Publications (19)48.94 Total impact
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Article: The usefulness of the consensus clinical diagnostic criteria in Brugada syndrome.
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ABSTRACT: BACKGROUND: Consensus statements were proposed for the diagnosis of Brugada syndrome (BS). The clinical diagnostic criteria were defined as documented ventricular fibrillation or ventricular tachycardia (VT), family history of sudden cardiac death at <45years, diagnostic ECGs of family members, inducibility of VT during electrophysiological study, syncope or nocturnal agonal respiration. The clinical validation of these criteria is still missing. Methods and results 280 patients (41±18years, male: 168 pts) with diagnostic coved type I ECG were included. Consensus clinical diagnostic criteria were present in 244 (87%) patients (40±18y, 142 males). In 36 pts (13% of the 280 pts, 51±12years, 27 males) consensus clinical diagnostic criteria were not met. Nine patients (25%) presented with spontaneous type I ECG. Ten of the 36 patients (28%) had a history of atrial fibrillation and 13 (36%) had conduction disease on the baseline ECG. In 23 patients (64%) family screening was not performed. Two of the 36 patients had undocumented syncope during follow-up. Univariate analysis showed no significant difference in event free survival between patients with or without consensus clinical diagnostic criteria. CONCLUSIONS: In a significant number of patients with diagnostic ECG pattern the current diagnostic criteria for BS are not met. These patients have frequently spontaneous type I ECG and clinical signs of Brugada syndrome as paroxysmal atrial fibrillation or conduction disturbances. Our results suggest that in patients with a diagnostic type I ECG pattern the current clinical consensus diagnostic criteria have limited added diagnostic value.International journal of cardiology 07/2012; · 7.08 Impact Factor -
Article: Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators.
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ABSTRACT: Transseptal puncture (TP) appears to be safe in experienced hands; however, it can be associated with life-threatening complications. The aim of our study was to demonstrate the added value of routine use of transoesophageal echocardiography (TEE) for the correct positioning of the transseptal system in the fossa ovalis, thus potentially preventing complications during fluoroscopy-guided TP performed by inexperienced operators. Two hundred and five patients undergoing pulmonary vein isolation procedure (PVI) for drug-resistant paroxysmal or persistent atrial fibrillation were prospectively included. When the operator (initially blinded to TEE) assumed that the transseptal system was in a correct position according to fluoroscopical landmarks, the latter was then checked with TEE unblinding the physician. If necessary, further refinement of the catheter position was performed. Refinement >10 mm, or in case of catheter pointing directly at the aortic root or posterior wall were considered as major repositioning. Thirty-four patients required major repositioning. Regression analysis revealed age (P: 0.0001, Wald: 12.9, 95% confidence interval: 1.04-1.16), left atrial diameter (P: 0.01, Wald: 6.6, 95% confidence interval: 1.04-1.34), previous PVI (P: 0.01, Wald: 6.3, 95% confidence interval: 1.31-8.76), and atrial septal thickness (P: 0.03, Wald: 4.5, 95% confidence interval: 1.05-3.4) as independent predictors of major revision with TEE. Routine 2D TEE in addition to traditional fluoroscopic TP appears to be very useful to guide the TP assembly in a correct puncture position and thus, to avoid TP-related complications. However, further randomized prospective comparative studies are necessary to support these suggestions.Europace 11/2011; 14(5):661-5. · 1.98 Impact Factor -
Article: Dissociation between anterograde and retrograde conduction during transvenous cryoablation of parahissian accessory pathways.
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ABSTRACT: Ablation of parahissian accessory pathways (APs) is a challenging procedure because of the high risk to provoke "iatrogenic" atrioventricular (AV) nodal block. The feasibility and safety of cryoablation (CA) have been already demonstrated both in patients with AV nodal reentry tachycardia and in those with anteroseptal APs. However, dissociation between anterograde and retrograde conduction after CA has not yet been described. We report two cases of CA of parahissian AP associated with transient dissociation between anterograde and retrograde conduction.Pacing and Clinical Electrophysiology 11/2011; 34(11):98-101. · 1.35 Impact Factor -
Article: You can't judge a book by its cover: a pseudo 1st degree A-V block in apparent absence of retrograde conduction.
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ABSTRACT: We report 3 tracings from an electrophysiological study in which the appearance of a pseudo 1st degree A-V block helped to unmask the presence of a retrograde conduction, previously unrecognized. Our case highlights the importance in specific cases to have more than 2 intracardiac tracings during an electrophysiological study.Acta cardiologica 08/2011; 66(4):531-4. · 0.61 Impact Factor -
Article: The value of a family history of sudden death in patients with diagnostic type I Brugada ECG pattern.
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ABSTRACT: We sought to investigate the value of a family history of sudden death (SD) in Brugada syndrome (BS). Two hundred and eighty consecutive patients (mean age: 41 ± 18 years, 168 males) with diagnostic type I Brugada ECG pattern were included. Sudden death occurred in 69 (43%) of 157 families. One hundred and ten SDs were analysed. During follow-up VF (ventricular fibrillation) or SD-free survival rate was not different between patients with or without a family history of SD of a first-degree relative, between patients with or without a family history of multiple SD of a first-degree relative at any age and between patients with or without a family history of SD in first-degree relatives ≤35 years. One patient had family history of SD of two first-degree relative ≤35 years with arrhythmic event during follow-up. In univariate analysis male gender (P = 0.01), aborted SD (P < 0.001), syncope (P = 0.04), spontaneous type I ECG (P < 0.001), and inducibility during electrophysiological (EP) study (P < 0.001) were associated with worse prognosis. The absence of syncope, aborted SD, spontaneous type I ECG, and inducibility during EP study was associated with a significantly better prognosis (P < 0.001). Family history of SD is not predictive for future arrhythmic events even if considering only SD in first-degree relatives or SD in first-degree relatives at a young age. The absence of syncope, aborted SD, spontaneous type I ECG, and inducibility during EP study is associated with a good five-year prognosis.European Heart Journal 07/2011; 32(17):2153-60. · 10.48 Impact Factor -
Article: Anatomical extent of pulmonary vein isolation after cryoballoon ablation for atrial fibrillation: comparison between the 23 and 28 mm balloons.
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ABSTRACT: Pulmonary vein isolation seems to occur in the distal part of the ostium leaving the atrium largely unablated when using the 23 mm cryoballoon catheter ablation for atrial fibrillation. We hypothesize that ablating with the larger 28 mm cryoballoon would target a wider portion of the left atrial cavity. To compare the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing atrial fibrillation ablation with a 23 mm or a 28 mm cryoballoon. Eight consecutive patients selected for circumferential pulmonary vein cryoballoon isolation for highly symptomatic paroxysmal atrial fibrillation were randomly assigned to ablation with the 23 or 28 mm balloon. After ablation, electroanatomical mapping was performed to compare the anatomical extent of pulmonary vein isolation between the two balloon dimensions. Extent of pulmonary vein isolation significantly differed when the lesions with either balloon dimensions were compared. Pulmonary vein isolation only occurred in the tubular part of the ostium when performed with the 23 mm balloon. Conversely, the lesion created with the 28 mm balloon included a larger portion of the left atrium. In fact, when using the smaller balloon (23 mm) the mean documented extent of electrical isolation was 20.7 ± 2.8% of the maps' surface, whereas it was 40.2 ± 3.9% when performing ablation with the bigger balloon (28 mm). The difference in calculated area of electrical isolation between group A and B was statistically significant (P < 0.05). Pulmonary vein isolation occurs significantly more proximally in the atrium when performing atrial fibrillation ablation with a 28 mm cryoballoon when compared with a 23 mm balloon.Journal of Cardiovascular Medicine 03/2011; 12(3):162-6. · 1.51 Impact Factor -
Article: Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation.
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ABSTRACT: No specific data are available on the influence of pulmonary vein (PV) anatomy and shape on cryoballoon ablation (CA) catheter efficacy in delivering cryothermal energy and, consequently, in obtaining PV isolation. Among a larger series of patients (68) with drug-refractory paroxysmal atrial fibrillation who underwent CA in our department, 52 patients were included in our study. All of them had a multislice cardiac computed tomography (MSCT) before the procedure. We retrospectively evaluated their MSCT scans focusing our attention on PV ovality and orientation in the frontal plane. A fair inverse association was documented between the ovality index of the left PVs and the degree of occlusion (r=-0.486 and P<0.003 for the LSPV and r=-0.360 and P=0.033 for the LIPV), whereas no association was found between the ovality index of the right PVs and the degree of occlusion (r=-0.283 and P=0.083 for the RSPV and r=0.235 and P=0.093 for RIPV). Nevertheless, a strong inverse association was found between the orientation of the PV ostia and the degree of occlusion in each vein (r=-0.804 and P<0.001 for the LSPV, r=-0.415 and P=0.013 for LIPV, r=-0.798 and P<0.001 for the RSPV, and r=-0.867 and P<0.001 for RIPV). Pulmonary vein ostium shape and orientation evaluated by MSCT proved to be useful in predicting the degree of occlusion obtained during CA.Europace 10/2010; 13(2):205-12. · 1.98 Impact Factor -
Article: Dissociation between Anterograde and Retrograde Conduction during Transvenous Cryoablation of Parahissian Accessory Pathways
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ABSTRACT: Ablation of parahissian accessory pathways (APs) is a challenging procedure because of the high risk to provoke “iatrogenic” atrioventricular (AV) nodal block. The feasibility and safety of cryoablation (CA) have been already demonstrated both in patients with AV nodal reentry tachycardia and in those with anteroseptal APs. However, dissociation between anterograde and retrograde conduction after CA has not yet been described. We report two cases of CA of parahissian AP associated with transient dissociation between anterograde and retrograde conduction. (PACE 2011; 34:e98–e101)Pacing and Clinical Electrophysiology 06/2010; 34(11):e98 - e101. · 1.35 Impact Factor -
Article: Unusual unmasking of Brugada syndrome electrocardiographic pattern during ajmaline test by leaning forward: a case report.
European Heart Journal 05/2010; 31(10):1286. · 10.48 Impact Factor -
Article: Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolation.
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ABSTRACT: Atrial fibrillation (AF) ablation is increasingly being performed in electrophysiology laboratories. Pericardial effusion (PE) is certainly one of the most frequently observed complications during AF ablation. The aim of our study was to investigate the incidence and outcome of PE following cryothermal energy balloon ablation (CBA) in comparison with conventional circumferential pulmonary vein isolation with a focal radiofrequency (RF) catheter. A total of 133 consecutive patients (105 males) with paroxysmal AF were included in this study. Forty-six patients (36 males) underwent CBA (Arctic Front, Medtronic, USA) and 87 (69 males) point-by-point RF ablation guided by electroanatomical mapping (Carto, Biosense Webster, Diamond Bar, CA, USA). Ablation was performed under general anaesthesia with both techniques. All patients underwent a 2D transthoracic echocardiogram within 24 h before and after the procedure as routinely performed in our centre. Pericardial effusion was detected in 19 (14.2%) of 133 patients. Sixteen patients presented mild effusion, one moderate effusion, and two pericardial tamponades. There was no significant difference in the incidence of PE between the cryoballoon and the RF group (11 vs. 16%). A longer procedural time, coronary artery disease, and arterial hypertension were found to be independent predictors of PE during AF ablation. Pericardial effusion occurred in a similar proportion following CBA and RF ablation for AF. Pericardial effusion was mostly mild and asymptomatic, with benign clinical outcome not requiring additional hospitalization days.Europace 03/2010; 12(3):337-41. · 1.98 Impact Factor -
Article: Feasibility, safety, and outcome of a challenging transseptal puncture facilitated by radiofrequency energy delivery: a prospective single-centre study.
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ABSTRACT: Although it has been shown that a transseptal (TS) puncture in the electrophysiology laboratory is associated with a high success and a low complication rate, this procedure remains challenging particularly in difficult septum anatomies (aneurismal septum and thick septum) and during repeat TS catheterization. Radiofrequency (RF) electrocautery current delivery through the TS needle has been shown to facilitate the TS puncture. The aim of this study was to verify prospectively the feasibility, safety, and outcome of RF energy delivery associated with the standard TS technique in patients undergoing a challenging TS puncture. Over a 14-month period, 162 consecutive patients underwent left atrial (LA) arrhythmia ablation in our centre. Among them, we enrolled 18 patients who failed LA access after two TS puncture attempts. In these patients, an RF delivery through TS (RF-TS) needle approach was used to reach the LA. All 18 patients had a successful RF-TS at the first attempt. A transoesophageal echocardiography (TEE) guidance and fluoroscopy views were used in all patients. No acute complications were reported. There have been no clinical sequelae after 10 +/- 4 months of follow-up following the RF-TS approach. Challenging TS punctures were more frequent in repeat LA catheterization when compared with the first LA catheterization, respectively, in 35% (13 of 37) and 4% (5 of 125) of the patients. Radiofrequency electrocautery delivery associated with the standard TS approach is a safe and reproducible technique to reach the left atrium, using the TEE guidance. This technique is helpful during repeat TS catheterization and in the presence of anatomical atrial septum abnormalities.Europace 02/2010; 12(5):662-7. · 1.98 Impact Factor -
Article: Atrial fibrillation ablation: a single center comparison between remote magnetic navigation, cryoballoon and conventional manual pulmonary vein isolation.
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ABSTRACT: The aim of the study was to compare in our center the effect of different ablation techniques on intermediate term freedom from atrial fibrillation (AF) or atrial tachycardia (AT) in patients affected by refractory AF. We retrospectively selected 94 patients who underwent AF ablation in our electrophysiological laboratory from June 2007 to December 2009. 29 patients underwent manual circumferential pulmonary vein isolation (mCPVI), 35 underwent remote magnetic navigation assisted CPVI (rmtCPVI) and 30 cryoballoon CPVI (cCPVI). Antiarrhythmic drugs were systematically stopped 2 months after the procedure (end of the "blanking period"). At a mean follow-up of 12,64 ± 6,41 months (range 2-31), the success rate for mCPVI group was 65.5% (19 patients), 66.7 % (20 patients) for the rmtCPVI group and 65.7 % (23 patients) for the cCPVI group (p = 0.625). Procedural and fluoroscopy times were significantly reduced in the cCPVI group (both p < 0.001). Univariate Cox regression showed that no clinical variables were independently associated with recurrence. In our center's experience cCPVI and rmtCPVI have been demonstrated to be as effective as mCPVI. cCPVI seemed to be associated with lower procedural and fluoroscopy times.Indian pacing and electrophysiology journal 01/2010; 10(11):486-95. -
Article: Accelerated idioventricular rhythm during ajmaline test: a case report.
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ABSTRACT: We present an unusual transient pro-arrhythmic effect of ajmaline in a patient with resuscitated cardiac arrest and a left ventricular apical aneurysm. We discuss the clinical presentation and the possible physio-pathological explanation for this new pro-arrhythmic effect linked to administration of intravenous ajmaline.Indian pacing and electrophysiology journal 01/2010; 10(10):474-8. -
Article: Cryoballoon ablation for paroxysmal atrial fibrillation in septuagenarians: a prospective study.
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ABSTRACT: To evaluate the effects of pulmonary vein isolation (PVI) in terms of feasibility, safety and success rate on a midterm follow-up period in septuagenarians undergoing ablation with the Arctic Front Cryoballoon for atrial fibrillation (AF). We prospectively enrolled 21 patients aged 70 years or older (14 male; age 73 ± 2.5 years) elected to circumferential PVI with the 28mm cryoballoon for symptomatic drug resistant paroxysmal AF. A total number of 82 pulmonary veins (PV) were evidenced. Successful isolation could be obtained in all 82 (100%) PV ostia at the end of procedure. No major complication occurred during procedure. At a mean follow-up of 11.5 ± 4.7 months following ablation, 62% of patients did not present recurrence of atrial arrhythmias. Cryoballoon ablation may be feasible and safe in older patients. Moreover a large proportion of the latter did not present AF recurrence during follow-up.Indian pacing and electrophysiology journal 01/2010; 10(9):393-9. -
Article: Stepwise transition of 2:1 atrio-ventricular block to 1:1 conduction induced by ventricular premature beats in a patient with atypical AVNRT.
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ABSTRACT: A 55-year-old man with a 2-year history of recurrent paroxysmal palpitations and with an electrocardiogram documentation of atypical atrioventricular nodal re-entrant tachycardia (AVNRT) was referred to us for catheter ablation. After an initial ablation attempt, several episodes of atypical AVNRT were induced. During one of these episodes, we documented a stepwise transition of 2:1 atrioventricular block to 1:1 conduction, following two single ventricular premature beats. This phenomenon confirmed the functional nature of the AV block during AVNRT and indirectly its infra-nodal location.Pacing and Clinical Electrophysiology 10/2009; 33(2):e20-3. · 1.35 Impact Factor -
Article: Ivabradine to treat inappropriate sinus tachycardia after the fast pathway ablation in a patient with severe pectus excavatum.
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ABSTRACT: We present the case of a 49-year-old woman with atrioventricular nodal re-entrant tachycardia and a severe pectus excavatum. The patient underwent an electrophysiological study and fast pathway ablation. Fast pathway ablation was not done on purpose but accidentally, likely due to the abnormal position of the heart in the chest cavity in this patient suffering from severe pectus excavatum. Some hours after the ablation, the patient developed inappropriate sinus tachycardia (IST), complaining of dyspnea and fatigue. IST has been described as a complication of fast pathway ablation in 10% of the cases. In our case it was not possible to treat IST with beta-blockers due to an important lowering of the blood pressure. Digitalis, given as second choice, was not successful. Ivabradine-the specific sinus node If current inhibitors-was used to successfully lower the heart rate with immediate relief of symptoms. A 24-hour Holter, 10 days later, showed a complete control of the heart rate without any episode of IST. The patient was completely symptom free and able to undertake her normal daily activities without any discomfort. Our case confirms the potential use of ivabradine for indications other than coronary artery disease.Pacing and Clinical Electrophysiology 10/2009; 33(3):e32-5. · 1.35 Impact Factor -
Article: Transient atriovenous reconnection induced by adenosine after successful pulmonary vein isolation with the cryothermal energy balloon.
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ABSTRACT: Cryothermal energy balloon ablation (CBA), using cryogenic ablative energy, has proven very effective in producing pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). Adenosine testing after PV isolation has demonstrated to be able to unmask incomplete lesion after radiofrequency (RF) ablation. The aim of our study was to assess the rate of transient atriovenous reconnection induced by adenosine after successful PV isolation with the CBA in a group of patients with paroxysmal AF. We prospectively enrolled 39 patients (31 male; age 59 +/- 11 years) elected to circumferential PV isolation with CBA for highly symptomatic paroxysmal AF. A total of 149 PVs were evidenced. Adenosine testing after CBA induced a left atrium-PV reconnection only in 7 (4.6%) of PV. Our study showed a low rate of transient PV reconnection after adenosine infusion following successful PV isolation with CBA. However, larger studies will be needed in order to confirm our findings and the prognostic value of adenosine testing after successful PV isolation obtained with CBA.Europace 10/2009; 11(12):1606-11. · 1.98 Impact Factor -
Article: Transseptal puncture for atrial fibrillation ablation in a patient with previous Tirone David intervention: the role of real-time 3D transesophageal echocardiography guidance.
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ABSTRACT: In this case report we describe the important role of real-time three-dimensional transesophageal echocardiography guidance in performing double transseptal puncture for atrial fibrillation ablation in a patient who underwent a previous Tirone David intervention.Journal of Cardiovascular Medicine 05/2009; 10(7):563-4. · 1.51 Impact Factor -
Article: Novel trans-septal approach using a Safe Sept J-shaped guidewire in difficult left atrial access during atrial fibrillation ablation.
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ABSTRACT: Nowadays, trans-septal (TS) puncture is a relatively safe and straightforward procedure in experienced hands. However, in the presence of a thick, aneurysmatic or extremely elastic fossa ovalis crossing the septum might be challenging. We here describe the use of a novel guidewire that permits easy and safe 'over the wire' TS access during atrial fibrillation ablation.Europace 05/2009; 11(5):657-9. · 1.98 Impact Factor
Top co-authors
Top Journals
Institutions
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2009–2011
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Vrije Universiteit Brussel
Brussels, BRU, Belgium -
University Hospital Brussels
Brussels, BRU, Belgium
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