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1. Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Author

Michiel Rienstra, Robert G Tieleman, Isabelle C van Gelder, Bart A Mulder, Yuri Blaauw, Meelad I H Al-Jazairi, Yong E S Tan, Ans C P Wiesfeld, Federico T Magni, and Hessel F Groenveld

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction Pulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and results We included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.Conclusions Using a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

Published
2021
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2. Initial experience with pulsed field ablation for atrial fibrillation

Author

Federico T. Magni, Bart A. Mulder, Hessel F. Groenveld, Ans C. P. Wiesfeld, Robert G. Tieleman, Moniek G. Cox, Isabelle C. Van Gelder, Tom Smilde, Eng S. Tan, Michiel Rienstra, and Yuri Blaauw

Subjects
atrial fibrillation, posterior wall ablation, learning curve, pulsed field ablation, catheter ablation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

IntroductionPulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients.Materials and methodsWe investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described.ResultsThe mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA2DS2-VASc score was 1.5 (IQR: 1.0–2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R2 = 0.034, p = 0.35; Operator 2 (junior): R2 = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access.ConclusionOur initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn.

Published
2022
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3. A randomized controlled trial of eplerenone in asymptomatic phospholamban p.Arg14del carriers

Author

Remco de Brouwer, Wouter P te Rijdt, Edgar T Hoorntje, Ahmad Amin, Folkert W Asselbergs, Moniek G P J Cox, Jeroen F van der Heijden, Hans Hillege, Jacco C Karper, Belend Mahmoud, Peter van der Meer, Anton Oomen, Anneline S J M te Riele, Herman H W Silljé, Hanno L Tan, Jan Peter van Tintelen, Dirk J van Veldhuisen, Berend Daan Westenbrink, Ans C P Wiesfeld, Tineke P Willems, Paul A van der Zwaag, Arthur A M Wilde, Rudolf A de Boer, and Maarten P van den Berg

Subjects
Cardiology and Cardiovascular Medicine
Published
2023
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4. Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Author

Bart A Mulder, Meelad I H Al-Jazairi, Federico T Magni, Hessel F Groenveld, Robert G Tieleman, Ans C P Wiesfeld, Yong E S Tan, Isabelle C Van Gelder, Michiel Rienstra, Yuri Blaauw, and Cardiovascular Centre (CVC)

Subjects
Male, Reoperation, Time Factors, Incidence, Middle Aged, electrophysiology, Treatment Outcome, Pulmonary Veins, Recurrence, Risk Factors, Atrial Fibrillation, Catheter Ablation, Electrocardiography, Ambulatory, Humans, Female, Arrhythmias and Sudden Death, Cardiology and Cardiovascular Medicine, Netherlands, Retrospective Studies
Abstract

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

Published
2021

5. Abstracts of papers and posters

Author

R. L. Anthonio, A. T. M. Willemsen, T. Visser, A. Waarde, P. Elzinga, A. Weemaes, J. G. Meeder, J. Pruim, G. Visser, P. K. Blanksma, W. Vaalburg, P. G. M. Bloemen, P. A. J. Henricks, L. Bloois, M. C. Tweel, F. P. Nijkamp, D. J. A. Crommelin, G. Storm, A. H. Boer, H. M. I. Winter, C. F. Lerk, J. Boer, H. Meurs, A. E. Bottone, M. Koopal, J. C. Visser, J. Zaagsma, P. Borger, H. F. Kauffman, J. L. J. Vijgen, D. S. Postma, E. Vellenga, Theresa L. Buckley, H. Buikema, W. H. Gilst, D. J. Veldhuisen, B. J. G. L. Smet, E. Scholtens, K. I. Lie, H. Wesseling, P. K. Cheung, F. W. D. Dijkhuis, W. W. Bakker, J. Visser, R. P. Coopes, L. Benthem, J. Leest, A. F. Roffel, R. P. Coppes, L. J. W. Zeilstra, A. Vissink, A. W. T. Konings, M. Dijkstra, G. In't Veld, M. Müller, G. J. Berg, F. Kuipers, R. J. Vonk, P. H. Elsinga, E. J. F. Franssen, W. T. A. Graaf, E. G. E. Vries, G. M. Visser, M. G. Vos, A. H. Braker, T. J. Visser, F. Engels, A. H. Houwelingen, M. J. Velde, R. T. Gansevoort, W. J. Sluiter, M. H. Hemmelder, D. Zeeuw, P. E. Jong, H. P. M. M. Gelissen, R. H. Henning, A. H. Epema, J. Eekeren, P. J. Hennis, A. Hertog, S. S. N. Graaf, S. J. Kellie, H. Bloemhof, I. Johnston, M. Besser, R. W. Chaseling, R. A. Ouvrier, D. R. A. Uqes, A. Haan, H. J. Geerligs, J. P. Huchshorn, G. J. M. Scharenburg, J. Wilschut, M. Haas, C. A. Kluppel, D. K. F. Meijer, F. Moolenaar, Eibert R. Heerdink, Hubert G. Leufkens, Ron M. C. Herings, Bruno H. Ch. Stricker, Albert Bakker, W. F. Heesen, F. W. Beltman, A. J. Smit, J. F. May, B. Meyboom-de Jong, M. Duin, J. Akker, M. F. W. Pas, J. P. Popta, S. A. Nelemans, H. J. Linde, A. Boer, F. Sturmans, E. M. Hessel, A. J. M. Oosterhout, C. L. Hofstra, J. Garssen, H. Loveren, H. F. J. Savelkoul, Y. Hoekstra, E. J. M. Weersink, J. W. Jong, B. Belt-Gritter, Lisa M. Jonkman, Chantal Kemner, Harry S. Koelega, Herman Engeland, Marinus N. Verbaten, M. Kalivianakis, I. Zijlstra, H. J. Verkade, H. Elzinga, F. Stellaard, J. A. A. M. Kamps, P. J. Swart, H. Morselt, G. L. Scherphof, J. L. Kenemans, M. M. Lorist, N. R. Koopen, A. D. Kraneveld, A. Si. Koster, M. E. Kuipers, M. Groenink, H. Huisman, H. Schuitemaker, H. S. Lau, I. J. P. M. Broek, A. Dijk, J. Oostinga, A. J. Porsius, Y. Lin, R. Havinga, R. J. Meijer, Th. W. Mark, G. H. Koëter, A. A. Michels, V. -T. Nguyen, O. Bensaude, H. H. Kampinga, Inge C. M. Mohede, J. M. Antoon, Grietje Molema, Thomas S. Edgington, Philip E. Thorpe, P. Olinga, G. W. Sandker, M. J. H. Slooff, M. T. Merema, G. M. M. Groothuis, G. Hofman, I. Ark, J. J. C. Paulussen, M. J. E. Fischer, N. J. Mol, L. H. M. Janssen, E. Th. J. Peters, G. Th. Werf, F. M. Haaijer-Ruskamp, Yigal M. Pinto, Gerrit Rooks, Jean G. Grandjean, Tjark Ebels, H. Schunkert, Frank A. Redegeld, Johan Garssen, Henk Loveren, Irma M. Rigter, Muck Groningen, Gertjan J. Boks, Jan P. Tollenaere, Keith I. Trollope, Jeremy G. Vinter, Gudarz Sadeghi Hashjin, Gert Folkerts, Peet G. F. Loo, R. E. Santing, C. G. Olymulder, K. Molen, Y. Pasman, Heleen Scheerens, T. J. A. Seppenwoolde-Waasdorp, P. Boer, H. M. J. Engelen, J. H. H. Thijssen, R. A. A. Maes, J. Smit, J. W. Smit, H. Steen, M. H. Steurs, P. F. M. Kuks, J. A. Leusink, Balázs M. Szabó, Harry J. G. M. Crijns, Ans C. P. Wiesfeld, H. Talsma, J. C. H. Borchert, M. J. Steenbergen, W. E. Hennink, K. B. Teeuw, H. Cromheecke, A. Schreudering, B. C. H. Teisman, W. Maselbas, G. T. P. Wolters-Keulemans, R. G. Tieleman, C. D. J. Langen, K. Bel, H. J. G. M. Crijns, J. Grandjean, M. Wijffels, A. H. Klimp, P. F. Meer, M. A. Allessie, H. A. Tissot Patot, B. M. Jongh, Y. S. Tuininga, J. Brouwer, J. Haaksma, A. J. Man in't Veld, F. J. Blomjous, M. H. Vingerhoeds, S. O. Belliot, H. J. Haisma, C. A. Visscher, R. M. Huisman, G. J. Navis, J. F. Vlieger, P. Wijngaard, J. Wilting, D. Heuven-Nolsen, A. A. Voors, B. L. Brussel, H. W. M. Plokker, R. C. A. M. Waardenburg, Prins J. Meijer, C. Vries, N. H. Mulder, P. K. Wierenga, P. Schoen, and R. Bron

