Laurent Pison

Maastricht Universitair Medisch Centrum, Maestricht, Limburg, Netherlands

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Publications (50)167.61 Total impact

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  • International Journal of Cardiology 03/2015; 185. DOI:10.1016/j.ijcard.2015.03.102 · 6.18 Impact Factor
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    ABSTRACT: This European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey aimed at exploring the common practices in approaching patients with atrial fibrillation (AF) and informing them about their risk profiles and available therapies in Europe. In the majority of 53 responding centres, patients were seen by cardiologists (86.8%) or arrhythmologists (64.2%). First- and follow-up visits most commonly lasted 21-30 and 11-20 min (41.5 and 69.8% of centres, respectively). In most centres (80.2%) stroke and bleeding risk had the highest priority for discussion with AF patients; 50.9% of centres had a structured patient education programme for stroke prevention. Individual patient stroke risk was assessed at every visit in 69.2% of the centres; 46.1% of centres had a hospital-based anticoagulation clinic. Information about non-vitamin K oral anticoagulants (NOACs) was communicated to all AF patients eligible for oral anticoagulation (38.5% of centres) or to warfarin-naive/unstable patients (42.3%). Only two centres (3.8%) had a structured NOAC adherence follow-up programme; in eight centres (15.4%) patients were requested to sign the statement they have been informed about the risks of non-adherence to NOAC therapy, and three centres (5.8%) had a patient education programme. Patient preferences were of the highest relevance regarding oral anticoagulation and AF ablation (64.7 and 49.0% of centres, respectively). This EP Wire Survey shows that in Europe considerable amount of time and resources are used in daily clinical practice to inform AF patients about their risk profile and available therapies. However, a diversity of strategies used across the European hospitals was noted, and further research is needed to better define optimal strategies for informing AF patients about their risk profile and treatment options. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
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    ABSTRACT: Aim Hybrid procedure (HP) involves epicardial isolation of pulmonary vein and posterior wall of left atrium, and endo-cardial checking of lesions and touchups (if needed). We aimed at observing the effect of hybrid procedure on P wave duration (PWD), calculated automatically from surface ECG leads at start and end of HP, and also for relationship to atrial fibrillation (AF) recurrence at 9 months. Methods Forty-one patients (32 male; mean age, 58.4 ± 9.5 years) underwent HP, as first ever ablation. A new auto-mated method was used for P wave segmentation and PWD estimation from recognizable P waves in ECG lead I or II before and after HP, based on fitting of each P wave by means of two Gaussian functions. Results Overall, PWD was significantly decreased after pro-cedure (104.4±25.1 ms vs. 84.7±23.8 ms, p=0.0151), espe-cially in persistent AF patients (122.4±32.2 ms vs. 85.6± 24.5 ms, p= 0.02). PWD preprocedure was significantly higher in persistent than in paroxysmal patients (122.4± 32.2 ms vs. 92.5±17.9 ms, p=0.0383). PWD was significant-ly decreased after procedure in prior electrical cardioverted patients (106.7±30.5 ms vs. 84.7±23.1 ms, p=0.0353). After 9-month follow-up of 40 patients, HP-induced PWD decrease was significant for the 12 persistent patients without recur-rence (122.4.1±35.3 ms vs. 85.6±22.0 ms, p=0.0210). Conclusion Preprocedure PWD was higher for persistent than paroxysmal patients. HP reduced PWD significantly. Nine-month follow-up suggests that HP is successful in restoring and maintaining sinus rhythm. To individualize AF therapy, AF type-based selection of patients may be possible before procedure. Automated analysis of PWD from surface ECG is possible.
