Giannis G Baltogiannis

Giannis G Baltogiannis
University Hospital Brussels | UZ Brussel · Heart Rhythm Management Centre

MD, PhD

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70
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Publications

Publications (70)
Article
Full-text available
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a primary electrical disease characterized by a normal resting electrocardiogram and induction of malignant arrhythmias during adrenergic stress leading to syncope or sudden cardiac death (SCD). CPVT is caused by mutations in the cardiac ryanodine receptor (RyR2) or in the sarcoplasmic...
Article
Background Autonomic responses participate in the pathophysiology of acute myocardial infarction, but their precise time course remains unclear. Here, we investigated the autonomic activity and ventricular tachyarrhythmias in conscious, unrestrained rats post-infarction. Methods The left coronary artery was ligated in 12 Wistar rats, and six rats...
Article
Backround: Patients with a drug-induced Brugada syndrome (BS) are considered at a lower risk than those with the spontaneous type I pattern. Nevertheless, they can present arrhythmic events. Objective: The purpose of this study was to investigate their clinical characteristics, long-term prognosis and risk factors. Methods: A consecutive cohor...
Article
Aims: Risk stratification in Brugada Syndrome (BS) remains challenging. Arrhythmic events can occur life-long and studies with long follow-ups are sparse. The aim of our study was to investigate long-term prognosis and risk stratification of BS patients. Methods and results: A single centre consecutive cohort of 400 BS patients was included and...
Article
Experimental studies indicate improved ventricular function after treatment with growth hormone (GH) post-myocardial infarction, but its effect on arrhythmogenesis is unknown. Here, we assessed the medium-term electrophysiologic remodeling after intra-myocardial GH administration in (n = 33) rats. GH was released from an alginate scaffold, injected...
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Aim: Peri-procedural thromboembolic (TE) and hemorrhagic events are complications of major concern for patients undergoing cryoballoon (CB) ablation for atrial fibrillation (AF). While peri-procedural anticoagulation management could decrease the incidence of these complications, data on CB ablation are scarce. The role of novel oral anticoagulant...
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Background:The phenotypic heterogeneity of Brugada syndrome (BrS) can lead some patients to show an additional inferolateral early repolarization pattern (ERP), or fragmented QRS (f-QRS). The aim of the study was to investigate the prevalence and clinical impact of f-QRS, ERP or combined f-QRS/ERP in high-risk patients with BrS. Methods and Results...
Article
Growth hormone, currently under evaluation for the prevention of left ventricular remodeling post-myocardial infarction, displays antiarrhythmic properties in the acute setting. However, it is uncertain whether these actions are retained after ischemia/reperfusion. Using implanted telemetry transmitters, we examined the effects of prolonged, intra-...
Article
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We investigated the effects of autonomic dysfunction and endothelin on local conduction and arrhythmogenesis during myocardial infarction. We recorded ventricular tachyarrhythmias, monophasic action potentials, and activation sequences in wild-type and ETB-deficient rats displaying high endothelin levels. Central sympathetic inputs were examined af...
Article
Introduction: . Second-generation cryoballoon (CB-Adv) ablation is highly effective in achieving pulmonary vein isolation (PVI) with promising mid-term clinical outcome. However, the ideal freezing strategy is still under debate. To assess the efficacy of a single 3-minutes approach compared to the conventional 4-minutes plus bonus application usi...
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Objectives: Brugada syndrome (BS) in women is considered an infrequent condition with a more favourable prognosis than in men. Nevertheless, arrhythmic events and sudden cardiac death (SCD) also occur in this population. Long-term follow-up data of this group are sparse. The purpose of the present study was to investigate the clinical characterist...
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Aims: Sympathetic activation during myocardial ischemia enhances arrhythmogenesis, but the underlying pathophysiologic mechanisms remain unclear. We investigated the central sympathetic effects on ventricular repolarization during the early-period post-coronary artery occlusion. Main methods: We studied 12 Wistar rats (254±2g) for 30min followin...
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Background: -The second-generation cryoballoon (CB-Adv) is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data is available regarding factors affecting late PV reconnection following CB-Adv ablation. Methods and results: -A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13...
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Aims To assess the incidence of late pulmonary vein (PV) reconnection following index PV isolation (PVI) procedure initially achieved with radiofrequency contact-force catheter ablation (CFCA) and second-generation cryoballoon ablation (CB-AdvA). Methods and results A total of 56 consecutive patients (41 male, 73.2%; mean age 60.8 ± 11.8 years) un...
Article
-Among BS patients, asymptomatic individuals are considered to be at the lowest risk. Nevertheless, arrhythmic events and sudden cardiac death (SCD) are not negligible. Literature focused on this specific group of patients is sparse. The purpose of the present study is to investigate the clinical characteristics, management and long term prognosis...
Article
-The prognostic value of electrophysiological investigations in individuals with Brugada syndrome remains controversial. Different groups have published contradictory data. Long-term follow up is needed to clarify this issue. -Patients presenting with spontaneous or drug-induced Brugada type I electrocardiogram (ECG) and in whom PES was performed a...
Article
Phrenic nerve palsy (PNP) is the most frequently observed complication in the setting of cryoballoon (CB) ablation (Arctic Front, Medtronic, MN). Although, usually transient, resolving before the end of the procedure, persistent PNP (not resolving before the end of procedure) can occur. Literature on persistent PNP after second generation CB ablati...
Article
Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-rela...
Article
Full-text available
Sympathetic activation during acute myocardial infarction (MI) is an important arrhythmogenic mechanism, but the role of central autonomic inputs and their modulating factors remain unclear. Using the in vivo rat-model, we examined the effects of clonidine, a centrally acting sympatholytic agent, in the presence or absence of myocardial endothelin-...
Article
Occurrence of atrial tachycardias (ATs) following radiofrequency (RF) pulmonary vein (PV) isolation for the treatment of paroxysmal atrial fibrillation (PAF) is a frequent complication. Cryoballoon (CB) ablation might create more homogeneous and demarcated lesions than traditional point by point RF approach, hypothetically leading to a lower incide...
Article
Full-text available
To assess the 1 year efficacy of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) comparing conventional radiofrequency irrigated-tip catheter ablation (RFCA) using contact-force technology and ablation using the second-generation cryoballoon (CB-AdvA). One hundred consecutive patients (74 male, 74%; mea...
Article
The second-generation cryoballoon (CB-Adv) is effective in achieving pulmonary vein isolation (PVI) with encouraging result. The mid-term clinical efficacy of a single 3-minutes freeze, without a routine bonus application, has been recently demonstrated. To assess long-term clinical outcome following PVI with the CB-Adv using a single 3-minutes app...
Article
Prolonged P-wave duration and dispersion are universally accepted noninvasive markers for atrial electrical remodeling. Our aim was to analyze P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial size. From January 2008 to December 2011, 426 patients with drug-resistant sy...
Article
Background No data is available about the clinical outcome of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) ablation using the second-generation Cryoballoon (CB-Adv). Objective To assess the 1-year efficacy of PVI as index procedure for PersAF ablation using the novel CB-Adv. Methods Sixty-three con...
Article
Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF). Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfracti...
Article
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Objectives To investigate clinical features, management and long-term follow-up of children with drug-induced Brugada syndrome (BS). Background BS patients younger than 12 years with spontaneous type I ECG have a higher risk of arrhythmic events. Data on drug-induced BS in patients younger than 12 years are lacking. Methods Among 505 patients wit...
Article
Background With respect to the first generation Cryoballoon (CB), the second generation (Cryoballoon Advance; Medtronic, USA; CB-A) was designed with technical modifications resulting in a larger and more uniform zone of freezing on the balloons surface aiming at procedural outcome improvement in the setting of atrial fibrillation (AF) ablation. Ho...
Article
IntroductionLonger observational time and adenosine challenge have proven to be able to detect pulmonary vein (PV) reconnections. The aim of this study was to assess incidence of spontaneous and adenosine-induced PV reconnection after ablation with second-generation cryoballoon (CB-Adv).Methods and ResultsFifty consecutive patients (76% male, mean...
Article
Full-text available
Aims Electrocardiographic documentation of symptomatic episodes of palpitations by means of traditional methods such as 24 h Holter monitoring (HM) or loop recorders is challenging. Patient-activated electrocardiography (ECG) recorders have been proved to be a useful tool in the diagnosis of arrhythmias in these patients. However, no comparison stu...
Article
The aim of this study was to compare the results of pulmonary vein isolation using conventional irrigated radiofrequency (RF) approach versus the cryoballoon (CB) ablation. From January 2008 to December 2011, a total of 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as the index proced...
Article
Early repolarization (ERP) is a common electrocardiographic finding. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is not known whether there is a clinical association with sudden cardiac arrest. 122 subjects (100% males; mean age: 13.5 +/- 2.7 years) were included from a local youth soccer team...
Article
Introduction Early repolarization (ERP) is a common electrocardiographic finding. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is not known whether there is a clinical association with sudden cardiac arrest. Methods 122 subjects (100% males; mean age: 13.5± 2.7 years) were included from a local...
