Tamas Szili-Torok

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (145)480.99 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite the effectiveness of ICD therapy in reducing mortality, the optimal timing of ICD implantation after MI remains inconclusive. The aim of this study is to evaluate the association of elapsed time from MI to implantable defibrillator (ICD) implantation on mortality and major adverse cardiac and cerebrovascular events (MACCE) in patients with prior myocardial infarction (MI). We studied 974 patients who underwent a first ICD implantation between October 1998 and August 2011. The median time from MI to ICD implantation was 7.2 years. Elapsed time from MI to ICD was categorized into tertiles (<2.5, 2.5-12.1, >12.1 years). Additionaly, the time from most recent MI to ICD implantation was dichotomized at 18 months. During a median follow-up of 3.4 years, 287 patients died. Cumulative mortality rates at 3, 5, and 8 years were 19%, 29%, 47%, respectively. In univariate analysis, there was a significant difference in mortality for patients in the highest tertile compared to those in the lowest tertile (HR 1.50; 95% CI 1.12 to 2.02; P = 0.007). After adjusting for baseline characteristics, there was no association between time from MI and mortality. At 8-years follow-up, the cumulative MACCE rate excluding mortality was 22%. No association between time from MI and MACCE was found. In this study, we found no association between the elapsed time from MI to ICD implantation and 8-year all-cause mortality or MACCE in post-MI ICD patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 08/2015; DOI:10.1111/pace.12739 · 1.25 Impact Factor
  • L J de Vries · F Zijlstra · T Szili-Torok
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 08/2015; DOI:10.1007/s12471-015-0737-y · 2.26 Impact Factor
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    ABSTRACT: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachyarrhythmia (VT) ablations has not been studied for their long-term efficacy. The aim of this study was to compare CF ablation to manual ablation (MAN) and remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long-term outcome. A total of 239 consecutive patients who underwent VT ablation with the use of MAN, CF or RMN catheters were included in this single-center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The median follow-up period was 25 months. Acute success was achieved in 182 out of 239 procedures (76%). Acute success in manual ablation, CF ablation and RMN ablation was 71%, 71% and 86%, respectively (P = 0.03). Major complications occurred in 3.3% and there were less major complications (P = 0.04) in the RMN group. After an initial successful procedure, 66 of 182 patients (36%) patients had a recurrence during follow-up. This was not significantly different between groups. Using an intention-to-treat analysis, 124 patients (52%) had a recurrence. The recurrence rate was lowest in the RMN group. The use of CF sensing catheters did not improve procedural outcome or safety profile in comparison to non-CF sensing ablation in this observational study of ventricular arrhythmia ablations. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 07/2015; DOI:10.1111/jce.12762 · 2.88 Impact Factor
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    ABSTRACT: Remote magnetic navigation (RMN) has been used in various electrophysiological procedures, including atrial fibrillation (AF) ablation. Atrial-esophageal fistula (AEF) is one of most disastrous complications of AF ablation. We aimed to evaluate the incidence of AEF during AF ablation using RMN in comparison to manual ablation. We conducted the first international survey among RMN operators for assessment of the prevalence of AEF and procedural parameters affecting the risk. Data from parallel survey of AEF among Canadian interventional electrophysiologists (CIE) using only manual catheters served as control. Fifteen RMN operators (who performed 3637 procedures) and 25 manual CIE operators (7016 procedures) responded to the survey. RMN operators were more experienced than CIE operators (16.3 ± 8.3 vs. 9.2 ± 5.4 practice years in electrophysiology, p = 0.007). The maximal energy output in the posterior wall was higher in the operator using RMN (33 ± 5 vs. 28.6 ± 4.9 W; p = 0.02). Other parameters including use of preprocedural images, irrigated catheter, pump flow rate, esophageal temperature monitoring, intracardiac echocardiography (ICE), and general anesthesia were similar. CIE operators administered proton-pump inhibitors postoperatively significantly more than RMN operators (76 vs. 35 %, p = 0.01). AEF was reported in 5 of the 7016 patients in the control group (0.07 %) but in none of the RMN group (p = 0.11). AEF is a rare complication and its evaluation necessitates large-scale studies. Although no AEF case with RMN was reported in this large study or previously on the literature, the rarity of this complication prevents firm conclusion about the risk.
