48 results on '"Jean-Yves Wielandts"'
Search Results
2. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery
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Alexandre Almorad, Louisa O'Neill, Jean-Yves Wielandts, Kris Gillis, Benjamin De Becker, Yosuke Nakatani, Carlo De Asmundis, Saverio Iacopino, Thomas Pambrun, La Meir Marc, Pierre Jaïs, Michel Haïssaguerre, Mattias Duytschaever, Jean-Baptista Chierchia, Nicolas Derval, and Sébastien Knecht
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atrial fibrillation ,mitral valve surgery ,ablation ,atrial tachyarrhythmias ,antiarrhythmic drugs ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AimsAtrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery.MethodsSixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2).ResultsAfter the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) (p = 0.3). After 62 (48–84) months of follow-up and 2 (2–2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm (p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs (p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred.ConclusionLong-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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- 2022
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3. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy
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Louisa O’Neill, Jean-Yves Wielandts, Kris Gillis, Gabriela Hilfiker, Jean-Benoit Le Polain De Waroux, Rene Tavernier, Mattias Duytschaever, and Sebastien Knecht
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persistent AF ,pulmonary vein isolation ,substrate ablation ,AF mapping ,novel ablation technology ,Medicine - Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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- 2021
- Full Text
- View/download PDF
4. How Close Are We toward an Optimal Balance in Safety and Efficacy in Catheter Ablation of Atrial Fibrillation? Lessons from the CLOSE Protocol
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Michelle Lycke, Louisa O’Neill, Kris Gillis, Jean-Yves Wielandts, Jean-Benoit Le Polain De Waroux, Rene Tavernier, Sebastien Knecht, and Mattias Duytschaever
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atrial fibrillation ,pulmonary vein isolation ,CLOSE ,safety ,efficacy ,Medicine - Abstract
Catheter ablation for atrial fibrillation (AF) is a common treatment strategy in patients with drug-resistant, symptomatic AF. In patients with paroxysmal and short-standing persistent AF, pulmonary vein isolation (PVI) is often enough to prevent recurrence of atrial tachyarrhythmia (ATA). Point-by-point encircling of the PVs with radiofrequency (RF) applications, together with cryoballoon ablation, have been the mainstay strategies for the last 10 to 20 years. Each of these strategies, however, suffers from the delicate balance between preventing PV reconnection, on the one hand (toward more energy), and preventing (mainly esophageal) complications (toward less energy), on the other. The CLOSE protocol was developed as an RF ablation strategy that would result in the safe creation of durable isolation leading to improved outcomes. Basically, the aim of the protocol is to enclose the pulmonary veins with stable, contiguous (intertag distance, ITD ≤ 6 mm) and optimized lesions (35 Watts, W, RF applications up to ablation index targets of ≥400 and ≥550 at the posterior and anterior wall). In this review, we describe the background of the CLOSE protocol and the studies from the St Jan Bruges research group on procedural performance, efficacy, and safety of the CLOSE protocol in (a) single-center prospective PILOT study (CLOSE-PILOT), (b) a single-center prospective study with continuous rhythm monitoring (CLOSE to CURE), (c) a database of systematic esophageal endoscopic studies, (d) a multicenter prospective study (VISTAX), and (e) the CLOSE database (comprising > 400 patients). We also discuss the results of the randomized POWER-AF study comparing conventional CLOSE to high power CLOSE (up to 50 W). Finally, we discuss the performance, safety, and efficacy of the CLOSE protocol in light of the emerging changes in the field of catheter ablation being ultra-short high-power ablation and electroporation.
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- 2021
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5. Very High-Power Ablation for Contiguous Pulmonary Vein Isolation
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Louisa O’Neill, Milad El Haddad, Benjamin Berte, Richard Kobza, Gabriela Hilfiker, Daniel Scherr, Martin Manninger, Adrianus P. Wijnmaalen, Serge A. Trines, Jean-Yves Wielandts, Kris Gillis, Michelle Lycke, Benjamin De Becker, Rene Tavernier, Jean-Benoit Le Polain De Waroux, Sebastien Knecht, and Mattias Duytschaever
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- 2023
6. Evaluation of a standardized approach using optimized and contiguous RF applications for electrical isolation of the superior vena cava
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Gabriela Hilfiker, Benjamin De Becker, Milad El. Haddad, Louisa O'Neill, Kris Gillis, Jean‐Yves Wielandts, René Tavernier, Jean‐Benoit Le Polain De Waroux, Mattias Duytschaever, and Sébastien Knecht
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
The superior vena cava (SVC) is well described as one of the most common non-pulmonary vein (PV)-triggers for atrial tachyarrhythmias (ATA). In our study we evaluated a standardized approach for electrical isolation of the SVC from the right atrium using a horseshoe-shaped lesion set with optimized and contiguous ostial RF lesions. The results are promising, demonstrating a very high rate of acute SVC isolation in a safe and time efficient manner (mostly less than 10 min).
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- 2022
7. Vein of Marshall Ethanol Infusion as First Step for Mitral Isthmus Linear Ablation
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Kris Gillis, Louisa O’Neill, Jean-Yves Wielandts, Gabriela Hilfiker, Alexandre Almorad, Michelle Lycke, Milad El Haddad, Jean-Benoît le Polain de Waroux, Rene Tavernier, Mattias Duytschaever, and Sebastien Knecht
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Ethanol ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Heart Atria ,Endocardium - Abstract
In this study, the authors sought to investigate the added value of vein of Marshall ethanol infusion (VOMEt) as first step in facilitating radiofrequency (RF)-guided mitral isthmus (MI) block.Achieving MI block with the use of RF ablation is challenging.Seventy patients planned for MI ablation were randomized 1:1 to VOMEt as a first step preceding RF (endocardial and epicardial, VOMIn VOMVOMEt as a first step in RF-guided MI line ablation significantly reduced the number of RF applications needed to achieve MI block, even if the sequence of the ablation steps did not affect the final incidence of block. (Evaluation of Vein of Marshall Ethanol Infusion During Left Atrial Linear Ablation in Patients With Persistent Atrial Fibrillation [MARSHALINE]; NCT04124328).
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- 2022
8. Left bundle branch area pacing guided by continuous uninterrupted monitoring of unipolar pacing characteristics
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Louisa O'Neill, Kris Gillis, Sébastien Knecht, Alina Vlase, Jean-Yves Wielandts, Gabriela Hilfiker, Mattias Duytschaever, Rene Tavernier, and Jean-Benoît le Polain de Waroux
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Qrs morphology ,Bundle of His ,medicine.medical_specialty ,Perforation (oil well) ,Ventricular Septum ,Electrocardiography ,QRS complex ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Left bundle branch ,medicine ,Humans ,Lead (electronics) ,Aged ,Aged, 80 and over ,Pacing impedance ,business.industry ,Cardiac Pacing, Artificial ,Middle Aged ,Stylet ,Treatment Outcome ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Continuous/uninterrupted - Abstract
INTRODUCTION During left bundle branch area pacing (LBBAP) lead implantation, intermittent monitoring of unipolar pacing characteristics confirms LBB capture and can detect septal perforation. We aimed to demonstrate that continuous uninterrupted unipolar pacing from an inserted lead stylet (LS) is feasible and facilitates LBBAP implantation. METHODS Thirty patients (mean age 76 ± 14 years) were implanted with a stylet-driven pacing lead (Biotronik Solia S60). In 10 patients (comparison-group) conventional implantation with interrupted unipolar pacing was performed, with comparison of unipolar pacing characteristics between LS and connector-pin (CP)-pacing after each rotation step. In 20 patients (uninterrupted-group) performance and safety of uninterrupted implantation during continuous pacing from the LS were evaluated. RESULTS In the comparison-group, LS and CP-pacing impedances were highly correlated (R2 =0.95, p
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- 2021
9. Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury
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Artur Berkovitz, Karin Nentwich, Kai Sonne, Thomas Deneke, Mattias Duytschaever, Jean-Benoît le Polain de Waroux, Elena Ene, Vincent De Wilde, Amelie Reichart, Lukas Lehmkuhl, Jean-Yves Wielandts, Sébastien Knecht, Philipp Halbfass, Ulrich Lüsebrink, Rene Tavernier, and Julian Mueller
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Male ,medicine.medical_specialty ,Radiofrequency ablation ,Fistula ,medicine.medical_treatment ,Catheter ablation ,Pulmonary vein ,law.invention ,Esophagus ,law ,Physiology (medical) ,Cardiac tamponade ,Atrial Fibrillation ,medicine ,Humans ,Stroke ,Aged ,Radiofrequency Ablation ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Very high-power short-duration (vHPSD) via temperature-controlled ablation (TCA) is a new modality to perform radiofrequency pulmonary vein isolation (PVI), conceivably at the cost of a narrower safety margin towards the oesophagus. In this two-centre trial, we aimed to determine the safety of vHPSD-based PVI with specific emphasis on silent oesophageal injury. Methods and results Ninety consecutive patients with atrial fibrillation (AF) underwent vHPSD-PVI (90 W, 3–4 s, TCA) using the QDOT MICRO catheter, in conjunction with the nGEN (Bad Neustadt, n = 45) or nMARQ generator (Bruges, n = 45). All patients underwent post-ablation oesophageal endoscopy. Procedural parameters and complications were recorded. A subgroup of 21 patients from Bad Neustadt underwent cerebral magnetic resonance imaging (cMRI) to detect silent cerebral events (SCEs). Mean age was 67 ± 9 years, 59% patients were male, and 66% patients had paroxysmal AF. Pulmonary vein isolation was obtained in all cases after 96 ± 29 min. No steam pop, cardiac tamponade, stroke, or fistula was reported. None of the 90 patients demonstrated oesophageal ulceration (0%). Charring was not observed in the nMARQ cohort (0% vs. 11% in the nGEN group). In 5 out of 21 patients (24%), cMRI demonstrated SCE (exclusively nGEN cohort). Conclusion Temperature-controlled vHPSD catheter ablation allows straightforward PVI without evidence of oesophageal ulcerations or symptomatic complications. Catheter tip charring and silent cerebral lesions when using the nGEN generator have led to further modification.