    Journal of Interventional Cardiac Electrophysiology 01/2015; DOI:10.1007/s10840-014-9969-9 · 1.39 Impact Factor
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    ABSTRACT: The aim of this survey was to provide insight into current practice regarding the management of paediatric arrhythmias in Europe. The survey was based on a questionnaire sent via the Internet to the European Heart Rhythm Association (EHRA) electrophysiology research network centres. The following topics were explored: patient and treatment selection, techniques and equipment, treatment outcomes and complications. The vast majority of paediatric arrhythmias concerns children older than 1 year and patients with grown-up congenital heart disease. In 65% of the hospitals there is a specialized paediatric centre, and the most commonly observed arrhythmias include Wolff-Parkinson-White syndrome and atrioventricular nodal re-entry tachycardias (90.24%). The medical staff performing paediatric catheter ablations in Europe are mainly adult electrophysiology teams (82.05% of the centres). Radiofrequency is the preferred energy source used for paediatric arrhythmia ablation. Catheter ablation is only chosen if two or more antiarrhythmic drugs have failed (94.59% of the centres). The majority of the centres use flecainide (37.8%) or atenolol (32.4%) as their first choice drug for prevention of recurrent supraventricular arrhythmias. While none of the centres performed catheter ablation in asymptomatic infants with pre-excitation, 29.7% recommend ablation in asymptomatic children and adolescents. The preferred choice for pacemaker leads in infants less than 1 year old is implantation of epicardial leads in 97.3% of the centres, which continues to be the routine even in patients between 1 and 5 years of age as reported by 75.68% of the hospitals. Almost all centres (94.59%) report equally small number of complications of catheter ablation in children (aged 1-14 years) as observed in adults. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.
    Europace 12/2014; 16(12):1852-6. DOI:10.1093/europace/euu313 · 3.05 Impact Factor
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    ABSTRACT: The aim of this survey was to describe the different strategies regarding the management of malfunctioning and recalled pacemaker and defibrillator leads across Europe. A questionnaire has been designed to assess the current practice and physician's approach to the management of leads which are faulty, unnecessary, and/or recalled. Responses to the questionnaire were received from 34 hospitals-members of the European Heart Rhythm Association (EHRA) electrophysiology (EP) research network. The survey involved both very high and low volume implanting centres, with 85% of the responding centres performing lead extraction. The survey provides a panoramic view of operator's decision making in the field of malfunctioning, recalled, and redundant leads and outlines a common point of view on lead abandonment and factors influencing the decision about lead extraction. The main factors strongly influencing the decision making were patient's age (59%), the presence of the damaged leads (44%), and the lead dwelling time (44%). Regarding the lead abandonment, the main concern (61%) was the potential greater difficulty associated with lead extraction in the future. High volume extracting centres showed a greater propensity to removing the malfunctioning or recalled leads compared with low volume or non-extracting centres. This EP Wire survey gives a snapshot of the operators' approaches and options regarding redundant, malfunctioning, and recalled lead management and may form the basis for future prospective research on this topic.
    Europace 11/2014; 16(11):1674-8. DOI:10.1093/europace/euu302 · 3.05 Impact Factor
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    Journal of the American Medical Directors Association 10/2014; DOI:10.1016/j.jamda.2014.08.015 · 4.78 Impact Factor
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    ABSTRACT: The purpose of this European Heart Rhythm Association (EHRA) survey was to explore the work-up and management of lone atrial fibrillation (AF) among the European centres. Thirty-two European centres, all members of the EHRA electrophysiology (EP) research network, responded to this survey and completed the list of questions. The prevalence of lone AF has been reported to be ≤10% by 19 (60%) of the participating centres. The presence of isolated left atrial enlargement and left ventricular diastolic dysfunction represent heart disease according to 50 and 84% of the centres, respectively, and exclude the diagnosis of lone AF. Fifty-nine per cent of responders do not routinely consider genetic testing in lone AF patients. The initial therapeutic approach in symptomatic paroxysmal lone AF is antiarrhythmic drug therapy as reported by 31 (97%) of the centres. Pulmonary vein isolation only is the first ablation strategy for patients with symptomatic persistent lone AF at 27 (84%) of the responding centres. Assessment for sleep apnoea, obesity, and intensive sports activity in lone AF is performed at 27 (84%) centres. In conclusion, this EP Wire survey confirms that the term 'lone AF' is still used in daily practice. The work-up typically includes screening for known risk factors but not genetic testing. The preferred management of paroxysmal lone AF is rhythm control with antiarrhythmic drugs, whereas pulmonary vein isolation is the first ablation strategy for the majority of patients with symptomatic persistent lone AF.
    Europace 10/2014; 16(10):1521-3. DOI:10.1093/europace/euu277 · 3.05 Impact Factor
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    ABSTRACT: AimCurrent targeted left ventricular (LV) lead placement strategy is directed at the latest activated region during intrinsic activation. However, cardiac resynchronization therapy (CRT) is most commonly applied by simultaneous LV and right ventricular (RV) pacing without contribution from intrinsic conduction. Therefore, targeting the LV lead to the latest activated region during RV pacing might be more appropriate. We investigated the difference in LV electrical activation sequence between left bundle-branch block (LBBB) and RV apex (RVA) pacing using coronary venous electro-anatomic mapping (EAM).Methods and resultsTwenty consecutive CRT candidates with LBBB underwent intra-procedural coronary venous EAM during intrinsic activation and RVA pacing using EnSite NavX. Left ventricular lead placement was aimed at the latest activated region during LBBB according to current recommendations. In all patients, LBBB was associated with a circumferential LV activation pattern, whereas RVA pacing resulted in activation from the apex of the heart to the base. In 10 of 20 patients, RVA pacing shifted the latest activated region relative to LBBB. In 18 of 20 patients, the LV lead was successfully positioned in the latest activated region during LBBB. For the whole study population, LV lead electrical delay, expressed as percentage of QRS duration, was significantly shorter during RVA pacing than during LBBB (72 ± 13 vs. 82 ± 5%, P = 0.035).Conclusion Right ventricular apex pacing alters LV electrical activation pattern in CRT patients with LBBB, and shifts the latest activated region in a significant proportion of these patients. These findings warrant reconsideration of the current practice of LV lead targeting for CRT.
    European Journal of Heart Failure 10/2014; 16(11). DOI:10.1002/ejhf.178 · 6.58 Impact Factor
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    ABSTRACT: Left ventricular (LV) lead placement in the latest activated region is an important determinant of response to cardiac resynchronization therapy (CRT). We investigated the feasibility of coronary venous electroanatomic mapping (EAM) to guide LV lead placement to the latest activated region.
    Europace 09/2014; 17(1). DOI:10.1093/europace/euu221 · 3.05 Impact Factor
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    ABSTRACT: Changes in P wave duration (PWD) following atrial fibrillation (AF) ablation have been described and may have diagnostic value. PWD is usually assessed manually from ECG. This study aimed at exploring a novel method for automated modeling of the P-wave and assessment of PWD. Moreover, it aimed at investigating the effect of hy-brid procedure (HP) for AF treatment on PWD. P-wave modeling is achieved by means of a concatenation of two half-Gaussian functions, to account for potential left and right asymmetries in the P-wave morphology. When com-pared with a single Gaussian model, the method showed better fitting in terms of normalized mean square error (NMSE; 0.14±0.07 vs. 0.28±0.11, p < 10 −4). When investigating the effect of HP on PWD, results showed that PWD was significantly decreased after procedure (111.49±23.29 ms vs. 96.27±30.28 ms, p = 0.0319). PWD pre-procedure, was significantly higher in persistent patients than in paroxysmal patients (126.85±15.50 ms vs. 106.70±23.82, p < 0.0272). Automated analysis of P-wave from ECG to extract PWD is possible. Results at 9 month follow-up suggest that selection of patients may be possible before procedure to individualize AF therapy.
    Computing in cardiology; 09/2014
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    ABSTRACT: There is limited literature available regarding PV (pulmonary vein) stenosis management. Starting from its incidence, subsequent follow up using imaging technologies to monitor the success and the way of managing different groups pose varied opinions. However, with newer technological advancements and better understanding of mechanism of the atrial fibrillation ablation, the incidence of PV stenosis secondary to catheter ablation is declining. This paper highlights the current trends and future of management of PV stenosis secondary to catheter ablation for atrial fibrillation.
    Journal of Atrial Fibrillation 08/2014; 7(1).
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    ABSTRACT: Adenosine administration after pulmonary vein (PV) isolation using radiofrequency and cryoablation can cause acute recovery of conduction to the PVs and predicts atrial fibrillation (AF) recurrence. This study evaluated whether adenosine testing after second-generation balloon devices (cryothermal and laser) could reveal dormant PV reconduction and recurrence rate of AF. Out of total 60 patients, 20 patients underwent PV isolation using laser balloon and for the remaining patients, the cryoballoon was used. Following PVI, waiting period of 30 min was obtained. Thereafter, a bolus 15-21 mg of adenosine was injected followed by rapid saline flush. The subsequent response was assessed for each vein using an in situ lasso catheter. Further ablation (if needed) using laser balloon and cryocatheter respectively was done, until no reconduction occurred after repeat adenosine. Acute PV isolation was achieved in all 80 PVs of 20 patients (100 %) using laser device and in 151 PVs (96.2 %) of 38 patients (95 %) using cryoballoon. However, in seven patients (35 %), 11 PVs (13.7 %) (4 LSPV, 2 LIPV, 4 RSPV, and 1 RIPV) showed dormant PV potentials after adenosine administration in laser group. Cryoballoon group showed dormant reconduction in four patients (10 %), four PVs (5 %) [one LSPV, one LIPV, and two RIPV]. The follow-up of 337 +/- 92.4 days for cryoballoon and 267 +/- 76.9 days for laser balloon group demonstrated similar success rates (85 %). Adenosine testing after PV isolation using second-generation balloon based energy devices (laser and cryothermal) reveals dormant conduction in initially isolated PVs with similar long-term success rate.
    Journal of Interventional Cardiac Electrophysiology 07/2014; 41(1). DOI:10.1007/s10840-014-9921-z · 1.55 Impact Factor
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    ABSTRACT: OBJECTIVES: Bipolar radiofrequency (RF) devices are used epicardially by cardiac surgeons and cryoballoon endocardially by cardiac electrophysiologists for atrial fibrillation (AF) ablation, but in separate entities. The study's objective was to evaluate the feasibility and safety of combining an endocardial cryoballoon with epicardial bipolar RF ablation for the treatment of AF. METHODS: A cohort of 7 patients with AF underwent a hybrid thoracoscopic surgical and endocardial ablation. To prevent bilateral sequential lung deflation in these patients with severe chronic obstructive pulmonary disease, the right pulmonary veins (PVs) were isolated using an epicardial bipolar RF clamp and the contralateral veins with an endocardial cryoballoon. A box lesion set was made epicardially using a bipolar RF pen. RESULTS: Acutely, pacing manoeuvres proved a bidirectional block in all PVs in all patients. No complications were seen. A box lesion was made in 5 patients. During follow-up, 2 of them had AF recurrence: 1 was treated successfully with sotalol and another underwent redo RF catheter ablation with reisolation of the right inferior PV. At present, 6 of 7 patients are in sinus rhythm without any anti-arrythmic drugs during a follow-up of more than 40 +/- 3 months. CONCLUSIONS: A hybrid approach to AF ablation using a cryoballoon endocardially and a bipolar RF device epicardially is feasible and safe.
    Interactive Cardiovascular and Thoracic Surgery 06/2014; 19(4). DOI:10.1093/icvts/ivu189 · 1.11 Impact Factor
  • Chest 06/2014; 145(6):1435. DOI:10.1378/chest.14-0236 · 7.13 Impact Factor
  • Europace 05/2014; 16(6):935-938. DOI:10.1093/europace/euu143 · 3.05 Impact Factor
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    ABSTRACT: The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to stroke and bleeding risk evaluation in atrial fibrillation, particularly regarding the use of risk evaluation schemes, among members of the EHRA electrophysiology (EP) research network. In this EP Wire survey, we have provided some insights into current practice in Europe for the use of these risk assessment schemes. There were some obvious practice differences. However, reassuring information on current practice in Europe was evident, but more focus on renal function is warranted, especially facing the fact that novel oral anticoagulants are used for antithrombotic therapy.
    Europace 05/2014; 16(5):698-702. · 3.05 Impact Factor
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    ABSTRACT: Inherited arrhythmia disorders associated with structurally normal heart (i.e. long and short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, early repolarization syndrome, idiopathic ventricular fibrillation) cause 10% of 1.1 million sudden deaths in Europe and the USA. The purpose of this European Heart Rhythm Association (EHRA) electrophysiology wire survey was to assess the European clinical practice adopted for the diagnosis and management of these disorders. The survey was based on an electronic questionnaire sent out to the EHRA Research Network centres. Responses were received from 50 centres in 23 countries. The results of the survey show that inherited arrhythmia syndromes have a relatively low burden and are diagnosed and managed in accordance with the current guidelines. However, more than 50% of centres do not participate in any existing registry underlining the need for establishing a pan-European registry of these disorders.
    Europace 04/2014; 16(4):600-3. DOI:10.1093/europace/euu074 · 3.05 Impact Factor
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    ABSTRACT: Patients with atrial fibrillation (AF) with enlarged atria or previous pulmonary vein isolation (PVI) are challenging patients for catheter ablation. Thoracoscopic surgery is an effective treatment for these patients but comes at the cost of an increase in adverse events. Recently, electrophysiological (EP) guided approaches to thoracoscopic surgery have been described which consist of EP guidance by measurement of conduction block across ablation lines. In this study we describe the efficacy and safety of EP-guided thoracoscopic surgery for AF in patients with enlarged atria and/or prior failed catheter ablation. A total of 72 patients were included. Two different approaches to EP-guided thoracoscopic surgery were implemented: epicardial or endocardial EP-guidance at the time of surgery. Residual intraoperative conduction requiring additional ablation was detected with epicardial or endocardial mapping techniques in 50% and 11%, respectively. Additional epicardial or endocardial ablation was performed until bidirectional block was confirmed. Follow-up consisted of an ECG and a 24h Holter at 3, 6 and 12months after the procedure. A total of 57 patients (79%) had freedom of AF and were off anti-arrhythmic drugs at one year follow-up (30 paroxysmal (83%), 27 persistent AF (75%)). Adverse events occurred in 13 patients (6 major). None of our patients died and all events were reversible. EP-guidance of thoracoscopic surgery can be safely performed both epicardially and endocardially and is associated with a high rate of long-term maintenance of sinus rhythm in patients with enlarged atria and/or a previously failed ablation.
    International journal of cardiology 02/2014; DOI:10.1016/j.ijcard.2014.02.043 · 6.18 Impact Factor
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    ABSTRACT: We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial technique for the treatment of lone atrial fibrillation. Between 2009 and 2012, a cohort of 78 consecutive patients (median age 60.5 years, 77% male) underwent ablation of atrial fibrillation (AF) as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3 months, 6 months, 1 year and yearly thereafter. All patients reached 1-year follow-up. Median follow-up was 24 months [interquartile range 12-36]. No death or conversion to cardiopulmonary bypass occurred. No patient demonstrated paralysis of the phrenic nerve. Overall, the incidence of perioperative complications was 8% (n=6). At the end of follow-up, sixty-eight patients (87%) were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting longer than 30 seconds and off antiarrhythmic drugs (ADD). Among patients with long-standing persistent AF, 15 (100%) were in SR and off AAD. Success rates were 82% (n=28) in persistent and 76% (n=22) in paroxysmal AF (P=0.08). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up. Thoracoscopic hybrid epicardial endocardial technique proved to be effective and safe in the treatment of LAF and to represent an important new suitable option to treat stand-alone AF. Our findings need to be confirmed by further larger studies.
    01/2014; 3(1):38-44. DOI:10.3978/j.issn.2225-319X.2013.12.10

Publication Stats

203 Citations
167.61 Total Impact Points

Institutions

  • 2011–2015
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2014
    • University of Sydney
      • Westmead Clinical School
      Sydney, New South Wales, Australia
  • 2013–2014
    • Maastricht University
      • Department of Cardiology
      Maestricht, Limburg, Netherlands
    • Children's Heart Center
      Las Vegas, Nevada, United States