    Journal of Interventional Cardiac Electrophysiology 05/2015; 43(2). DOI:10.1007/s10840-015-0003-7 · 1.55 Impact Factor
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    02/2015; 1(3). DOI:10.1016/j.hrcr.2015.02.010
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    Sing-Chien Yap · Corstiaan A. den Uil · Tamas Szili-Torok
    01/2015; 1(1):37-38. DOI:10.1016/j.hrcr.2014.11.004
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    Pal Abraham · Kadir Caliskan · Joanne Verheij · Tamas Szili-Torok
    01/2015; 1(1):10-12. DOI:10.1016/j.hrcr.2014.10.001
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    ABSTRACT: Background: Mitral annulus (MA) remodeling was suggested to have a role in the occurrence of mitral valve (MV) leaflet flail in pts with organic mitral regurgitation (OMR). Aim: To assess the extent of MA remodeling and dysfunction in relation to the severity of MV disease in pts with OMR. Methods: We acquired 3D full-volumes of the MA and left ventricle (LV) in 52 pts (57 ± 15 yrs, 34 men) with OMR (40 pts with posterior mitral prolapse, 12 pts with Barlow disease), and in sinus rhythm. MV morphology was assessed using both en-face view of volume rendered images and longitudinal slices of the datasets. MA size and function were automatically assessed during cardiac systole (MV assessment 2.3, TomTec). LV volumes and ejection fraction (LVEF) were measured with AutoLVQ (Echopac BT 12, GE). Results: 14 pts showed a flail of the MV, and 38 pts MV prolapse without flail. LVEF, MA displacement and MA size and geometry were similar in pts with and without MV flail (Table). Conversely, MA fractional area change was significantly decreased in pts with leaflet flail. Binary logistic regression showed that decreased MA fractional area change was associated with the presence of leaflet flail (β=0.20, p=0.02). Conclusions: In pts with OMR and normal LV function, the contractile dysfunction of the MA, and not the size of the MA, is associated with the presence of leaflet flail. Further studies are needed to assess if the MA contractile dysfunction precedes or is a consequence of the occurrence of MV flail. MA parametersMVP with flail N=14MVP without flail N=38pAntero-posterior diameter (cm)3.6 ± 0.63.4 ± 0.60.274Anterolateral-posteromedial diameter (cm)4.6 ± 0.74.6 ± 0.70.946MA area (cm2)13.8 ± 3.812.9 ± 4.10.458MA circumference (cm)13.5 ± 2.013.0 ± 2.00.464Anterior leaflet area (cm2)6.3 ± 2.26.5 ± 2.30.485Posterior leaflet area (cm2)9.1 ± 2.47.5 ± 2.90.063Sphericity Index0.8 ± 0.080.75 ± 0.070.051Non-planarity angle (0)150 ± 12155 ± 110.190MA height (mm)6.0 ± 0.25.4 ± 0.20.297MA fractional area change (%)19 ± 323 ± 60.015*MA displacement (mm)10.6 ± 2.69.5 ± 3.30.237
    European Heart Journal – Cardiovascular Imaging 12/2014; 15 Suppl 2(suppl 2):ii9-ii12. DOI:10.1093/ehjci/jeu237 · 4.11 Impact Factor
  • Ferdi Akca · Petter Janse · Dominic A M J Theuns · Tamas Szili-Torok
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    ABSTRACT: Contact force (CF) sensing catheters provide advantages with regard to safety and efficacy. This study aimed to evaluate if CF catheters reduce cardiac perforations and other major complications and offer equal safety compared to the magnetic navigation system (MNS). Data from 1.517 ablation procedures from our prospective registry was analyzed. Ablations were performed using either CF guided catheters (CF group, n=248), non-CF catheters (NCF group, n=813), or MNS (n=456). Four subgroups were analyzed: atrial fibrillation (AF, n=557), supraventricular tachycardia (SVT, n=715), ventricular tachycardia (VT, n=190) and patients with congenital heart defects (CHD, n=55). The primary endpoint of this study was incidence of cardiac perforation. Secondary endpoints were major and minor complications within 30days of the procedure. Complications occurred in 11.3% (n=172) of the procedures. In 2.8% (n=43) a major complication occurred, 0.9% (n=13) had a perforation, 8.5% (n=129) had a minor complication and 2 patients died (0.1%). No cardiac perforation occurred in the CF group, which was significantly different from NCF procedures (0.0% vs. 1.6%; relative risk 0.76, 95% CI 0.74-0.79, P=0.031) and equal to MNS (0.0%). This was also observed in the AF subgroup (0.0% vs. 3.3%; RR 0.67, 95% CI 0.63-0.72, P=0.021), and the occurrence of major complications was lower for CF versus NCF procedures (2.1% vs. 7.8%, P=0.010). CF-guided catheter ablation is superior to NCF with regard to procedural safety and avoidance of cardiac perforation. This difference is due to a reduction of cardiac perforation and major complications in the AF subgroup. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 179. DOI:10.1016/j.ijcard.2014.11.105 · 6.18 Impact Factor