Article
Full-text available
Background The novel cryoballoon Advance (CB-A) has proven to achieve significantly lower temperatures and faster pulmonary vein isolation (PVI) times in comparison with the first-generation device. Although acutely very effective, to the best of our knowledge, data on mid-term clinical follow-up is lacking. Aims The aim of the study was to analys...
Article
The effects and the safety of ajmaline challenge in elderly patients with suspected atrioventricular (AV) conduction disease have not been systematically investigated. The purpose of this study was to assess the response of intravenous administration of ajmaline in patients older than 75years suspected to be affected by AV conduction disease with r...
Article
The clinical course and prognosis of Brugada syndrome (BS) in the elderly is unknown. The purpose of this study was to investigate the clinical characteristics, management and prognosis of BS in an elderly population. A total of 437 patients with BS were included in this study. Patients were categorized in 2 groups according to the age at the time...
Article
The second-generation cryoballoon (CB-A) (Arctic Front Advance, Cryocath, Medtronic, MN, USA) might significantly improve procedural outcome with respect to the first-generation balloon. These technological improvements might also question the current recommendation of the need a 4-min freeze to achieve durable pulmonary vein isolation (PVI). The m...
Article
Background: The relative role of acute myocardial ischemia and infarction in ventricular arrhythmogenesis is incompletely understood. We compared the arrhythmia pattern after ischemia/infarction to that observed after direct myocardial necrosis without preceding ischemia in rats. Methods: Coagulation necrosis was induced in Wistar rats (n=20, 28...
Article
Full-text available
AimsPharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BS) might be challenging as many antiarrhythmic drugs (AADs) with sodium channel blocking properties might expose the patients to the development of ventricular arrhythmias. Moreover, patients with BS and implantable cardioverter-defibrillator (ICD) might...
Article
Sustained ventricular arrhythmias (sVA), such as polymorphic ventricular tachycardia or ventricular fibrillation, can complicate ajmaline challenge in patients with Brugada syndrome (BS). Aim of this study was to assess the incidence of life-threating sVA during ajmaline administration in a large series of patients with BS. In addition, clinical ch...
Article
Pulmonary vein (PV) isolation by means of cryoballoon (CB) technology is an effective treatment for symptomatic paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy. The CB requires a 15F transseptal sheath that may lead to the creation of a iatrogenic atrial septal defect (IASD). Individuals having undergone PV isolation b...
Article
Cryoballoon ablation (CBA) (Arctic Front, Medtronic, USA) has proven very effective in achieving pulmonary vein isolation (PVI). Different transseptal (TS) puncture sites might influence CBA procedure. The aim of the present study was to analyze the influence of different TS puncture sites (anterior, medial and posterior) on the acute and midterm o...
Article
To examine the effect of ibutilide on novel indexes of repolarization in patients with persistent atrial fibrillation (AF). We studied consecutive patients scheduled for elective electrical cardioversion. Intravenous ibutilide (1 + 1 mg) was administered before the electrical cardioversion while close electrocardiographic (ECG) monitoring was perfo...
Article
Phrenic nerve palsy (PNP) is the most frequently observed complication during cryoballoon ablation (CB; Arctic Front, Medtronic, MN) occurring in roughly 7%-9% of the cases. The new second-generation cryoballoon ablation Arctic Front Advance (CB-A) (Arctic Front) has recently been launched in the market. To evaluate the incidence of right PNP with...
Article
Full-text available
AimsThe ideal energy source needed to perform 're-isolation' of the pulmonary veins (PVs) during a repeat procedure for recurrence of paroxysmal atrial fibrillation (AF) has not been established yet. In this study we analysed the outcome of repeat procedure using radiofrequency (RF) energy after initial cryoballoon (CB) ablation at 2-year follow-up...
Article
Full-text available
Reductionist approaches and linear experimentation have expanded our knowledge in biology over the past century and represent till today the basis for the prevention, diagnosis and treatment of all diseases in clinical medicine. However, major diseases still remain incurable. All currently available drugs target a single gene or protein ignoring dy...
Article
We sought to define the incidence and predictive factors of pulmonary hypertension in β-thalassemia major. We studied 27 consecutive patients (19 male, 38 ± 9 years of age) with β-thalassemia major. All the patients had normal (left and right) ventricular (systolic and diastolic) function and underwent echocardiographic assessment of pulmonary arte...
Article
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Background. Endothelin-1 (ET-1) is implicated in left ventricular dysfunction after ischaemia-reperfusion. ETA and ETB receptors mediate diverse actions, but it is unknown whether these actions depend on ischaemia type and duration. We investigated the role of ETB receptors after four ischaemia-reperfusion protocols in isolated rat hearts. Methods...
Article
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We report a case of torsade de pointes after intravenous amiodarone and concurrent hypokalemia. Despite treatment cessation and correction of electrolyte abnormalities, excessive QTc prolongation was noted, which persisted for 14 days. This prolonged course for QTc normalization may be attributed to the high rate of amiodarone loading and concurren...
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Transforming growth factor-β (TGF-β) inhibition is an investigational therapy for pulmonary arterial hypertension with promising results in experimental studies. The present work compared this approach with endothelin-receptor blockade and evaluated the effects of combined administration. Pulmonary arterial hypertension was induced by single monocr...
Article
Chronic hind-limb ischemia confers cytoprotection after coronary occlusion, but it is unclear whether it ameliorates substrate formation for ventricular tachyarrhythmias (VTs). Chronic hind-limb ischemia was generated by femoral artery excision in 50 rats, while 25 animals were sham-operated. Left coronary artery ligation was performed after 3 week...
Article
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Chronic skeletal muscle ischemia confers cytoprotection to the ventricular myocardium during infarction, but the underlying mechanisms remain unclear. Although neovascularization in the left ventricular myocardium has been proposed as a possible mechanism, the functional capacity of such vessels has not been studied. We examined the effects of chro...
Article
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The role of transforming growth factor-β in the pathogenesis of pulmonary arterial hypertension is unclear. We examined the effects of T9429, an antibody against transforming growth factor-β receptors, on hemodynamic, histological and functional parameters in the rat model of monocrotaline-induced pulmonary hypertension. One week after monocrotalin...
Article
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We improved the cut-down approach aiming at minimizing the subclavian/axillary vein puncture during implantation of permanent pacemaker leads. We incorporated previously reported refinements of the cut-down approach, i.e. the use of a hydrophilic guidewire when direct lead insertion failed and cannulation of retro-pectoral veins in cases of insuffi...
Article
Sudden cardiac death constitutes a major health-related problem. In the majority of cases, sudden cardiac death is due to ventricular tachyarrhythmias secondary to acute myocardial infarction. The pathophysiologic chain of events leading to ventricular tachyarrhythmias after acute coronary occlusion is complex and incompletely understood. Experimen...
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The arrhythmogenic effects of endothelin-1 (ET-1) are mediated via ETA-receptors, but the role of ETB-receptors is unclear. We examined the pathophysiologic role of ETB-receptors on ventricular tachyarrhythmias (VT/VF) during myocardial infarction (MI). MI was induced by coronary ligation in two animal groups, namely in wild-type (n = 63) and in ET...
Article
The effects of dual (ETA and ETB) endothelin receptor blockade on ventricular arrhythmogenesis during acute myocardial infarction are not well defined. We randomly allocated Wistar rats to bosentan (100 mg/kg daily, n=24), a dual endothelin receptor antagonist, or vehicle (n=23). After 7 days of treatment, myocardial infarction was induced by perma...
Article
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Pulmonary hypertension portends an adverse outcome. Animal models have improved current understanding of the complex pathophysiology of the disease, but may be technically demanding. Moreover, plexiform vascular lesions are rarely observed, limiting the extrapolation to human pathophysiology. The aim of the present study was first, to assess the fe...
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GH (growth hormone) administration during acute MI (myocardial infarction) ameliorates subsequent LV (left ventricular) dysfunction. In the present study, we examined the effects of such treatment on arrhythmogenesis. A total of 53 Wistar rats (218+/-17 g) were randomized into two groups receiving two intraperitoneal injections of either GH (2 inte...
Article
The effects of dronedarone, a non-iodinated derivative of amiodarone, on ventricular tachycardia and ventricular fibrillation post-myocardial infarction are not well established. Fifty-five Wistar rats were randomly allocated to a 2-week oral treatment with either vehicle (n=18), amiodarone (30 mg/kg, n=20), or dronedarone (30 mg/kg, n=17). After a...
Article
Ventricular remodeling is a common corollary of myocardial infarction. We hypothesized that this process may be attenuated by growth hormone, administered as a single high-dose, selectively in the infarct zone, early postmyocardial infarction. In 35 pigs (29+/-4 kg), myocardial infarction was generated by inflation of an over-the-wire angioplasty b...
Article
Endothelin-1 (ET-1) production increases during acute myocardial infarction (MI) and may contribute to the genesis of ventricular tachycardia (VT) and ventricular fibrillation (VF). However, the antiarrhythmic effects of ET-1 receptor blockade, examined shortly after MI, have been debated. In the present study, we examined the effects of such treat...