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- 2021
10. Flatline on the alternate vector…Is this subcutaneous implantable cardiac defibrillator lead fractured?
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Kris Gillis, Jean-Benoît le Polain de Waroux, Mattias Duytschaever, Louisa O'Neill, Rene Tavernier, Jean-Yves Wielandts, Sébastien Knecht, and Gabriela Hilfiker
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medicine.medical_specialty ,business.industry ,Subcutaneous implantable cardiac defibrillator ,Case Report ,Device Complication ,Alternate vector flatline ,Lead fracture ,RC666-701 ,Internal medicine ,Device complication ,medicine ,Cardiology ,Diseases of the circulatory (Cardiovascular) system ,Flatline ,Automated screening tool ,Cardiology and Cardiovascular Medicine ,business ,Defibrillator lead - Published
- 2021
11. Subcutaneous implantable cardioverter-defibrillator update allows for unexpected diagnosis of paroxysmal atrioventricular block causing recurrent syncope
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Louisa O’Neill, Kris Gillis, Jean-Yves Wielandts, Benjamin De Becker, Rene Tavernier, and Jean-Benoit Le Polain De Waroux
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Cardiology and Cardiovascular Medicine - Published
- 2023
12. A fishbone revealed
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Sébastien Knecht, Jean-Yves Wielandts, Jean-Benoît le Polain de Waroux, and Mattias Duytschaever
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medicine.medical_specialty ,business.industry ,Parasystole ,medicine.disease ,Tachogram ,Junctional rhythm ,Pacemaker ,Ectopy ,Internal medicine ,Implantable loop recorder ,medicine ,Cardiology ,Image ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
13. D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation
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Sébastien Knecht, Brahim Berdaoui, Louisa O'Neill, Thomas Nguyen, Milad El Haddad, Mattias Duytschaever, Thierry William Verbeet, Marielle Morissens, Yves Vandekerckhove, Georgiana Pintea Bentea, Laura Anghel, Jean-Yves Wielandts, Sophie Samyn, José Castro Rodriguez, Alexandre Almorad, Eva De Keyzer, Anush Ohanyan, Rene Tavernier, and Michelle Lycke
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Male ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Cardioversion ,Fibrin Fibrinogen Degradation Products ,Internal medicine ,Atrial Fibrillation ,D-dimer ,medicine ,Humans ,In patient ,cardiovascular diseases ,Thrombus ,Left atrial thrombus ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Thrombosis ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Pulmonary embolism ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
ObjectiveLeft atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient’s age (DDAge), based on the cut-off used to exclude pulmonary embolism.Methods142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.ResultsLA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; pConclusionsThis study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.
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- 2020
14. Catheter Ablation in Persistent AF, the Evolution towards a More Pragmatic Strategy
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Jean-Yves Wielandts, Louisa O'Neill, Gabriela Hilfiker, Jean-Benoît le Polain de Waroux, Rene Tavernier, Sébastien Knecht, Kris Gillis, and Mattias Duytschaever
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persistent AF ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Catheter ablation ,Review ,Pulmonary vein ,Internal medicine ,medicine ,substrate ablation ,novel ablation technology ,education ,pulmonary vein isolation ,Heterogeneous disorder ,education.field_of_study ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,General Medicine ,Ablation ,medicine.disease ,Catheter ,AF mapping ,Cardiology ,Medicine ,business - Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
- Published
- 2021
15. Left Bundle Branch Area Pacing guided by Continuous Uninterrupted Monitoring of the unipolar Pacing Characteristics
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Louisa O'Neill, Gabriela Hilfiker, Kris Gillis, Rene Tavernier, S Knecht, Jean-Benoît le Polain de Waroux, Alina Vlase, Mattias Duytschaever, and Jean-Yves Wielandts
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Qrs morphology ,Pacing impedance ,medicine.medical_specialty ,business.industry ,Perforation (oil well) ,Stylet ,QRS complex ,Internal medicine ,Left bundle branch ,Cardiology ,medicine ,Lead (electronics) ,business ,Continuous/uninterrupted - Abstract
Introduction. During left bundle branch area pacing (LBBAP) lead implantation, intermittent monitoring of unipolar pacing characteristics validates LBB capture and can detect septal perforation. We aimed to demonstrate that continuous uninterrupted unipolar pacing from an inserted lead stylet (LS) is feasible and facilitates LBBAP implantation. Methods. Thirty patients (mean age 76 ± 14 years) were implanted with stylet-driven pacing lead (Biotronik Solia S60). In 10 patients (validation-group) conventional, interrupted implantation was performed, with comparison of unipolar pacing characteristics between LS and connector-pin (CP)-pacing after each rotation step. In 20 patients (feasibility-group) performance and safety of uninterrupted implantation during continuous pacing from the LS were analyzed. Results. In the validation-group, LS and CP-pacing impedances were highly correlated (R=0.95, p
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- 2021
16. Left bundle branch area pacing as alternative to his bundle pacing for cardiac resynchronisation therapy: a case report
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Jean-Yves Wielandts, Rene Tavernier, Mattias Duytschaever, Alexandre Almorad, Gabriela Hilfiker, Jean-Benoît le Polain de Waroux, Anaïs Gauthey, Yves Vandekerckhove, Sébastien Knecht, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire
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physiologic pacing ,Bundle of His ,medicine.medical_specialty ,complication ,Ventricular Septum ,macromolecular substances ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,His bundle pacing ,Internal medicine ,Left bundle branch ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,cardiac resynchronisation therapy ,Ejection fraction ,left bundle area pacing ,Left bundle branch block ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,humanities ,Heart failure ,Bundle ,cardiovascular system ,Cardiology ,CRT ,Cardiology and Cardiovascular Medicine ,Complication ,business ,circulatory and respiratory physiology - Abstract
Case description : A 74-year-old man suffering from severe heart failure (NYHA III – LVEF 28%) associated with left bundle branch block (LBBB) (Figure 1(A)) and uncontrolled permanent atrial fibrillation (AF) despite optimal medical treatment was referred for His ablation and rescue physiological pacing after a first unsuccessful LV lead implantation through the coronary sinus (CS). Careful review of the occluded CS angiogram indeed revealed no side branches. Concordantly, the patient was offered a ‘rescue’ HBP procedure. Using the SelectSecure lead (model 3830) and a C315 His sheath (Both Medtronic, Inc. MN), His mapping (HV ¼ 106ms) and recruitment were easily obtained, unfortunately without LBBB correction.
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- 2020
17. High-resolution parahisian mapping and ablation using microelectrode embedded ablation catheters
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Benjamin Berte, Gabi Hilfiker, Saagar Mahida, Jean-Yves Wielandts, Alexandre Almorad, Sebastien Knecht, Dipen Shah, Johan Vijgen, Mattias Duytschaever, and Richard Kobza
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Electrocardiography ,Catheters ,Physiology (medical) ,Atrioventricular Node ,Catheter Ablation ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Atrioventricular Block ,Microelectrodes - Abstract
Accurate mapping of the compact atrioventricular (AV) node is critical during ablation of a range of arrhythmias.The purpose of this multicenter prospective study was to test the hypothesis that microelectrode (ME)-embedded catheters more accurately define the near-field compact AV node compared to conventional catheters.For the mapping phase, detailed AV junction maps were created in 47 patients using an ME-embedded catheter. His electrograms (EGMs) detected by conventional electrodes (HisIn the mapping phase, 7.0 ± 5.4 HisME more accurately defines the region of the compact node, and ablation in this region is associated with a high risk for AV block. ME-based mapping has the potential to significantly enhance ablation safety and efficacy.
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- 2021
18. Biosense Webster's QDOT Micro™ radiofrequency ablation catheter
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Kris Gillis, Jean-Yves Wielandts, Sébastien Knecht, Mattias Duytschaever, Benjamin Berte, Rene Tavernier, Milad El Haddad, Alexandre Almorad, Gabriela Hilfiker, Johan Vijgen, and Jean-Benoît le Polain de Waroux
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Catheters ,Temperature sensing ,business.industry ,Catheter ,Radiofrequency ablation catheter ,Treatment Outcome ,Pulmonary Veins ,Atrial Fibrillation ,Catheter Ablation ,Molecular Medicine ,Medicine ,Humans ,Quality level ,Cardiology and Cardiovascular Medicine ,business ,Biomedical engineering - Abstract
The QDOT Micro™ catheter (Biosense Webster, Inc., CA, USA) is a new radiofrequency ablation catheter based on the SmartTouch SF™ (Biosense Webster, Inc.). It combines diffuse external irrigation with six thermocouples located within the outer metal shell and three additional microelectrodes in a 3.5 mm-tip contact force radiofrequency catheter. This article focuses on the different characteristics of the catheter, which incorporates the ability of high power delivery, irrigation flow control based on temperature sensing through the six thermocouples and the generation of microelectrograms. An outline of its performance in preclinical and clinical setting is presented, showing promising results, especially concerning procedural efficiency and short-term safety. Additional studies need to confirm long-term effectiveness, and durability studies should evaluate whether superiority on a lesion quality level can be achieved.Lay abstract Radiofrequency (RF) energy is the most widely used type of energy in the field of catheter ablation, an invasive treatment for heart rhythm disorders. In patients with atrial fibrillation (AF; the most frequent type of problem with the rhythm of the heart), catheter ablation aims at delivering RF energy around the pulmonary veins (PVs). PVs have been shown to contain AF triggers. Catheter ablation results in electrical isolation of the PV, making them less likely to trigger AF. The latest technical developments resulted in better success rate of the procedure (up to 90% success rate after 1 year follow-up) without increasing complication rates. During the last decade, the catheter used to isolate the PV has improved a lot and includes now contact force measurement in addition to the delivery mechanism for RF energy and can record the local electrical activity. The newly developed QDOT Micro™ catheter (Biosense Webster, Inc., CA, USA), presented in this article, combines different aspects of further technical development. These include the integration of smaller electrodes, resulting in higher local electrical signal resolution, more accurate feedback of local tissue temperature during the procedure and the ability to use higher RF power which reduces the RF delivery time and therefore reduced the duration of the procedure. An outline of its performance in preclinical and clinical setting is presented in this paper. These studies have shown promising results, especially concerning procedural efficiency and short-term safety. However, additional studies need to confirm long-term treatment success and potential superiority in comparison with other ablation approaches.
