Tamas Szili-Torok

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (140)448.26 Total impact

  • [Show abstract] [Hide abstract]
    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; DOI:10.1007/s10840-015-0003-7 · 1.55 Impact Factor
  • 02/2015; 1(3). DOI:10.1016/j.hrcr.2015.02.010
  • Sing-Chien Yap, Corstiaan A. den Uil, Tamas Szili-Torok
    01/2015; 1(1):37-38. DOI:10.1016/j.hrcr.2014.11.004
  • 01/2015; 1(1):10-12. DOI:10.1016/j.hrcr.2014.10.001
  • European Heart Journal – Cardiovascular Imaging 12/2014; 15 Suppl 2:ii9-ii12. DOI:10.1093/ehjci/jeu237 · 2.65 Impact Factor
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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
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    ABSTRACT: A left atrial 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 left atrial (LA) septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism.
    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.
    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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    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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    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; 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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    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
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    ABSTRACT: Ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) is a highly effective procedure both with radiofrequency (RF) and cryoenergy (CE). Conventionally, it requires several diagnostic catheters and hospital admission. This study assessed the safety and efficacy of a highly simplified approach using the magnetic navigation system (MNS) compared to CE and manual RF ablation (MAN). In the MNS group a single magnetic-guided quadripolar catheter was inserted through the internal jugular vein to perform ablation. In the CE group cryomapping preceded ablation and for MAN procedures conventional ablation was performed. The following parameters were analysed: success- and recurrence rate, procedure-, fluoroscopy- and total application time. In total 69 eligible patients were treated with MNS (n = 26), CE (n = 25) and MAN (n = 16). The success rates were 100%, 100% and 94%, respectively (p = ns). The mean procedural time was 83 +/- 25 min for MNS, 117 +/- 47 min for CE and 117 +/- 55 min for MAN (P < 0.01). Total radiation time was significantly lower for MNS [0.0 min (IQR 0.0-0.0)] compared to CE [15.1 min (IQR 9.1-23.8), P < 0.001] and MAN [17.5 min (IQR 7.0-31.3), P < 0.001]. The total application time was comparable for both RF groups: 357 +/- 315 s (MNS) vs 204 +/- 177 s (MAN) (P = 0.14). No major adverse events occurred. After 3 months follow-up similar PR intervals were recorded for all patients. During a follow-up of 26 +/- 5 months recurrence rates were 3.8%, 4.0% and 6.3%, respectively, for each group. The MNS-guided single-catheter approach is a feasible and safe technique for the treatment of patients with typical AVNRT.
    Acta cardiologica 12/2013; 68(6):559-67. DOI:10.2143/AC.68.6.8000002 · 0.56 Impact Factor
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    ABSTRACT: Atrial tachycardias (ATs) frequently develop in patients with congenital heart defects (CHDs). This study aimed to evaluate the effects of extensive atrial scar formation on the total atrial activation time (TAAT) and its relation to the tachycardia cycle length (CL) to classify AT.METHODS AND RESULTS: Seventy-one patients were included and divided into two groups: patients without CHD (Group I, 35 patients) and with CHD (Group II, 36 patients). All patients underwent CARTO electroanatomical activation mapping. Two subgroups were created: centrifugal (CAT) or macroreentrant AT (MRAT). Total atrial activation time, CL, and mean bipolar signal amplitude (BiSA) were analysed. In Group I, 18 patients (51.4%) had CAT and 17 (48.6%) MRAT. The mean BiSA for Group I was 1.30 ± 0.32 mV. Total atrial activation time/CL ratios were different between CAT and MRAT (28.4 ± 16.9 vs. 66.6 ± 14.3%, P < 0.001). In Group II, 18 patients (50%) had CAT and 18 patients (50%) MRAT. The mean BiSA was 0.94 ± 0.50 mV and was not different for CAT and MRAT subgroups (1.04 ± 0.64 vs. 0.85 ± 0.29, P = 0.243). Total atrial activation time/CL ratios were comparable between CAT and MRAT patients (69.0 ± 40.4 vs. 83.6 ± 8.3%, P = 0.243). A significant lower BiSA was found for CAT with TAAT/CL ratios above 40% (0.62 ± 0.11 vs. 1.90 ± 0.18 mV, P < 0.001). A strong negative correlation was identified between the BiSA and the TAAT/CL ratio in patients with CAT in Group II (-0.742; P < 0.001).CONCLUSION: Low mean BiSA values in CHD patients are associated with altered impulse propagation, making TAAT- and CL-based diagnostic tools inaccurate. Further diagnostic tests are needed to determine the correct mechanism of ATs.
    Europace 11/2013; 16(6). DOI:10.1093/europace/eut338 · 3.05 Impact Factor
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    ABSTRACT: To assess the outcome and associated risks of atrial defragmentation for the treatment of long-standing persistent atrial fibrillation (LSP-AF). Thirty-seven consecutive patients (60.4 ± 7.3 years; 28 male) suffering from LSP-AF who underwent pulmonary vein isolation (PVI) and linear ablation were compared. All patients were treated with the Stereotaxis magnetic navigation system (MNS). Two groups were distinguished: patients with (n = 20) and without (n = 17) defragmentation. The primary endpoint of the study was freedom of AF after 12 months. Secondary endpoints were AF termination, procedure time, fluoroscopy time and procedural complications. Complications were divided into two groups: major (infarction, stroke, major bleeding and tamponade) and minor (fever, pericarditis and inguinal haematoma). No difference was seen in freedom of AF between the defragmentation and the non-defragmentation group (56.2 % vs. 40.0 %, P = 0.344). Procedure times in the defragmentation group were longer; no differences in fluoroscopy times were observed. No major complications occurred. A higher number of minor complications occurred in the defragmentation group (45.0 % vs. 5.9 %, P = 0.009). Mean hospital stay was comparable (4.7 ± 2.2 vs. 3.4 ± 0.8 days, P = 0.06). Our study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy.
    Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 10/2013; 22(1). DOI:10.1007/s12471-013-0483-y · 2.26 Impact Factor
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    ABSTRACT: Robotic systems are becoming increasingly common in complex ablation procedures. We conducted systematic review and meta-analysis on the procedural outcomes of Magnetic Navigation System (MNS) in comparison to conventional catheter navigation for atrial fibrillation (AF) ablation. An electronic search was performed using multiple databases between 2002 & 2012. Outcomes were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times. Fifteen studies (11 nonrandomized controlled studies & 4 case series) involving 1647 adult patients were identified. In comparison between MNS and conventional groups, a tendency towards higher acute success was noted with conventional group but with similar long-term freedom from AF (95% vs. 97%, odds ratio (OR) 0.25 (95% confidence interval [CI] 0.06; 1.04, p=0.057); 73% vs. 75%, OR 0.92 (95% CI 0.69; 1.24, p=0.59), respectively). A significantly shorter fluoroscopic time was achieved with MNS (57 vs. 86min, standardized difference in means (SDM) -0.90 (95% CI -1.68; -0.12, p=0.024)). Longer total procedure and ablation times were noted with MNS (286 vs. 228min, SDM 0.7 (95% CI 0.28; 1.12, p=0.001); 67 vs. 47min, SDM 0.79 (95% CI 0.18; 1.4, p=0.012), respectively). Overall complication rate was similar (2% vs. 5%, OR 0.48 (95% CI 0.18; 1.26, p=0.135)), however rate of significant pericardial complication defined either as tamponade or effusion requiring intervention/hospitalization was significantly lower in MNS (0.3% vs. 2.5%, p=0.005). Our results suggest that MNS has similar rates of success and possibly superior safety outcomes when compared to conventional manual catheter ablation for AF.
    International journal of cardiology 09/2013; 169(3). DOI:10.1016/j.ijcard.2013.08.086 · 6.18 Impact Factor

Publication Stats

1k Citations
448.26 Total Impact Points

Institutions

  • 2001–2014
    • Erasmus MC
      • Department of Cardiology
      Rotterdam, South Holland, Netherlands
  • 2009
    • National Cardiology Hospital, Bulgaria
      Ulpia Serdica, Sofia-Capital, Bulgaria
  • 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