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    ABSTRACT: The data supporting the practice of empiric slow pathway ablation (ESPA) in patients with documented supraventricular tachycardia (SVT) who are non-inducible at electrophysiology study (EPS) is limited. The aim of this study is to assess the efficacy of ESPA in adults.MethodsA multi-center cohort study of patients who had ESPA between January 2008 and October 2013 was performed. Patients were identified by screening sequential SVT ablation procedures.ResultsForty-three (5%) out of 859 SVT ablation procedures were identified as ESPA. The median age was 53 (IQR: 24) years; 63% were female. All patients had pre-EPS documentation of SVT (either strip or ECG). In 23 (53.5%) cases, pre-EPS ECG showed short RP tachycardia. Thirty-two (74.4%) patients had dual atrioventricular nodal physiology (DAVNP) plus echo beats. Junctional rhythm (JR) as procedural endpoint was noted in 39 (90.7%) patients. In 18 (41.9%) patients, the abolishment of DAVNP was achieved. No complications were encountered. A median follow-up of 17 months (range: 6 to 31 months) revealed 83.7% (36 of 43) success rate, defined as the absence of pre-procedural symptoms and any documented sustained arrhythmia. As compared to patients with recurrence (n = 7), patients with no recurrence (n = 36) had significantly higher prevalence of clinical short RP tachycardia (61.1% vs. 14.3%, p = 0.038), and EPS finding of DAVNP plus echo beats (80.6% vs. 42.9%, p = 0.034).ConclusionsESPA is a reasonable approach in patients with documented SVT, in particular in short RP tachycardia, who are not inducible at EPS. Larger studies are required to assess this practice.
    International Journal of Cardiology 10/2014; 179. DOI:10.1016/j.ijcard.2014.10.043 · 6.18 Impact Factor
  • The Canadian journal of cardiology 10/2014; 30(10):S322-S323. DOI:10.1016/j.cjca.2014.07.582 · 3.94 Impact Factor
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    ABSTRACT: A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism. Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage. A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.
    Journal of Cardiovascular Electrophysiology 09/2014; 26(1). DOI:10.1111/jce.12543 · 2.88 Impact Factor
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    ABSTRACT: Background Hypertrophic cardiomyopathy (HCM) patients may develop interatrial activation delay, indicated by complete separation of right and left atrial activation on the ECG. This study aimed to determine the prevalence of interatrial activation delay and the relation to atrial tachycardia (AT) cycle length (CL) in HCM patients. Methods 159 HCM patients were included (mean age 52 ± 14 yrs). In group I (n = 15,9%) patients had atrial arrhythmias and progressive ATCL. In group II (n = 22, 14%) patients had a stable ATCL. In group III (n = 122, 77%) HCM patients without AT were included. P wave morphology and change in P wave duration (ΔP and Pmax) and changes in ATCL (ΔATCL) were analysed. Mean follow up was 8.7 ± 4.7 years. Results In group I 33% (n = 5) had separated P waves. In group II no P wave separation was identified (OR 1.50 [1.05-2.15], p = 0.007). In group I patients were older compared to group III (62.6 ± 15.1vs. 50.2 ± 14.0 y, p = 0.002) and had longer follow up (13.4 ± 2.2 vs. 7.8 ± 4.6 y, p < 0.001). In group III Pmax and ΔP was significantly lower (105.1 ± 22.0 ms and 8.9 ± 13.2 ms, both p < 0.0001). Group I patients had an increased LA size compared to group II (61.1 ± 11.6 vs. 53.7 ± 7.5 mm, p = 0.028) and higher E/A and E/E prime ratios (p = 0.007; p = 0.037, respectively). In group I 93.3% of the identified mutations were typical Dutch founder mutations of the MYBPC3 gene. Conclusion In HCM patients a unique combination of separated P waves and regularization of ATs is associated with larger atria, higher LA pressures and myosin binding protein mutations.
