic use, Blood Pressure, Female, Humans, Hypertension drug therapy, Male, Middle Aged, Netherlands epidemiology, Preoperative Period, Prospective Studies, Renal Artery innervation, Sympathectomy methods, Time, Treatment Outcome, Hypertension surgery, Registries, Renal Artery surgery, Sympathectomy statistics & numerical data
- Abstract
Background: Percutaneous renal denervation (RDN) has recently been introduced as a treatment for therapy-resistant hypertension. Also, it has been suggested that RDN may be beneficial for other conditions characterised by increased sympathetic nerve activity. There are still many uncertainties with regard to efficacy, safety, predictors for success and long-term effects. To answer these important questions, we initiated a Dutch RDN registry aiming to collect data from all RDN procedures performed in the Netherlands., Methods: The Dutch RDN registry is an ongoing investigator-initiated, prospective, multicentre cohort study. Twenty-six Dutch hospitals agreed to participate in this registry. All patients who undergo RDN, regardless of the clinical indication or device that is used, will be included. Data are currently being collected on eligibility and screening, treatment and follow-up., Results: Procedures have been performed since August 2010. At present, data from 306 patients have been entered into the database. The main indication for RDN was hypertension (n = 302, 99%). Patients had a mean office blood pressure of 177/100 (±29/16) mmHg with a median use of three (range 0-8) blood pressure lowering drugs. Mean 24-hour blood pressure before RDN was 157/93 (±18/13) mmHg. RDN was performed with different devices, with the Simplicity™ catheter currently used most frequently., Conclusion: Here we report on the rationale and design of the Dutch RDN registry. Enrolment in this investigator-initiated study is ongoing. We present baseline characteristics of the first 306 participants.
- Published
- 2016
21. Ventricular fibrillation waveform characteristics differ according to the presence of a previous myocardial infarction: A surface ECG study in ICD-patients.
- Author
-
Bonnes JL, Thannhauser J, Hermans MC, Westra SW, Oostendorp TF, Meinsma G, de Boer MJ, Brouwer MA, and Smeets JL
- Subjects
- Aged, Algorithms, Female, Follow-Up Studies, Heart Arrest epidemiology, Heart Arrest therapy, Humans, Incidence, Male, Middle Aged, Myocardial Infarction physiopathology, Netherlands epidemiology, Prognosis, Prospective Studies, Survival Rate trends, Ventricular Fibrillation complications, Ventricular Fibrillation therapy, Defibrillators, Implantable, Electromyography methods, Heart Arrest etiology, Heart Rate physiology, Myocardial Infarction complications, Ventricular Fibrillation physiopathology
- Abstract
Background: Characteristics of the ventricular fibrillation (VF) waveform reflect arrest duration and have been incorporated in studies on algorithms to guide resuscitative interventions. Findings in animals indicate that VF characteristics are also affected by the presence of a previous myocardial infarction (MI). As studies in humans are scarce, we assessed the impact of a previous MI on VF characteristics in ICD-patients., Methods: Prospective cohort of ICD-patients (n=190) with defibrillation testing at the Radboudumc (2010-2013). VF characteristics of the 12-lead surface ECG were compared between three groups: patients without a history of MI (n=88), with a previous anterior (n=47) and a previous inferior MI (n=55)., Results: As compared to each of the other groups, the mean amplitude and amplitude spectrum area were lower, for an anterior MI in lead V3 and for an inferior MI in leads II and aVF. Across the three groups, the bandwidth was broader in the leads corresponding with the infarct localisation. In contrast, the dominant and median frequencies only differed between previous anterior MI and no history of MI, being lower in the former., Conclusions: The VF waveform is affected by the presence of a previous MI. Amplitude-related measures were lower and VF was less organised in the ECG-lead(s) adjacent to the area of infarction. Although VF characteristics of the surface ECG have so far primarily been considered a proxy for arrest duration and metabolic state, our findings question this paradigm and may provide additional insights into the future potential of VF-guided resuscitative interventions., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
22. Characteristics of ventricular fibrillation in relation to cardiac aetiology and shock success: A waveform analysis study in ICD-patients.
- Author
-
Bonnes JL, Keuper W, Westra SW, Zegers ES, Oostendorp TF, Brouwer MA, and Smeets JL
- Subjects
- Cohort Studies, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction complications, Remission Induction, Retrospective Studies, Ventricular Fibrillation etiology, Defibrillators, Implantable, Electric Countershock, Ventricular Fibrillation physiopathology, Ventricular Fibrillation therapy
- Abstract
Background: Ventricular fibrillation (VF) waveform characteristics are associated with cardiac arrest duration and defibrillation success. Recent animal studies found that VF characteristics and shock success also depend on the presence of myocardial infarction (MI). In patients, VF induction after implantable cardioverter defibrillator (ICD) implantation offers a unique setting to study early VF characteristics: we studied the relation with cardiac disease--either presence or absence of a previous MI--and with shock success., Methods: Retrospective cohort study of ICD-patients who underwent defibrillation testing, 117 (63%) with and 69 (37%) without a previous MI. Intracardiac recordings of induced VF were analysed using Fourier analysis., Results: In previous MI-patients, the fundamental frequency and organisation index of the VF signal were significantly lower as compared with patients without a previous MI: 4.9 Hz ± 0.6 vs. 5.2 Hz ± 0.6 (p = 0.005) and 56% ± 10 vs. 60% ± 9 (p = 0.001), respectively. The median frequency was not different (p = 0.25). We found no association between VF characteristics and ICD shock success., Conclusions: In analogy with observations in animals, we found that a history of a previous MI was associated with slower and less organised VF. In our cohort of ICD-patients, early VF waveform characteristics were not associated with shock outcomes. Further study is warranted to determine to what extent VF characteristics are influenced by the underlying aetiology on the one hand, and time delay on the other. These findings could improve insight into the potential value of VF analysis to guide shock delivery., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
23. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease.
- Author
-
van Brakel TJ, van der Krieken T, Westra SW, van der Laak JA, Smeets JL, and van Swieten HA
- Subjects
- Aged, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Fibrosis, Heart Valve Diseases diagnosis, Heart Valve Diseases surgery, Humans, Middle Aged, Reproducibility of Results, Sensitivity and Specificity, Atrial Appendage pathology, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Coronary Artery Disease complications, Electrocardiography methods, Heart Valve Diseases complications
- Abstract
Purpose: This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for potential ablation therapy., Methods: Interstitial fibrosis from right (RAA) and/or left atrial appendages (LAA) was studied in patients with sinus rhythm (SR, n = 8), paroxysmal (n = 21), and persistent AF (n = 20) undergoing coronary artery bypass and/or aortic or mitral valve surgery. Atrial fibrosis quantification was performed with Masson trichrome staining. Intraoperative bipolar epicardial electrophysiological measurements were performed to correlate fibrosis to electrogram fractionation, voltage, and AF cycle length., Results: The average degree of fibrosis was 11.2 ± 7.2 % in the LAA and 22.8 ± 7.6 % in the RAA (p < 0.001). Fibrosis was not significantly higher in paroxysmal AF patients compared to SR subjects (18.2 ± 8.7 versus 20.7 ± 5.3 %). Persistent AF patients had a higher degree of LAA and RAA fibrosis compared to paroxysmal AF patients (LAA 14.6 ± 8.7 versus 8.6 ± 4.7 %, p = 0.02, and RAA 28.2 ± 7.9 versus 18.2 ± 8.7 %, respectively, p = 0.04). The left atrial end diastolic volume index was higher in persistent AF patients compared to SR controls (38.3 ± 16.4 and 28 ± 11 ml/m(2), respectively, p = 0.04). No correlation between atrial fibrosis and electrogram fractionation or voltage was found., Conclusion: Patients with structural heart disease undergoing cardiac surgery have more fibrosis in the RAA than in the LAA. Furthermore, RAA fibrosis is increased in persistent AF but not paroxysmal AF patients compared to control subjects. Electrogram fractionation and low voltage did not provide accurate identification of the fibrotic substrate.
- Published
- 2013
- Full Text
- View/download PDF
24. [A woman with anginal symptoms and normal coronary arteries].
- Author
-
Asselman MA, Westra SW, and Verheugt FW
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Aspirin therapeutic use, Electrocardiography methods, Exercise Tolerance physiology, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Middle Aged, Treatment Outcome, Microvascular Angina diagnosis, Microvascular Angina drug therapy
- Abstract
Angina pectoris is usually the first manifestation ofischaemic heart disease. Men are more often affected than women, but women are often denied the full diagnostic work-up of ischaemic heart disease. A 58-year-old woman had typical angina, positive exercise electrocardiography and a negative coronary arteriogram: syndrome X. She was treated with a beta blocker, aspirin, a statin and an angiotensin-converting enzyme (ACE) inhibitor, and eventually obtained relief of her symptoms.
- Published
- 2008
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.