Subjects
Pharmacology, Pharmaceutical Science, Pharmacology (medical), Pharmacy, General Medicine, Toxicology
Published
1994
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6. Determinants and outcome of amiodarone-associated thyroid dysfunction

Author

Sheba, Ahmed, Isabelle C, Van Gelder, Ans C P, Wiesfeld, Dirk J, Van Veldhuisen, and Thera P, Links

Subjects
Adult, Male, Databases, Factual, Age Factors, Thyroid Gland, Amiodarone, Thyrotropin, Arrhythmias, Cardiac, Kaplan-Meier Estimate, Middle Aged, Thyroid Function Tests, Thyrotoxicosis, Treatment Outcome, Hypothyroidism, Multivariate Analysis, Diabetes Mellitus, Humans, Female, Anti-Arrhythmia Agents, Aged, Follow-Up Studies, Retrospective Studies
Abstract

Amiodarone is frequently associated with thyroid dysfunction. Identifying predictors for amiodarone-associated thyroid dysfunction and assessing treatment outcome may aid clinicians in daily practice.We included 303 consecutive patients with amiodarone therapy for cardiac arrhythmias (260 with atrial fibrillation and 43 with ventricular arrhythmias). Thyroid function tests were performed every 6 months.Mean age was 63 ± 12 years and 66% was male. After median follow-up of 3·3 (0·1-24) years, 23 (8%) patients developed amiodarone-associated thyrotoxicosis (incidence rate 1·9 per 100 person years) and 18 (6%) hypothyroidism (incidence rate 1·1 per 100 person years). The only predictor for amiodarone-associated thyrotoxicosis was age62 years [HR = 2·4 (95% CI 1·0-5·7), P = 0·05]. Predictors for amiodarone-associated hypothyroidism were thyroid stimulating hormone1·4 mU/l at baseline [HR = 5·1 (95% CI 1·1-22·4), P = 0·03], left ventricular ejection fraction45% [HR = 3·8 (95% CI 1·1-13·3), P = 0·04] and diabetes mellitus at baseline [HR = 3·3 (95% CI 1·1-10·3), P = 0·04]. Gender was not a predictor for amiodarone-associated thyroid dysfunction. Five out of 12 (42%) patients with thyrotoxicosis exhibited spontaneous normalization of thyroid function on continuation of amiodarone therapy. Mean time to normalization in the total group was 6·2 ± 3·3 months, with no difference between continuing or discontinuing amiodarone (6·6 ± 3·8 vs 5·8 ± 2·8 months, P = 0·5).During median follow-up of 3·3 years, the incidence of amiodarone-associated thyrotoxicosis was higher compared to hypothyroidism. Only general predictors for amiodarone-associated thyroid dysfunction were observed. Discontinuation of amiodarone did not influence treatment outcome.

Published
2011

7. Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report

Author

Götz J. K. Wietasch, Herman G. D. Hendriks, Ann de Haes, Kinge van der Heide, and Ans C. P. Wiesfeld

Subjects
Medicine(all), medicine.medical_specialty, Laparoscopic adrenalectomy, business.industry, lcsh:R, lcsh:Medicine, Torsades de pointes, Case Report, General Medicine, Perioperative, medicine.disease, QT interval, Hypomagnesemia, Pheochromocytoma, Internal medicine, medicine, Cardiology, Family history, business, Flecainide, medicine.drug
Abstract

Introduction Torsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia. Case presentation We describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor. Conclusion We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.

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