    IJC Heart and Vessels 08/2014; 4. DOI:10.1016/j.ijchv.2014.07.003
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    ABSTRACT: Objective It is not clear whether patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention should undergo device replacement if they never experienced an appropriate ICD therapy during the first generator longevity. This study evaluated the incidence and predictors of appropriate ICD therapy after device replacement in this specific population. Methods From two large prospective ICD registries, we identified all primary prevention patients who had a first ICD replacement without previous appropriate ICD therapy. Cox regression analysis was used to identify predictors of appropriate ICD therapy. Results Of 403 primary prevention patients needing first ICD replacement, 275 patients (68%) had not received previous appropriate ICD therapy. Patients without previous appropriate ICD therapy before first ICD replacement (mean age at replacement 62+/-12 years, 75% male) had a mean follow-up of 86+/-24 months after the initial implantation and 30+/-24 months after device replacement. Following replacement, 3-year cumulative incidence of appropriate ICD therapy was 13.7% (95% CI 8.6 to 18.8%). No predictive factors associated with appropriate ICD therapy after replacement could be identified in spite of including seven clinically relevant factors. Conclusions A considerable number of primary prevention patients without previous appropriate ICD therapy before first ICD replacement received appropriate ICD therapy after replacement. As there were no predictors of appropriate ICD therapy after replacement, replacing an ICD is still recommended in all primary prevention patients despite the lack of appropriate ICD therapy during first battery service life.
    Heart (British Cardiac Society) 08/2014; 100(15):1188-92. DOI:10.1136/heartjnl-2014-305535 · 6.02 Impact Factor
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    ABSTRACT: BACKGROUND: A 72-year-old man with an infected permanent dual chamber pacemaker. INVESTIGATION: The patient underwent successful generator removal, although the pacemaker leads were left due to severe entrapment despite energetic external traction, Percutaneous lead extraction was performed and was complicated by tricuspid valve avulsion leading to severe tricuspid regurgitation. DIAGNOSIS: Entrapment of infected pacemaker lead. MANAGEMENT: First, a loop around the leads was created using the combination of a gooseneck snare and a wire. Second, a single goose snare was used to remove the remaining severel gentrapped piece of lead.