- Published
- 2021
19. Repositioning and Extraction of Stylet-Driven Pacing Leads with Extendable Helix used for Left Bundle Branch Area Pacing
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Bert Geerts, Jean Yves Wielandts, Rene Tavernier, Sébastien Knecht, Antonio Sorgente, Jean-Benoît le Polain de Waroux, Gabriela Hilfiker, Kris Gillis, Lucio Capulzini, and Mattias Duytschaever
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medicine.medical_specialty ,business.industry ,Computer science ,Acute complication ,030204 cardiovascular system & hematology ,Stylet ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Helix ,Left bundle branch ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Lead (electronics) - Abstract
Conventional stylet-driven leads with extendable helix can be implanted successfully for Left Bundle Branch Area Pacing (LBBAP) with a low acute complication rate. However, removal and repositioning techniques of these leads haven’t been yet described. We report 2 cases in which lead repositioning after a first unsuccessful attempt to LBBAP was associated with fracture of the helix rotating mechanism and failure to fully extract the pacing lead.
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- 2021
20. Insights from Temperature Feedback and Current in Ablation Index-Guided Pulmonary Vein Isolation
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Sébastien Knecht, Alexandre Almorad, Benjamin Berte, Federico Moccetti, Johan Vijgen, Saagar Mahida, Jean-Yves Wielandts, Pierre Jaïs, Thomas Phlips, Richard Kobza, and Gabriela Hilfiker
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Physics ,Lesion ,business.industry ,medicine.medical_treatment ,medicine ,Right posterior ,medicine.symptom ,Ablation ,Nuclear medicine ,business ,Right anterior ,Pulmonary vein - Abstract
Objectives: To gain further knowledge of in-vivo lesion assessment and the complex regional interplay of lesion parameters during pulmonary vein isolation (PVI). Background: Although ablation index (AI) results in favourable outcomes of CLOSE protocol-guided PVI but its' relationship with other lesion parameters is not fully understood. Methods: 62 patients undergoing CLOSE-PVI (35-50W, {less than or equal to}6mm, AI 400-550) using a QDOT catheter were prospectively included. Lesion-specific data (impedance change [∆-IMP], current [mA], delivered energy [J], power [W], contact force [CF], thermocouple temperature [Temp] and micro-electrogram amplitude [ME-EGM]) were collected. Results: Although AI targets were reached for all 3166 lesions, 479 (15%) had very low ∆-IMP (
- Published
- 2021
21. Prospective Randomized Evaluation of High Power During CLOSE-Guided Pulmonary Vein Isolation: The POWER-AF Study
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Gabriela Hilfiker, Michelle Lycke, Teresa Strisciuglio, Alexandre Almorad, Jean-Yves Wielandts, Maria Kyriakopoulou, Milad El Haddad, Yves Vandekerckhove, Jean-Benoît le Polain de Waroux, Rene Tavernier, Philippe Unger, Sébastien Knecht, Thomas Phlips, Mattias Duytschaever, Wielandts, Jean-Yve, Kyriakopoulou, Maria, 1, Alexandre Almorad, Hilfiker, Gabriela, Strisciuglio, Teresa, Phlips, Thoma, El Haddad, Milad, Lycke, Michelle, Unger, Philippe, Le Polain de Waroux, Jean-Benoît, Vandekerckhove, Yve, Tavernier, Rene, Duytschaever, Mattia, Knecht, Sebastien, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire
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Male ,Time Factors ,medicine.medical_treatment ,Operative Time ,radiofrequency catheter ablation ,Pulmonary vein ,power ,Heart Conduction System ,Heart Rate ,Recurrence ,biophysics ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,Prospective Studies ,pulmonary vein ,business.industry ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Treatment Outcome ,Surgery, Computer-Assisted ,Radiofrequency catheter ablation ,Pulmonary Veins ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Follow-Up Studies - Abstract
Background: CLOSE-guided atrial fibrillation (AF) ablation is based on contiguous (intertag distance ≤6 mm), optimized (Ablation Index >550 anteriorly and >400 posteriorly) point-by-point radiofrequency lesions. The optimal radiofrequency power remains unknown. Methods: The POWER-AF study is a prospective, randomized controlled monocentric study including patients with paroxysmal AF, planned for first CLOSE-guided pulmonary vein isolation using a contact force radiofrequency catheter (Thermocool SmartTouch, Biosense Webster, Inc, Irvine, CA). A total of 100 patients were randomized into 2 groups (1:1). The control group received AF ablation using the standard CLOSE protocol (35 W), whereas in the experimental group, pulmonary vein isolation was performed using high power (45 W). Endoscopic evaluation was performed in patients with intraesophageal temperature rise >38.5 °C. Results: The resulting sample size was 96 (48+48) patients. In the high power group, shorter procedure time (80 versus 102 minutes, P P P P P =0.31) showed an ulcerative perforation in a high power group patient (treated by endoscopic stenting and normalization after ≈4 months) and a superficial ulcerative lesion in a control group patient (conservative treatment). Both occurred following excessive Ablation Index applications (up to 460 and 480, respectively) with excessive contact force (30 g on average, with peaks up to 50 g). Six-months AF recurrence was not significantly different (10% in high power versus 8% in control, P =0.74). Conclusions: This randomized controlled study shows that a 45 W radiofrequency power CLOSE protocol in patients with paroxysmal AF significantly increases the global procedural efficiency with similar midterm efficacy. However, our study showed a narrower safety margin and a limited increased efficiency at the posterior wall using high power. This advocates against the use of high power in the region neighboring the esophagus.
- Published
- 2021
22. B-AB21-05 ADDED VALUE OF VEIN OF MARSHAL ETHANOLISATION FOR MITRAL ISTHMUS LINE ABLATION. A RANDOMIZED STUDY
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Mattias Duytschaever, Louisa O'Neill, Jean-Yves Wielandts, Rene Tavernier, Kris Gillis, Sébastien Knecht, Jean-Benoît le Polain de Waroux, and Gabriela Hilfiker
- Subjects
medicine.anatomical_structure ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,Medicine ,Mitral isthmus ,Line (text file) ,Cardiology and Cardiovascular Medicine ,business ,Ablation ,Vein ,Nuclear medicine - Published
- 2021
23. Registration-based filtering: An acceptable tool for noise reduction in left ventricular dynamic rotational angiography images?
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Jean-Yves Wielandts, Stijn De Buck, Joris Ector, Dieter Nuyens, Frederik Maes, and Hein Heidbüchel
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- 2014
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24. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation
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Yves Vandekerckhove, Maria Kyriakopoulou, Milad El Haddad, Jean-Yves Wielandts, Michelle Lycke, Philippe Unger, Alexandre Almorad, Gabriela Hilfiker, Sébastien Knecht, Rene Tavernier, Jean-Benoît e Polain de Waroux, Teresa Strisciuglio, Mattias Duytschaever, Michael Wolf, Jan De Pooter, Lycke, M., Kyriakopoulou, M., El Haddad, M., Wielandts, J. -Y., Hilfiker, G., Almorad, A., Strisciuglio, T., De Pooter, J., Wolf, M., Unger, P., Vandekerckhove, Y., Tavernier, R., de Waroux, J. -B. E. P., Duytschaever, M., and Knecht, S.
- Subjects
Male ,medicine.medical_specialty ,Left atrium diameter ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Left atrium ,Catheter ablation ,030204 cardiovascular system & hematology ,Pilmonary vein isolation ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Recurrence ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Diagnosis-to-ablation time ,Predictors ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,Atrial fibrillation recurrence ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Increased risk ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,business - 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.
- Published
- 2020
25. Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions
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Jan De Pooter, Teresa Strisciuglio, Thomas Phlips, Philippe Unger, Jean-Yves Wielandts, Yves Vandekerckhove, Maria Kyriakopoulou, Sébastien Knecht, Milad El Haddad, Alexandre Almorad, Michelle Lycke, Mattias Duytschaever, Rene Tavernier, Gabriela Hilfiker, Kyriakopoulou, M., Wielandts, J. -Y., Strisciuglio, T., El Haddad, M., Pooter, J. D., Almorad, A., Hilfiker, G., Phlips, T., Unger, P., Lycke, M., Vandekerckhove, Y., Tavernier, R., Duytschaever, M., and Knecht, S.
- Subjects
Male ,Time Factors ,Cardiologie et circulation ,medicine.medical_treatment ,Action Potentials ,Pilot Projects ,030204 cardiovascular system & hematology ,Pulmonary vein ,high power ablation ,0302 clinical medicine ,Postoperative Complications ,Heart Rate ,Recurrence ,Retrospective Studie ,Physiologie générale ,Atrial Fibrillation ,atrial fibrillation ,030212 general & internal medicine ,pulmonary vein isolation ,Atrial fibrillation ,Pulmonary Vein ,Middle Aged ,Ablation ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Human ,Time Factor ,Paroxysmal atrial fibrillation ,Operative Time ,Catheter ablation ,Lesion ,03 medical and health sciences ,Physiology (medical) ,Heart rate ,medicine ,Humans ,Pilot Project ,Action Potential ,Retrospective Studies ,Aged ,business.industry ,Retrospective cohort study ,medicine.disease ,Postoperative Complication ,Nuclear medicine ,business ,contact force - Abstract
Aims: “CLOSE”-guided pulmonary vein isolation (PVI) is based on contiguous (≤6 mm) and optimized radiofrequency (RF) ablation lesions (ablation index [AI] ≥ 400 posteriorly and ≥ 550 anteriorly]. However, the optimal RF power to reach the desired AI is unknown. Therefore we evaluated the efficiency of an ablation strategy using higher power (40 W) during a first “CLOSE”-guided PVI. Methods: Eighty consecutive patients undergoing “CLOSE”-guided PVI for symptomatic paroxysmal atrial fibrillation were ablated with 40 W (group A). Results were compared with 105 consecutive patients enrolled in the “CLOSE to CURE”-study and were ablated using the same protocol with 35 W (group B). Results: In group A, ablation was associated with shorter ablation procedure time (91 vs 111 minutes; P .733) were similar in both groups (groups A and B, respectively). No complications occurred. In group A, a gastroscopy—performed in five patients with esophageal temperature rise more than 42°C—did not reveal any esophageal lesion. Postprocedural recurrence of atrial tachyarrhythmia at 1 year was not significantly different between both groups. Conclusions: Using the “CLOSE”-protocol, increased power increases the efficiency of PVI without compromising patients' safety., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2020
26. Bumping-induced electrical dissociation of an arrhythmogenic fossa ovalis
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Jean-Yves Wielandts, Gabriela Hilfiker, Rene Tavernier, Mattias Duytschaever, Sébastien Knecht, and Alexandre Almorad
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Atrial Septum ,business.industry ,Arrhythmias, Cardiac ,Dissociation (chemistry) ,Nuclear magnetic resonance ,medicine.anatomical_structure ,Physiology (medical) ,Heart Septum ,Bumping ,Medicine ,Humans ,Fossa ovalis ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
27. Left Bundle Branch Area Pacing as an alternative to His Bundle pacing for Cardiac Resynchronization Therapy: a case report
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Anais Gauthey, Jean-Yves Wielandts, Yves Vandekerckhove, Rene Tavernier, Mattias Duytschaever, Alexandre Almorad, S Knecht, Gabriela Hilfiker, and Jean-Benoît le Polain de Waroux
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medicine.medical_specialty ,Ejection fraction ,Ventricular lead ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,medicine.disease ,QRS complex ,Bundle ,Heart failure ,Internal medicine ,Left bundle branch ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,business ,Coronary sinus - Abstract
Biventricular pacing (BVP) has been demonstrated to improve functional outcomes and mortality of patients with symptomatic heart failure, reduced LVEF and wide QRS. Unfortunately, difficult coronary sinus anatomy can limit left ventricular lead placement. In such clinical situation, His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP) have recently appeared as attractive alternatives to BVP. We describe the case of a patient with an indication for Cardiac Resynchronization Therapy (CRT) and AV node ablation, where left ventricular lead implantation and corrective HBP failed. LBBAP allowed for electrical and echocardiographic resynchronization with significant functional improvement.
- Published
- 2020
28. Electrogram signature of specific activation patterns: Analysis of atrial tachycardias at high-density endocardial mapping
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Takeshi Kitamura, Nathaniel Thompson, Arnaud Denis, Sana Amraoui, Hubert Cochet, Nora Al-Jefairi, Antonio Frontera, Konstantinos Vlachos, Masateru Takigawa, Mélèze Hocini, Ghassen Cheniti, Michel Haïssaguerre, Nicolas Derval, Michael Wolf, Ruairidh Martin, Elvis Teijeira, Josselin Duchateau, Pierre Jaïs, Grégoire Massoullié, Seigo Yamashita, Frederic Sacher, and Jean Yves Wielandts
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,High density ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Physiology (medical) ,Internal medicine ,Image Processing, Computer-Assisted ,Tachycardia, Supraventricular ,medicine ,Humans ,Heart Atria ,030212 general & internal medicine ,Short duration ,Atrial tachycardia ,business.industry ,Body Surface Potential Mapping ,Reproducibility of Results ,Middle Aged ,Ablation ,Electrophysiology ,Mapping system ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Basket catheter ,business ,Endocardium - Abstract
Background The significance of fractionated electrograms (EGMs) is object of debate, with multiple mechanisms described. Objective Using Rhythmia, a high-density mapping system, we sought to investigate the relationship between specific electrophysiological phenomena and EGM characteristics at those sites. Methods Twenty-five consecutive patients underwent high-density atrial mapping during atrial tachycardias. Bipolar EGMs were recorded with a 64-electrode basket catheter. The following atrial phenomena were identified: slow conduction (SC) areas, lines of block (LB), wavefront collisions (WFC), pivot sites (PS), and gaps. EGMs collected at these predefined areas were analyzed in terms of amplitude, duration, and morphology. Results Twenty-five atrial maps with 195 sites of interest (1755 EGMs) were object of our analysis. Thirty-five percent were sites of SC: fractionation had low amplitude (0.16 ± 0.07 mV) and long duration (87.8 ± 10.7 ms); wavefront collisions were seen in 38% of sites with EGMs shorter in duration (46.5 ± 4.5 ms) and higher in voltage (0.58 ± 0.13 mV); 17% were lines of block, never responsible for fractionation (0.13 ± 0.05 mV; 122.4 ms ± 24.8 ms); 9% were PS with a high degree of fractionation (0.55 ± 0.15 mV; 85.8 ± 7.9 ms). Two gaps were identified (1%) with a low degree of fractionation. Conclusion Specific EGM characteristics in atrial tachycardia can be reproducibly linked to electrophysiological mechanisms. High-voltage and short-duration EGMs are associated with collision sites and PS that are unlikely to form critical sites for ablation; long-duration, low-voltage EGMs are associated with SC. However, not all SC regions will lie within the critical circuit and identification by only EGM characteristics cannot guide ablation.
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- 2018
29. Performance and Safety of Temperature- and Flow-Controlled Radiofrequency Ablation in Ablation Index–Guided Pulmonary Vein Isolation
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Benjamin Berte, Richard Kobza, Alexandre Almorad, Sébastien Knecht, Rene Tavernier, Milad El Haddad, Thomas Phlips, Johan Vijgen, Mattias Duytschaever, and Jean-Yves Wielandts
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Radiofrequency Ablation ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Temperature ,Ablation ,Pulmonary vein ,law.invention ,Pulmonary Veins ,law ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Medicine ,business ,Biomedical engineering - Published
- 2021
30. How Close Are We toward an Optimal Balance in Safety and Efficacy in Catheter Ablation of Atrial Fibrillation? Lessons from the CLOSE Protocol
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Jean-Benoît le Polain de Waroux, Kris Gillis, Sébastien Knecht, Louisa O'Neill, Jean-Yves Wielandts, Rene Tavernier, Michelle Lycke, and Mattias Duytschaever
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safety ,Protocol (science) ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,efficacy ,Anterior wall ,Catheter ablation ,Atrial fibrillation ,Review ,General Medicine ,Ablation ,medicine.disease ,CLOSE ,Pulmonary vein ,Surgery ,Medicine ,atrial fibrillation ,business ,Prospective cohort study ,pulmonary vein isolation ,Balance (ability) - Abstract
Catheter ablation for atrial fibrillation (AF) is a common treatment strategy in patients with drug-resistant, symptomatic AF. In patients with paroxysmal and short-standing persistent AF, pulmonary vein isolation (PVI) is often enough to prevent recurrence of atrial tachyarrhythmia (ATA). Point-by-point encircling of the PVs with radiofrequency (RF) applications, together with cryoballoon ablation, have been the mainstay strategies for the last 10 to 20 years. Each of these strategies, however, suffers from the delicate balance between preventing PV reconnection, on the one hand (toward more energy), and preventing (mainly esophageal) complications (toward less energy), on the other. The CLOSE protocol was developed as an RF ablation strategy that would result in the safe creation of durable isolation leading to improved outcomes. Basically, the aim of the protocol is to enclose the pulmonary veins with stable, contiguous (intertag distance, ITD ≤ 6 mm) and optimized lesions (35 Watts, W, RF applications up to ablation index targets of ≥400 and ≥550 at the posterior and anterior wall). In this review, we describe the background of the CLOSE protocol and the studies from the St Jan Bruges research group on procedural performance, efficacy, and safety of the CLOSE protocol in (a) single-center prospective PILOT study (CLOSE-PILOT), (b) a single-center prospective study with continuous rhythm monitoring (CLOSE to CURE), (c) a database of systematic esophageal endoscopic studies, (d) a multicenter prospective study (VISTAX), and (e) the CLOSE database (comprising > 400 patients). We also discuss the results of the randomized POWER-AF study comparing conventional CLOSE to high power CLOSE (up to 50 W). Finally, we discuss the performance, safety, and efficacy of the CLOSE protocol in light of the emerging changes in the field of catheter ablation being ultra-short high-power ablation and electroporation.
- Published
- 2021
31. Multi-phase rotational angiography of the left ventricle to assist ablations: feasibility and accuracy of novel imaging
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Joris Ector, Hein Heidbuchel, Frederik Maes, Koen Michielsen, Ruan Louw, Christophe Garweg, Stijn De Buck, Jean-Yves Wielandts, and Johan Nuyts
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Contrast Media ,Catheter ablation ,030204 cardiovascular system & hematology ,Coronary Angiography ,Radiation Dosage ,030218 nuclear medicine & medical imaging ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Medical imaging ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Cardiac catheterization ,medicine.diagnostic_test ,Cardiac cycle ,business.industry ,Original Articles ,General Medicine ,Middle Aged ,PSI_MIC ,Rotational angiography ,Angiography ,Catheter Ablation ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Radiology ,Tomography ,Artifacts ,Cardiology and Cardiovascular Medicine ,business ,Monte Carlo Method ,Algorithms - Abstract
Aims Interventional left ventricular (LV) procedures integrating static 3D anatomy visualization are subject to mismatch with dynamic catheter movements due to prominent LV motion. We aimed to evaluate the accuracy of a recently developed acquisition and post-processing protocol for low radiation dose LV multi-phase rotational angiography (4DRA) in patients. Methods and results 4DRA image acquisition of the LV was performed as investigational acquisition in patients undergoing left-sided ablation (11 men; BMI = 24.7 ± 2.5 kg/m²). Iodine contrast was injected in the LA, while pacing from the RA at a cycle length of 700 ms. 4DRA acquisition and reconstruction were possible in all 11 studies. Reconstructed images were post-processed using streak artefact reduction algorithms and an interphase registration-based filtering method, increasing contrast-to-noise ratio by a factor 8.2 ± 2.1. This enabled semi-automatic segmentation, yielding LV models of five equidistant phases per cardiac cycle. For evaluation, off-line 4DRA fluoroscopy registration was performed, and the 4DRA LV contours of the different phases were compared with the contours of five corresponding phases of biplane LV angiography, acquired in identical circumstances. Of the distances between these contours, 95% were
- Published
- 2015
32. Left ventricular four-dimensional rotational angiography with low radiation dose through interphase registration
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Hein Heidbuchel, Joris Ector, Jean-Yves Wielandts, Stijn De Buck, Frederik Maes, and Dieter Nuyens
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Rotation ,Swine ,Image quality ,Heart Ventricles ,Cardiac-Gated Imaging Techniques ,Radiation Dosage ,Ventricular tachycardia ,Sensitivity and Specificity ,Imaging, Three-Dimensional ,Radiation Protection ,Physiology (medical) ,medicine ,Animals ,Segmentation ,business.industry ,Angiography ,Reproducibility of Results ,medicine.disease ,Confidence interval ,Radiographic Image Enhancement ,medicine.anatomical_structure ,Signal-to-noise ratio (imaging) ,Ventricle ,Subtraction Technique ,Rotational angiography ,Interphase ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Aims Ventricular tachycardia ablations could benefit from four-dimensional (4D) (dynamic 3D) visualization of the left ventricle (LV) as roadmap for anatomy-guided procedures. Our aim was to develop an algorithm that combines information of several cardiac phases to improve signal-to-noise ratio in low-dose, noisy rotational angiography [three-dimensional rotational angiography (3DRA)] image datasets, enabling semi-automatic segmentation and generation of 4D rotational angiography (4DRA) LV surface models. Methods and results We developed a novel slow pacing protocol for low-dose 4DRA imaging and applied interphase registration (IPR) to improve contrast-to-noise ratio (CNR) such that 4D LV segmentation could be achieved using a single iso-intensity value (ISO). The method was applied to construct four-phase dynamic LV models from five porcine experiments. Optimal choice of IPR and ISO parameters and resulting LV model accuracy were assessed by comparison with ‘groundtruth’ manual LV delineations using surface distance measures [root mean square distance (RMSD), Hausdorff distance (HD), fraction of surface distances ≤3 mm (d3 mm)]. Using IPR with optimized parameters, CNR improved by 88% ( P < 0.0001) and increased segmentation accuracy was proven irrespective of ISO. Significant improvement was achieved in RMSD [mean at optimal ISO: −28.3% (95% confidence interval (CI) −21.7 to −35.0, P < 0.0001)], HD [−21.4% (95% CI −18.6 to −24.1, P < 0.0001)], and d3 mm [+7.8% (95% CI +4.6 to +10.9, P < 0.0001)]. An average d3 mm of 95.6 ± 2.8% was reached at optimal ISO. Time to generate a 4D model was ±11.5 min with IPR vs. ±22 min without. Conclusion Interphase registration significantly improves 4DRA image quality and facilitates semi-automatic segmentation, resulting in clinically useful accuracy despite low-dose image acquisition protocols, while shortening 4D model generation time. This opens the prospect of 4D imaging in clinical settings.
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- 2014
33. Cardiac three-dimensional rotational angiography can be performed with low radiation dose while preserving image quality
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Dieter Nuyens, Hein Heidbuchel, Joris Ector, Jean-Yves Wielandts, Stijn De Buck, Thomas Phlips, Christophe Garweg, and Becker S.N. Alzand
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Adult ,Male ,Image quality ,medicine.medical_treatment ,Catheter ablation ,Radiation Dosage ,Effective dose (radiation) ,Pulmonary vein ,Imaging, Three-Dimensional ,Predictive Value of Tests ,Physiology (medical) ,Humans ,Medicine ,Computer Simulation ,Heart Atria ,Prospective Studies ,business.industry ,Angiography ,Arrhythmias, Cardiac ,Atrial fibrillation ,Three dimensional rotational angiography ,Middle Aged ,medicine.disease ,Surgery, Computer-Assisted ,Fluoroscopy ,Rotational angiography ,Catheter Ablation ,Feasibility Studies ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Tomography ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Monte Carlo Method - Abstract
Aims The effective radiation dose (ED) of three-dimensional rotational angiography (3DRA) is 5–8 mSv, leading to reticence on its use. We evaluated the potential of 3DRA with a reduced number of frames (RNF) and a reduced dose per frame. Methods and results Three-dimensional rotational angiography was performed in 60 patients (52.5 ± 9.6 years, 16 females) referred for ablation in the right (RA; n = 10) and left atrium (LA; n = 50). In a simulation group ( n = 20), the effect of dropping frames from a conventional 248 frames 3DRA LA acquisition was simulated. In a prospective group ( n = 40), RNF 3DRA were acquired of LA ( n = 30) and RA ( n = 10) with 67 frames (0.24 Gy/frame) and 45 frames (0.12 μGy/frame), respectively. Accuracy was evaluated qualitatively and quantitatively. Effective radiation dose was determined by Monte Carlo simulation on every frame. In the simulation group, surface errors increased minimally and non-significantly when reducing frames from 248 to 124, 83, 62, 50, 42, and 31: 0.49 ± 0.51, 0.52 ± 0.46, 0.61 ± 0.49, 0.62 ± 0.47, 0.71 ± 0.48, and 0.81 ± 0.47 mm, respectively (Pearson coefficient 0.20). All 3D LA images were clinically useful, even with only 31 frames. In the prospective group, good or optimal 3D image quality was achieved in 80% of LA and all of RA reconstructions. These accurate models were obtained with ED of 2.6 ± 0.4 mSv for LA and 1.2 ± 0.5 mSv for RA. Conclusion Three-dimensional rotational angiography is possible with a significant reduction in ED (to the level of prospectively gated cardiac computed X-ray tomography) without compromising image quality. Low-dose 3DRA could become the preferred online 3D imaging modality for pulmonary vein isolation and other anatomy-dependent ablations.
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- 2013
34. Safety and efficacy of applying a low-dose radiation fluoroscopy protocol in device implantations
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Wilhelm Haverkamp, Philipp Attanasio, Pierre Jaïs, Martin Huemer, Leif-Hendrik Boldt, Melika Mirdamadi, Florian Blaschke, Jean-Yves Wielandts, and Burkert Pieske
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Adult ,Male ,medicine.medical_specialty ,Pacemaker, Artificial ,Adolescent ,030204 cardiovascular system & hematology ,Prosthesis Design ,Radiation Dosage ,Radiography, Interventional ,Risk Assessment ,law.invention ,Prosthesis Implantation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,law ,Risk Factors ,Physiology (medical) ,Chart review ,Germany ,medicine ,Fluoroscopy ,Humans ,030212 general & internal medicine ,Cardiac Resynchronization Therapy Devices ,Procedure time ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Radiation dose ,Middle Aged ,Protective Factors ,Radiation Exposure ,Surgery ,Defibrillators, Implantable ,Artificial cardiac pacemaker ,Dose reduction ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Complication ,Nuclear medicine ,business ,Low Dose Radiation ,Program Evaluation - Abstract
Aims For cardiac implantable electronic device (CIED) implantations, visualization of lead placement is necessary and fluoroscopy remains by far the most commonly used technique. With simple changes in the X-ray system settings, total radiation dose can be reduced significantly. The purpose of this study was to assess the safety and efficacy of various CIED implantations performed after implementation of a new dose reduction protocol (DRP). Methods and results We conducted a retrospective chart review of 584 patients undergoing CIED implantation or revision in our hospital. Of these patients, 280 (48%) underwent the implantation prior to and 304 (52%) after the DRP introduction. The DRP included various changes for optimized image processing and exposure system settings to enable dose reduction, as well as a reduced frame rates (4 FPS for fluoroscopy and 7.5 FPS for cinematographic images). Of the 584 patients, 53 (9.1%) had a one-chamber pacemaker, 232 (39.7%) a two-chamber pacemaker, 133 (22.8%) a one-chamber ICD, 35 (6.0%) a two-chamber ICD, 82 (14.0%) a CRT ( de novo ) implantation, and 49 (8.3%) had an upgrade to a CRT device. DRP was associated with a 64% reduction of the dose-area product (1372 ± 2659 vs. 3792 ± 5025 cGcm2, P < 0.001), while fluoroscopy duration (13 ± 15 vs. 13 ± 15 min) and procedural duration (93 ± 52 vs. 92 ± 52 min.) did not significantly increase. Complication rates did not differ significantly between the two groups. Conclusion The DRP proved to effectively reduce radiation dose for all types of CIED implantations. Fluoroscopy time, total procedure time, and the number of complications did not increase after introducing the DRP.
- Published
- 2016
35. Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures
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S. De Buck, Hilde Bosmans, Jean-Yves Wielandts, Joris Ector, Hein Heidbuchel, and K. Smans
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Male ,medicine.medical_specialty ,Rotation ,medicine.medical_treatment ,Catheter ablation ,Coronary Angiography ,Radiation Dosage ,Models, Biological ,Effective dose (radiation) ,Collimated light ,Body Mass Index ,Automation ,Imaging, Three-Dimensional ,Humans ,Medicine ,Computer Simulation ,Radiology, Nuclear Medicine and imaging ,Automatic exposure control ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Arrhythmias, Cardiac ,Middle Aged ,Cardiac Ablation ,Ablation ,Rotational angiography ,Angiography ,Catheter Ablation ,Female ,Radiology ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Algorithms - Abstract
There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose-area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 +/- 1.4 mSv according to ICRP 60 and 6.6 +/- 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.
- Published
- 2010
36. Three-dimensional cardiac rotational angiography: effective radiation dose and image quality implications
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Hilde Bosmans, Hein Heidbuchel, André Lagerche, Joris Ector, Rik Willems, Jean-Yves Wielandts, and Stijn De Buck
- Subjects
Adult ,Male ,medicine.medical_specialty ,Image quality ,medicine.medical_treatment ,Catheter ablation ,Iterative reconstruction ,Effective dose (radiation) ,Collimated light ,Body Mass Index ,Imaging, Three-Dimensional ,Physiology (medical) ,Humans ,Medicine ,Aged ,business.industry ,Angiography ,Arrhythmias, Cardiac ,Dose-Response Relationship, Radiation ,Heart ,Middle Aged ,Cardiac Ablation ,Ablation ,Rotational angiography ,Catheter Ablation ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Algorithms ,Software - Abstract
Aims Three-dimensional rotational angiography (3DRA) is a promising new online tool for 3D imaging during cardiac ablation procedures. No precise data exist concerning its associated radiation dose. The current study evaluated the effective dose (ED) of cardiac rotational angiography and its relation to patient properties, imaging system input settings, and quality of reconstructed 3D images. Methods and results We performed Monte Carlo simulation-based radiation dose calculations in 42 patients referred for ablation of cardiac arrhythmias. Detailed tube setting information from the 3DRA system (Siemens Axiom Artis dBC with Syngo DynaCT Cardiac software) was used to provide an accurate input for dose calculations in all 248 frames used during image acquisition. Our calculations yielded an overall mean ED of 6.6 +/- 1.8 mSv (based on ICRP 103 weighing factors). Manual collimation of the radiation beam can reduce ED by more than 20%. Image quality did not significantly relate to patient body mass index (BMI), dose per frame setting, or dose-area product (DAP), but was rather explained by contrast filling, cardiac motion reduction, and absence of image reconstruction artefacts. In the system evaluated, DAP values are nearly independent from BMI (R(2) = 0.30), due to its technical specifications. Therefore, patient BMI showed an unexpected strong inverse relation to ED. Conclusion Three-dimensional rotational angiography can be performed with acceptable patient radiation dose, comparable to cardiac CT. With the 3DRA system studied (Siemens Axiom), slender patients may currently receive unnecessarily high radiation doses when compared with obese patients, so that further dose reduction seems feasible for many patients. Adequate collimation is imperative to limit patient exposure.
- Published
- 2009
37. Exercise pathophysiology and sildenafil effects in chronic thromboembolic pulmonary hypertension
- Author
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Hein Heidbuchel, Guido Claessen, Jean-Yves Wielandts, Johan Van Cleemput, Andre La Gerche, Piet Claus, Jan Bogaert, Wim A. Wuyts, and Marion Delcroix
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Male ,medicine.medical_specialty ,Cardiac output ,Supine position ,Sildenafil ,Heart Ventricles ,Hypertension, Pulmonary ,Vasodilator Agents ,Hemodynamics ,Magnetic Resonance Imaging, Cine ,Piperazines ,Sildenafil Citrate ,chemistry.chemical_compound ,Oxygen Consumption ,Internal medicine ,medicine ,Humans ,Pulmonary Wedge Pressure ,Exercise ,Sulfonamides ,business.industry ,Healthy subjects ,Middle Aged ,Pathophysiology ,Surgery ,Treatment Outcome ,chemistry ,Purines ,Chronic Disease ,Cardiology ,Exercise Test ,Ventricular Function, Right ,Chronic thromboembolic pulmonary hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Anaerobic exercise - Abstract
Symptoms in patients with chronic thromboembolic pulmonary hypertension (CTEPH) predominantly occur during exercise, while haemodynamic assessment is generally performed at rest. We hypothesised that exercise imaging of RV function would better explain exercise limitation and the acute effects of pulmonary vasodilator administration than resting measurements.Fourteen patients with CTEPH and seven healthy control subjects underwent cardiopulmonary testing to determine peak exercise oxygen consumption (VO2peak) and ventilatory equivalent for carbon dioxide (VE/VCO2) at the anaerobic threshold. Subsequently, cardiac MRI was performed at rest and during supine bicycle exercise with simultaneous invasive measurement of mean pulmonary arterial pressure (mPAP) before and after sildenafil.During exercise, patients with CTEPH had a greater increase in the ratio of mPAP relative to cardiac output (CO) than controls (6.7 (5.1-8.7) vs 0.94 (0.86-1.8) mm Hg/L/min; p0.001). Stroke volume index (SVi) and RVEF increased during exercise in controls, but not in patients with CTEPH (interaction p0.001). Sildenafil decreased the mPAP/CO slope and increased SVi and RVEF in patients with CTEPH (p0.05) but not in controls. In patients with CTEPH, RVEF reserve correlated moderately with VO2peak (r = 0.60; p = 0.030) and VE/VCO2 (r = -0.67; p = 0.012). By contrast, neither VO2peak nor VE/VCO2 correlated with resting RVEF.Exercise measures of RV function explain much of the variance in the exercise capacity of patients with CTEPH while resting measures do not. Sildenafil increases SVi during exercise in patients with CTEPH, but not in healthy subjects.
- Published
- 2015
38. Characterization of the Left-Sided Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy
- Author
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Nora Al Jefairi, Michel Haïssaguerre, Antonio Frontera, Benjamin Berte, Yuki Komatsu, Frederic Sacher, Xavier Pillois, Nicolas Derval, Mélèze Hocini, Michel Montaudon, Seigo Yamashita, Sana Amraoui, Jean-Yves Wielandts, Hubert Cochet, François Laurent, Pierre Jaïs, Saagar Mahida, Arnaud Denis, Jean-Marc Sellal, SELLAL, Jean-Marc, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
- Subjects
Adult ,Male ,arrhythmogenic right ventricular dysplasia ,medicine.medical_specialty ,cardiac ,medicine.medical_treatment ,Cardiomyopathy ,Catheter ablation ,multidetector computed tomography ,tachycardia ,Right ventricular cardiomyopathy ,Ventricular Function, Left ,Electrocardiography ,Cardiac magnetic resonance imaging ,Physiology (medical) ,Internal medicine ,catheter ablation ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,medicine.diagnostic_test ,business.industry ,Isoproterenol ,Magnetic resonance imaging ,Adrenergic beta-Agonists ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Arrhythmogenic right ventricular dysplasia ,ventricular ,Dysplasia ,Cardiology ,Tachycardia, Ventricular ,Ventricular Function, Right ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,arrhythmias ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background— The correlates of left ventricular (LV) substrate in arrhythmogenic right ventricular (RV) cardiomyopathy are largely unknown. Methods and Results— Thirty-two patients with arrhythmogenic RV cardiomyopathy (47±14 years; 6 women) were included. RV and LV dysplasia were defined from multidetector computed tomography and cardiac magnetic resonance imaging. Arrhythmias were characterized as right-sided or left-sided on 12-lead ECG recordings at baseline and during isoproterenol testing. In 14 patients, the imaging substrate was compared with voltage mapping and local abnormal ventricular activity. Imaging abnormalities were found in 32 (100%) and 21 (66%) patients on the RV and LV, respectively, intramyocardial fat on multidetector computed tomography being the most sensitive feature. LV involvement related to none of the Task Force criteria. Right-sided arrhythmias were more frequent than left-sided arrhythmias ( P =0.003) although the latter were more frequent in case of LV involvement ( P =0.02). The agreement between low voltage and fat on multidetector computed tomography was high on the RV when using either endocardial unipolar or epicardial bipolar data (κ=0.82 and κ=0.78, respectively) but lower on the LV (κ=0.54 for epicardial bipolar). LV local abnormal ventricular activity was found in all patients with LV involvement, and none of the others. The density of local abnormal ventricular activity within fat areas was similar between the RV and LV ( P =0.57). Conclusions— LV substrate is frequent in arrhythmogenic RV cardiomyopathy, but poorly identified by current diagnostic strategies. Left-sided arrhythmias are more frequent in case of LV involvement. LV fat hosts the same density of local abnormal ventricular activity as RV fat, but is less efficiently detected by voltage mapping. These results support the need for alternative diagnostic strategies to identify LV dysplasia.
- Published
- 2015
39. Image Artefact Propagation in Motion Estimation and Reconstruction in Interventional Cardiac C-arm CT
- Author
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Rebecca Fahrig, S. De Buck, Joachim Hornegger, Kerstin Müller, Andreas Maier, Guenter Lauritsch, Chris Schwemmer, and Jean-Yves Wielandts
- Subjects
Cone beam computed tomography ,Image quality ,Computer science ,Swine ,Movement ,Streak ,Cardiac-Gated Imaging Techniques ,Computed tomography ,Iterative reconstruction ,Imaging phantom ,Article ,Imaging, Three-Dimensional ,Motion estimation ,Shadow ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Cardiac imaging ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Phantoms, Imaging ,Heart ,Cone-Beam Computed Tomography ,Compressed sensing ,Bilateral filter ,Artificial intelligence ,business ,Artifacts - Abstract
The acquisition of data for cardiac imaging using a C-arm computed tomography system requires several seconds and multiple heartbeats. Hence, incorporation of motion correction in the reconstruction step may improve the resulting image quality. Cardiac motion can be estimated by deformable three-dimensional (3D)/3D registration performed on initial 3D images of different heart phases. This motion information can be used for a motion-compensated reconstruction allowing the use of all acquired data for image reconstruction. However, the result of the registration procedure and hence the estimated deformations are influenced by the quality of the initial 3D images. In this paper, the sensitivity of the 3D/3D registration step to the image quality of the initial images is studied. Different reconstruction algorithms are evaluated for a recently proposed cardiac C-arm CT acquisition protocol. The initial 3D images are all based on retrospective electrocardiogram (ECG)-gated data. ECG-gating of data from a single C-arm rotation provides only a few projections per heart phase for image reconstruction. This view sparsity leads to prominent streak artefacts and a poor signal to noise ratio. Five different initial image reconstructions are evaluated: (1) cone beam filtered-backprojection (FDK), (2) cone beam filtered-backprojection and an additional bilateral filter (FFDK), (3) removal of the shadow of dense objects (catheter, pacing electrode, etc) before reconstruction with a cone beam filtered-backprojection (cathFDK), (4) removal of the shadow of dense objects before reconstruction with a cone beam filtered-backprojection and a bilateral filter (cathFFDK). The last method (5) is an iterative few-view reconstruction (FV), the prior image constrained compressed sensing combined with the improved total variation algorithm. All reconstructions are investigated with respect to the final motion-compensated reconstruction quality. The algorithms were tested on a mathematical phantom data set with and without a catheter and on two porcine models using qualitative and quantitative measures. The quantitative results of the phantom experiments show that if no dense object is present within the scan field of view, the quality of the FDK initial images is sufficient for motion estimation via 3D/3D registration. When a catheter or pacing electrode is present, the shadow of these objects needs to be removed before the initial image reconstruction. An additional bilateral filter shows no major improvement with respect to the final motion-compensated reconstruction quality. The results with respect to image quality of the cathFDK, cathFFDK and FV images are comparable. In conclusion, in terms of computational complexity, the algorithm of choice is the cathFDK algorithm.
- Published
- 2014
40. Registration based filtering: an acceptable tool for noise reduction in left ventricular dynamic rotational angiography images?
- Author
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Hein Heidbuchel, Stijn De Buck, Joris Ector, Dieter Nuyens, Frederik Maes, Jean-Yves Wielandts, Yaniv, ZR, and Holmes, DR
- Subjects
medicine.diagnostic_test ,Computer science ,business.industry ,Noise reduction ,medicine.medical_treatment ,Catheter ablation ,Image segmentation ,Filter (signal processing) ,Noise ,medicine.anatomical_structure ,PSI_MIC ,Ventricle ,Rotational angiography ,Angiography ,medicine ,Computer vision ,Segmentation ,Artificial intelligence ,business ,Biomedical engineering - Abstract
VT ablations could benefit from Dynamic 3D (4D) left ventricle (LV) visualization as road-map for anatomy-guided procedures. We developed a registration-based method that combines information of several cardiac phases to filter out noise and artifacts in low-dose 3D Rotational Angiography (3DRA) images. This also enables generation of accurate multi-phase surface models by semi-automatic segmentation (SAS). The method uses B-spline non-rigid inter-phase registration (IPR) and subsequent averaging of the registered 3DRA images of 4 cardiac phases, acquired with a slow atrial pacing protocol, and was validated on data from 5 porcine experiments. IPR parameter settings were optimized against manual delineations of the LVs using a composed similarity score (Q), dependent on DICE-coefficient, RMSDistance, Hausdorff (HD) and the percentage of inter-surface distances ≤3mm and ≤4mm. The latter are clinically acceptable error cut-off values. Validation was performed after SAS for varying voxel intensity thresholds (ISO), by comparison between models with and without prior use of IPR. Distances to the manual delineations at optimal ISO were reduced to ≤3mm for 95.6±2.7% and to ≤4mm for 97.1±2.0% of model surfaces. Improved quality was proven by significant mean Q-increase irrespective of ISO (7.6% at optimal ISO (95%CI 4.6-10.5, p
- Published
- 2014
41. A new cryoenergy for ventricular tachycardia ablation: a proof-of-concept study
- Author
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Pierre Jaïs, Benjamin Berte, Olivier Bernus, Rukshen Weerasooriya, Xavier Pillois, Frederic Sacher, Jean-Yves Wielandts, and Saagar Mahida
- Subjects
medicine.medical_specialty ,Time Factors ,Heart Ventricles ,medicine.medical_treatment ,Action Potentials ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Cryosurgery ,Proof of Concept Study ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Physiology (medical) ,Internal medicine ,medicine ,Animals ,030212 general & internal medicine ,Sheep, Domestic ,Endocardium ,Coronary sinus ,business.industry ,Cryoablation ,Equipment Design ,medicine.disease ,Ablation ,Disease Models, Animal ,medicine.anatomical_structure ,Ventricle ,Ventricular fibrillation ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,Ventricular Ablation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Lack of transmural lesion formation during radiofrequency (RF) ablation for ventricular tachycardia (VT) is an important determinant of arrhythmia recurrence. The aim of this proof-of-concept study was to evaluate safety and efficacy of a new and more powerful cryoablation system for ventricular ablation. Methods and results Five healthy female sheep (59 ± 6 kg) underwent a surgical sternotomy for epicardial and endocardial access [endocardial access via right atrial appendage and left ventricular (LV) apex]. A cryoablation system with liquid nitrogen (IceCure) was used to create 3 min freezes at the right ventricle (RV). Left ventricular cryoablation was performed with either a 6 min or 2 × 4 min freezes. To assess safety, ablation was also performed on the mid left anterior descending artery and the proximal coronary sinus. A total of 45 lesions were created (RV epicardial, n = 12; LV epicardial, n = 18; RV endocardial, n = 7; LV endocardial, n = 8; LAD, n = 4; and CS, n = 4). The mean lesion volume was 5055 ± 92 mm3 (length: 32 ± 4.6 mm, width: 16.0 ± 6.4 mm, and depth: 11.2 ± 4.4 mm). Lesions were transmural in 28/45 (62%) and >10 mm in depth in 35/45 (78%). Of the endocardial lesions, 12/15 were transmural (80%). There was no benefit of the bonus freeze in LV lesions (6 vs. 2 × 4 min: 6790 ± 44 vs. 5595 ± 63 mm3; P = 0.44). All ablated vascular structures appeared macroscopically normal without acute stenosis. One animal died due to incessant Ventricular fibrillation (VF). Conclusion Our results indicate that a more powerful cryoablation system is able to create large, transmural ventricular lesions from both the endocardium and the epicardium. The technology may hold potential for both surgical and catheter-based VT ablation in humans.
- Published
- 2016
42. A new approach for prospectively gated cardiac rotational angiography
- Author
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Stijn De Buck, Piet Claus, Stefan Janssens, Hein Heidbuchel, Dieter Nuyens, Jean-Yves Wielandts, and Dieter Dauwe
- Subjects
medicine.medical_specialty ,Contouring ,medicine.diagnostic_test ,business.industry ,Cardiac Ablation ,Effective dose (radiation) ,medicine.anatomical_structure ,Ventricle ,Rotational angiography ,Angiography ,medicine ,Image noise ,Medical physics ,Nuclear medicine ,business ,Cardiac imaging - Abstract
Cardiac rotational angiography (RA) is well suited for 3-D cardiac imaging during catheter based interventions but remained limited to static images or was characterized by high dose patient radiation dose. We present a new prospective imaging technique that is capable of imaging the dynamics of the cardiac cavities in a single C-arm run during the intervention with a relatively low dose. By combining slow atrial pacing to obtain a stable heart rhythm and a single C-arm rotation with imaging at a regular imaging interval, a prospective 4DRA is established. Pacing interval and imaging framerate can be adapted such that a single cardiac phase is imaged multiple times and a motion free state is imaged from different equiangular positions. A practical implementation of this technique was realized in which the cardiac cavities are imaged while pacing at 105 bpm (574 msec) and imaging at approximately 15 fps. A number of animal experiments were conducted in which the technique was applied and MR imaging was performed subsequently. Quantitative comparison was made by manual contouring of the left ventricle in the RA and MR images of both end-systolic and end-diastolic phases. Reconstructed images of the individual cardiac phases showed all four chambers and important vessels in spite of substantial image noise. 4DRA and MR absolute surface distance errors amounted to 2:8 ± 0:7 mm, which is acceptable. Further, no systematic difference could be identified. Finally, it is expected that the effective dose of a clinical protocol with 381 images will be lower than the current retrospective gated RA protocols.
- Published
- 2013
43. 216-28: Electrophysiological effects of amiodarone in patients with persistent atrial fibrillation
- Author
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Michel Haïssaguerre, Arnaud Denis, Grégoire Massoullié, Nathaniel Thompson, Sana Amraoui, Frontera Antonio, Elvis Teijeira Fernandez, Claudia Camaioni, Nicolas Derval, Arnaud Chaumeil, Pierre Jaïs, Nora Al Jefairi, Ghassen Cheniti, Jean-Yves Wielandts, Mélèze Hocini, Frederic Sacher, and Masateru Takigawa
- Subjects
medicine.medical_specialty ,business.industry ,P wave ,030204 cardiovascular system & hematology ,Amiodarone ,03 medical and health sciences ,Electrophysiology ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Persistent atrial fibrillation ,Cardiology ,Medicine ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2016
44. 189-03: Mapping of Conventional Anatomical Macrorentrant Tachycardia in Patients with Prior Ablations Guided by Rhythmia Mapping System
- Author
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Masateru Takigawa, Michel Haïssaguerre, Pierre Jaïs, Claudia Camaioni, Grégoire Massoullié, Nathaniel Thompson, Nora Al Jefairi, Arnaud Chaumeil, Frontera Antonio, Mélèze Hocini, Sana Amraoui, Jean-Yves Wielandts, Elvis Teijeira Fernandez, Nicolas Derval, Arnaud Denis, Frederic Sacher, and Seigo Yamashita
- Subjects
Tachycardia ,medicine.medical_specialty ,business.industry ,Physiology (medical) ,Mapping system ,Medicine ,In patient ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
45. Asymmetric collimation can significantly reduce patient radiation dose during pulmonary vein isolation
- Author
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Hein Heidbuchel, Christophe Garweg, Stijn De Buck, Pieter Koopman, Andre La Gerche, Joris Ector, Jean-Yves Wielandts, and Dieter Nuyens
- Subjects
Adult ,Male ,medicine.medical_specialty ,Electromagnetics ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,Radiation Dosage ,law.invention ,Pulmonary vein ,Imaging, Three-Dimensional ,law ,Physiology (medical) ,Atrial Fibrillation ,Medical imaging ,medicine ,Fluoroscopy ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Ablation ,Treatment Outcome ,Pulmonary Veins ,Mauriceau–Smellie–Veit maneuver ,Catheter Ablation ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Aims Current fluoroscopic and 3D image-guided treatment of atrial fibrillation (AF) by radiofrequency ablation is characterized by a substantial amount of X-ray radiation. We investigated the potential of an asymmetric collimation technique to reduce dose. Methods and results For 30 patients, referred for AF ablation, we determined the received fluoroscopy dose for various collimation scenarios: a single collimation window encompassing all veins as used in most labs (Sc 1), an optimal adjusted symmetric collimation window encompassing each two ipsilateral veins (Sc 2) or each individual vein (Sc 3) and an optimal asymmetric collimation window encompassing each two ipsilateral veins (Sc 4) or each individual vein (Sc 5). Twenty patients were studied retrospectively and 10 were studied prospectively. Total fluoroscopy effective dose for all collimation strategies amounted to 45 ± 31 mSv for a single collimation field (Sc 1), 36 ± 25 mSv (Sc 2), and 24 ± 14 mSv (Sc 3) for a symmetrically adjusted collimation window and 15 ± 10 (Sc 4) and 5 ± 3 mSv (Sc 5) for an asymmetrically adjusted collimation approach. Validation of symmetric (Sc 2) and asymmetric (Sc 4) collimation in 10 patients confirmed the retrospective analysis. Conclusions Implementation and effective application of an optimal asymmetric collimation approach would yield an average three- to nine-fold reduction of fluoroscopy dose during AF ablation procedures. This reduction exceeds what has been previously reported by implementing an electromagnetic catheter tracking approach. Furthermore, it can be easily integrated in the clinical workflow with limited additional one-time cost. Manufacturers of imaging systems should consider its implementation a priority, and physicians should adopt it in their workflow.
- Published
- 2011
46. Body Surface Mapping to Guide Atrial Fibrillation Ablation
- Author
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Hubert Cochet, Michel Haïssaguerre, Darren A. Hooks, Han S. Lim, Nicolas Derval, Pierre Jaïs, Jean-Yves Wielandts, Arnaud Denis, Antonio Frontera, Ashok J. Shah, Benjamin Berte, Seigo Yamashita, Sana Amraoui, Jean-Marc Sellal, Nora Al Jefairi, Saagar Mahida, Mélèze Hocini, Frederic Sacher, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], and SELLAL, Jean-Marc
- Subjects
medicine.medical_specialty ,driver ,medicine.medical_treatment ,non-invasive ,body surface mapping ,Catheter ablation ,Ablation ,Physiology (medical) ,Internal medicine ,Medicine ,atrial fibrillation ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Interventional treatment ,Guide catheter ,business.industry ,Body surface mapping ,Non invasive ,Atrial fibrillation ,medicine.disease ,Heart failure ,Cardiology ,Clinical Arrhythmias ,Cardiology and Cardiovascular Medicine ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Atrial fibrillation (AF) is the most common rhythm disorder, and is strongly associated with thromboembolic events and heart failure. Over the past decade, catheter ablation of AF has advanced considerably with progressive improvement in success rates. However, interventional treatment is still challenging, especially for persistent and long-standing persistent AF. Recently, AF analysis using a non-invasive body surface mapping technique has been shown to identify localised reentrant and focal sources, which play an important role in driving and perpetuating AF. Non-invasive mapping-guided ablation has also been reported to be effective for persistent AF. In this review, we describe new clinical insights obtained from non-invasive mapping of persistent AF to guide catheter ablation.
- Published
- 2015
47. Left ventricular 4D imaging with low radiation dose through optimised interphase registration of rotational angiography images
- Author
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Frederik Maes, Hein Heidbuchel, Joris Ector, Stijn De Buck, Jean-Yves Wielandts, and Dieter Nuyens
- Subjects
Physics ,business.industry ,Filter (signal processing) ,Hausdorff distance ,medicine.anatomical_structure ,Ventricle ,Rotational angiography ,medicine ,Segmentation ,Interphase ,Image warping ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Cardiac imaging - Abstract
Cardiologia CROATICA Objectives: VT ablations could benefit from dynamic 3D (i.e. 4D) visualisation of the left ventricle (LV) as roadmap for anatomy-guided procedures, e.g. by means of rotational angiography (3DRA). To limit radiation burden, low-dose, noisy 3DRA image datasets have to be used. Our aim was to develop an algorithm combining information of several cardiac phases to filter out noise, enabling accurate semi-automatic segmentation (SAS) and generation of multi-phase segmentation surfaces. Methods and Results: We explored non-rigid interphase registration (IPR) using image warping and subsequent image averaging of 4 cardiac phases in low-dose 3DRA images from 5 porcine experiments, acquired with a novel protocol of slow atrial pacing. IPR parameter settings were optimised against manual delineations of the LVs using a score (Q) composed of standardised similarity measures. SAS was done for varying voxel intensity thresholds (ISO). Figure A shows a 4D posterior view sequence of 4 LV phases constructed with and without IPR, after SAS at ISO = 0 relative to optimal ISO. Relevant structures are the apex (1), LV inflow (2), LV outflow tract (3) and posterior papillary muscle (4). Distances to the manual delineations were reduced to 3 mm for 95.6 ± 2,7% of model surfaces (d3mm) at optimal ISO with IPR. Post-SAS IPR and non-IPR models were compared using 3 quality measures (Q; d3mm and Hausdorff Distance [HD, reflecting maximum error]). Improved quality was proven by significant increases in d3mm (illustrated in Figure B for the experiment of Figure A) and Q irrespective of ISO (mean increase at optimal ISO was 7.75% (95%CI 4.60-10.90, p
- Published
- 2013
48. Rotational angiography (LARCA) during electrophysiological examination detects pulmonary vein stenosis
- Author
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Pieter-Jan Palmers, Roxana Voigt, Jens-Uwe Voigt, Hein Heidbuchel, Jean-Yves Wielandts, and Stijn De Buck
- Subjects
Male ,Aortic valve ,medicine.medical_specialty ,Electrophysiological Phenomena ,Constriction, Pathologic ,Sensitivity and Specificity ,Predictive Value of Tests ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,Fluorescein Angiography ,Pulmonary vein stenosis ,medicine.diagnostic_test ,business.industry ,Angiography, Digital Subtraction ,Reproducibility of Results ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Fluorescein angiography ,Electrophysiology ,medicine.anatomical_structure ,Pulmonary Veins ,Aortic Valve ,Predictive value of tests ,Rotational angiography ,Cardiology ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2014
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