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 07/2014; 10(3):403-5. DOI:10.4244/EIJV10I3A67 · 3.76 Impact Factor
  • Sophie Van Malderen · Tamas Szili-Torok
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 07/2014; 10(3):404-405. · 3.76 Impact Factor
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    W Anné · D A M J Theuns · B Schaer · Y Van Belle · T Szili-Torok · T Smith · J Res · L Jordaens
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    ABSTRACT: The implantable cardioverter defibrillator (ICD) is effective in preventing sudden cardiac death. However, in elderly patients (aged 75 years or older) the role of ICDs is still not well-defined and controversial. We retrospectively analysed all clinical and survival data of all ICD patients who were ≥75 years at the date of implantation in the Erasmus MC, Rotterdam, the Netherlands and the University Hospital, Basel, Switzerland. Kaplan-Meier survival analysis was performed, and mortality predictors were identified. Mortality of the cohort was compared with a random sample of patients aged 60-70 years originating from the same database and to an age- and sex-matched cohort of Dutch persons. The study cohort consisted of 179 patients aged 75 years or older who were implanted between February 1999 and July 2008. The median follow-up time was 2.0 (IQR 2.8) years. Survival rates after 1, 2 and 3 years were 87, 82, 75 %, respectively. Survival was similar for primary and secondary prevention. Mortality in this study population could be predicted by combining four clinical risk factors: QRS duration >120 ms, NYHA class > II, renal failure and atrial fibrillation (AF). Survival was worse compared with the group of ICD patients aged 60-70 years and to the age- and sex-matched group of elderly persons. However, survival was not significantly worse when comparing elderly ICD patients without additional risk factors to the general population. Elderly patients still have an acceptable survival probability independent of prevention indication, certainly if there are no additional clinical risk factors. The presence or absence of additional clinical risk factors should be taken into account when making the decision for implantation, since they strongly correlate with survival.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 05/2014; 22(6). DOI:10.1007/s12471-014-0553-9 · 2.26 Impact Factor
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    L Dabiri Abkenari · F Akca · N M Van Mieghem · T Szili-Torok
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    ABSTRACT: Contact force (CF) is one of the major determinants for sufficient lesion formation. CF-guided procedures are associated with enhanced lesion formation and procedural success. We report our initial experience in epicardial ventricular tachycardia (VT) ablation with a force-sensing catheter using a new approach with an angioplasty balloon. Two patients with arrhythmogenic right ventricular cardiomyopathy who underwent prior unsuccessful endocardial ablation were treated with epicardial VT ablation. CF data were used to titrate force, power and ablation time.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 04/2014; 22(5). DOI:10.1007/s12471-014-0554-8 · 2.26 Impact Factor
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    ABSTRACT: After catheter ablation there is often a discrepancy between acute and chronic success rates. We aimed to evaluate major determinants for lesion quality and understand different manifestations of lesion structures. In a canine thigh muscle model radiofrequency (RF) current was delivered for 60 seconds at 30 W (n = 39) or 50 W (n = 18) with 15-g contact force. A second-generation 12-hole gold open irrigation catheter (SGIT) and a first-generation six-hole platinum-iridium catheter (FGIT; Biotronik, Berlin, Germany) were used. Electrode and tissue temperatures (at the surface and 3.5-mm and 7-mm depth) were recorded and lesion dimensions were measured. Lesions with steam pops were excluded. Histological examination was performed to evaluate homogeneity of the lesions. Inhomogeneity was defined as a visual multiband lesion pattern indicating different histological characteristics. In total 57 lesions were created. Seventeen lesions were excluded (steam pops) and 40 lesions were analyzed. A total number of 11 homogeneous and 29 inhomogeneous lesions were identified. Using the SGIT catheter 16.7% of the lesions was homogeneous and 83.3% inhomogeneous; for FGIT it was 43.8% and 56.2% (P = 0.065), respectively. Homogeneous lesions had lower volumes as compared to inhomogeneous lesions (514.0 ± 198.8 vs 914.8 ± 399.1 mm, P = 0.003). Multiple logistic regression analysis indicated that the SGIT catheter is a significant predictor for inhomogeneous lesions (odds ratio 6.5, 95% confidence interval 1.1-38.8; P = 0.040) independent from power setting and flow rate. The development of inhomogeneous lesions after acute RF ablation is associated with higher lesion volumes and the use of the second-generation irrigation gold-tip catheter.
    Pacing and Clinical Electrophysiology 02/2014; DOI:10.1111/pace.12359 · 1.25 Impact Factor
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    A Yaksh · D Haitsma · T Ramdjan · K Caliskan · T Szili-Torok · N M S de Groot
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 01/2014; 22(4). DOI:10.1007/s12471-013-0513-9 · 2.26 Impact Factor

Publication Stats

1k Citations
480.99 Total Impact Points

Institutions

  • 2002–2015
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 2003
    • Universitair Ziekenhuis Ghent
      • Department of Cardiology
      Gent, VLG, Belgium
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
  • 2002–2003
    • Erasmus Universiteit Rotterdam
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands