Laurent Pison

Maastricht Universitair Medisch Centrum, Maestricht, Limburg, Netherlands

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Publications (68)353.77 Total impact

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    ABSTRACT: Purpose: Data on epicardial contact force efficacy in dual epicardial-endocardial atrial fibrillation ablation procedures are lacking. We present an in vitro study on the importance of epicardial and endocardial contact forces during this procedure. Methods: The in vitro setup consists of two separate chambers, mimicking the endocardial and epicardial sides of the heart. A circuit, including a pump and a heat exchanger, circulates porcine blood through the endocardial chamber. A septum, with a cut out, allows the placement of a magnetically fixed tissue holder, securing porcine atrial tissue, in the middle of both chambers. Two trocars provide access to the epicardium and endocardium. Force transducers mounted on both catheter holders allow real-time contact force monitoring, while a railing system allows controlled contact force adjustment. We histologically assessed different combinations of epi-endocardial radiofrequency ablation contact forces using porcine atria, evaluating the ablation's diameters, area, and volume. Results: An epicardial ablation with forces of 100 or 300 g, followed by an endocardial ablation with a force of 20 g did not achieve transmurality. Increasing endocardial forces to 30 and 40 g combined with an epicardial force ranging from 100 to 300 and 500 g led to transmurality with significant increases in lesion's diameters, area, and volumes. Conclusions: Increased endocardial contact forces led to larger ablation lesions regardless of standard epicardial pressure forces. In order to gain transmurality in a model of a combined epicardial-endocardial procedure, a minimal endocardial force of 30 g combined with an epicardial force of 100 g is necessary.
    Full-text · Article · Jan 2016 · Journal of Interventional Cardiac Electrophysiology
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    ABSTRACT: The aim of this survey was to provide insight into current practice regarding ablation of persistent atrial fibrillation (AF) among members of the European Heart Rhythm Association electrophysiology research network. Thirty centres responded to the survey. The main ablationtechnique for first-time ablation was stand-alone pulmonary vein isolation (PVI): in 67% of the centres for persistent but not long-standing AF and in 37% of the centres for long-standing persistent AF as well. Other applied techniques were ablation of fractionated electrograms, placement of linear lesions, stepwise approach until AF termination, and substrate mapping and isolation of low-voltage areas. However, the percentage of centres applying these techniques during first ablation did not exceed 25% for any technique. When stand-alone PVI wasperformed in patients with persistent but not long-standing AF, the majority (80%) of the centres used an irrigated radiofrequency ablation catheter whereas 20% of the respondents used the cryoballoon. Similar results were reported for ablation of long-standing persistent AF (radiofrequency 90%, cryoballoon 10%). Neither rotor mapping nor one-shot ablation tools were used as the main first-time ablation methods. Systematic search for non-pulmonary vein triggers was performed only in 10% of the centres. Most common 1-year success rate offantiarrhythmic drugs was 50-60%. Only 27% of the centres knew their 5-year results. In conclusion, patients with persistent AF represent a significant proportion of AF patients undergoing ablation. There is a shift towards stand-alone PVI being the primary choice in many centresfor first-time ablation in these patients. The wide variation in the use of additional techniques and in the choice of endpoints reflects the uncertainties and lack of guidance regarding the most optimal approach. Procedural success rates are modest and long-term outcomes areunknown in most centres.
    No preview · Article · Oct 2015 · Europace
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    Mindy Vroomen · Mark La Meir · Laurent Pison

    Full-text · Conference Paper · Sep 2015
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    Laurent Pison · Mindy Vroomen · Harry J G M Crijns
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    ABSTRACT: To the Editor: Verma et al. (May 7 issue)(1) report that the performance of neither linear ablation nor ablation of complex fractionated electrograms provided an incremental benefit when added to pulmonary-vein isolation to decrease the rate of recurrent atrial fibrillation. Di Biase et al.(2) note that the left atrial appendage acts as a potential trigger for atrial fibrillation or atrial tachycardia in approximately 27% of patients with atrial fibrillation who require repeat catheter ablation. They found that recurrent atrial fibrillation was significantly reduced in patients undergoing isolation of the left atrial appendage (segmental or circumferential ablation), with a recurrence rate . . .
    Preview · Article · Aug 2015 · New England Journal of Medicine
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    ABSTRACT: The purpose of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in the management of ventricular tachycardia (VT). The data are based on an electronic questionnaire sent to the members of the EHRA Research Network. Responses were received from 31 centres in 16 countries. The results of the survey show that the management of VT is in general in accordance with guidelines. Antiarrhythmic drugs are still frequently used for VT treatment. In patients at high risk of sudden cardiac death, an implantable cardioverter-defibrillator is routinely recommended, while the treatment options vary for patients with moderate or low risk. A discreet attitude is adopted for catheter ablation in high-risk patients as demonstrated by a relatively low rate of catheter ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Full-text · Article · Aug 2015 · Europace
  • Laurent Pison · Mindy Vroomen · Harry J G M Crijns

    No preview · Article · Jul 2015 · New England Journal of Medicine
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    ABSTRACT: Delayed left ventricular (LV) lateral wall (LVLW) activation is considered the electrical substrate underlying LV dysfunction amenable to cardiac resynchronization therapy (CRT). We assessed LVLW activation in CRT candidates using coronary venous electro-anatomic mapping (EAM), and investigated whether the QRS area (QRSAREA) on the vectorcardiogram (VCG) can identify delayed LVLW activation. Fifty-one consecutive CRT candidates (29 left bundle-branch block [LBBB], 15 intra-ventricular conduction delay [IVCD], 7 right bundle-branch block [RBBB]) underwent intra-procedural coronary venous EAM using EnSite NavX. VCGs were constructed from pre-procedural digital 12 lead ECGs using the Kors method. QRSAREA was assessed, and compared to QRS duration and 5 different LBBB definitions. Delayed LVLW activation (activation time>75% of QRS duration) occurred in 38/51 patients (29/29 LBBB, 8/15 IVCD, 1/7 RBBB). QRSAREA was larger in patients with than in patients without delayed LVLW activation (108±42 vs 51±27 µVs, p<0.001), and identified delayed LVLW activation better than QRS duration (AUC 0.89 [95% CI 0.79-0.99] vs 0.49 [95% CI 0.33-0.65]). QRSAREA>69 µVs diagnosed delayed LVLW activation with a higher sum of sensitivity (87%) and specificity (92%) than any of the LBBB definitions. Of the different LBBB definitions, the European Society of Cardiology textbook definition performed best with a sensitivity of 76% and specificity of 100%. Coronary venous EAM can be used during CRT implantation to determine the presence of delayed LVLW activation. QRSAREA is a non-invasive alternative for intra-cardiac measurements of electrical activation, which identifies delayed LVLW activation better than QRS duration and LBBB morphology. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
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    ABSTRACT: Despite the advent of non-fluoroscopic technologies, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies to ablation interventions and device implantation. The purpose of the European Heart Rhythm Association survey was to provide an insight into regulatory policies and physicians' clinical practice when using fluoroscopy during ablation procedures and device implantation. The survey has shown that only 50% of the participating centres worked with low frame rates (3-6 frames per second) and that the left anterior oblique projection, with higher radiation exposure for the physician, is used for nearly every ablation target. Although three-dimensional imaging systems may reduce the radiation exposure, most centres never used these systems for standard ablation procedures and a trend is that non-fluoroscopy technologies are even less frequently used than in 2012, when the use of robotic systems was still rare. Even less costly equipment such as lead gloves, lead glass cabins, or radiation absorbing pads are still not routinely used. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    No preview · Article · Jul 2015 · Europace
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    ABSTRACT: Atrial fibrillation (AF) is the most common chronic arrhythmia in the adult population. Ablation lines have largely replaced the historical and challenging cut and sew techniques. Surgical ablation of AF is commonly performed in cases with other indications for cardiac surgery and less commonly as a stand-alone therapy. Pulmonary vein isolation is the cornerstone of this procedure. Extended left atrial ablation lines may increase efficacy in cases with longstanding persistent or permanent AF. Additional efficacy by adding right atrial ablation is controversial but is often performed in cases undergoing right atrial or atrial septal surgery. Left atrial volume reduction is recommended in cases with large left atria and AF undergoing another cardiac surgery. Arrhythmia recurrence is not uncommon after surgical ablation of AF and varies among studies due to heterogeneity in patient population, lesion set and endpoints. Freedom from AF recurrence was 65-87% at 12 months and 58-70% at 2 years follow-up. Long-term monitoring is recommended due to an increased prevalence of asymptomatic recurrences. The strongest predictors of AF recurrence are longstanding or persistent AF and a large left atrium. The most common mechanisms of recurrence are pulmonary vein reconnection, non-pulmonary vein triggers, and gaps in the ablation lines. About 20% of atrial tachyarrhythmia recurrences are atrial flutter or atrial tachycardia. There are not enough data in the surgical literature to support withdrawal of anticoagulation after surgical AF ablation. Patients selected for stand-alone surgical ablation usually have low risk profiles and low postoperative mortality rates (0.2%). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jun 2015 · Journal of Cardiovascular Electrophysiology

  • No preview · Article · Jun 2015 · Journal of the American College of Cardiology
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    ABSTRACT: The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey of patients undergoing atrial fibrillation (AF) ablation, conducted to collect patient-based data on current clinical practices in AF ablation in context of the latest AF Guidelines and contemporary oral anticoagulant therapies. The EP Research Network Centres were asked to prospectively enrol consecutive patients during a 6-week period (September/October 2014). Data were collected via the web-based case report form. We present the results pertinent to the use of antithrombotic therapies. Thirteen countries prospectively enrolled 455 eligible consecutive patients [mean age 59 ± 10.8 years, 131 (28.8%) females]. The mean CHA2DS2-VASc score was 1.12 ± 1.06 [137 patients (30.1%) had a score of ≥2]. Before ablation, 443 patients (97.4%) were on anticoagulant therapy [143 (31.4%) on non-vitamin K antagonist oral anticoagulants (NOACs) and 264 (58.0%) on vitamin K antagonists (VKAs)]. Of the latter, 79.7% underwent ablation without VKA interruption, whilst a variety of strategies were used in patients taking NOAC. After ablation, most patients (89.3%) continued the same anticoagulant as before, and 2 (0.4%) were not prescribed any anticoagulation. At discharge, 280 patients (62.2%) were advised oral anticoagulation for a limited period of mean 3.8 ± 2.2 months. On multivariate analysis, CHA2DS2-VASc, AF duration, prior VKA use, and estimated AF ablation success were significantly associated with the decision on short-term anticoagulation. Our results show the increasing use of NOAC in patients undergoing AF ablation and emphasize the need for more information to guide the periprocedural use of both NOACs and VKAs in real-world setting. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    No preview · Article · Jun 2015 · Europace
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    Mindy Vroomen · Laurent Pison
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    ABSTRACT: BACKGROUND: Since its introduction in 1953, lone atrial fibrillation (LAF) has not been defined with any consistency, resulting in an enormous variation in the way the term is used. Inherent to this, results from studies vary considerably. Many predisposing factors and pathogenic influences have been discovered over the past years, which raise the question if the term LAF should still be used and if the treatment should be different from non-lone atrial fibrillation (non-LAF). Therefore this systematic review on LAF provides an overview of risk factors and triggers, the second part focuses on the application of catheter and surgical ablation techniques. METHODS: A systematic literature search was performed in the PubMed database. All identified articles were screened and checked for eligibility by the two authors. Additional literature was sought by screening the references of eligible articles. RESULTS: The term LAF is used very variably and inconsistently, and results concerning etiology in different studies are often contradictory. Overall finding is that LAF has many risk factors (e.g. subclinical atherosclerosis, enlarged left atrial volume, left ventricular dysfunction, occult hypertension, arterial stiffness, systemic inflammation and genetic factors) and can be induced by many different triggers (e.g. use of substances, endurance sports, mental stress and sleeping). However, compared to non-LAF there are no unique mechanisms related to LAF. Concerning the therapy, catheter ablation is first or second choice after antiarrhythmic drugs, however surgical and hybrid approaches may be indicated in complex cases. CONCLUSIONS: Insufficient evidence exists to consider LAF as a real, isolated and useful entity. A re-definition or even avoiding the use of the term LAF might be appropriate.
    Full-text · Article · Jun 2015 · Journal of Atrial Fibrillation
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    ABSTRACT: Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No study has systematically analysed this phenomenon. Twenty consecutive patients with symptomatic AF underwent cryoballoon ablation without sedation. Headache was evaluated before, during, and after the first cryoapplication in every pulmonary vein (PV) using a visual representation of a head for location of the headache, a numerical rating scale (NRS) for measuring pain intensity and the short-form McGill pain questionnaire (MPQ) for qualitative analysis of pain. The order in which the PVs were ablated was randomized. Sixteen (80%) patients perceived mainly frontal headache during cryoablation. The overall NRS scores were significantly higher during (5.1 ± 1.7), compared with before (2.7 ± 1.4), and after (3.5 ± 2.2) a cryoapplication (P < 0.05). The NRS score was significantly higher during ablation of the first PV. The intensity of the perceived headache was not related to the temperature reached 150 s after initiation of a cryoapplication (P = 0.81). Of the MPQ, three sensory adjectives and one affective adjective averaged between scores 1 and 2, representing mild-to-moderate severity of pain. The majority of patients treated by balloon cryoablation experienced headache during a cryoapplication. There was no correlation between the temperature reached during a cryoballoon freeze and the intensity of the headache. Cryoballoon ablation of the first PV was significantly more painful than the remaining PVs. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Full-text · Article · Jun 2015 · Europace

  • No preview · Article · May 2015 · Europace
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    ABSTRACT: Adenosine administration after pulmonary vein (PV) isolation using radiofrequency, laser, and cryoablation can cause acute recovery of conduction to the PVs and predict atrial fibrillation (AF) recurrence. This study evaluates whether ablation of dormant potentials post-adenosine administration following second-generation cryoballoon (CB-2G) ablation may improve the success rate for AF. In 45 of 90 patients after a waiting period of 30 min, a bolus 15-21 mg of adenosine was administered followed by rapid saline flush. The response was assessed for each PV using a circular octapolar catheter. If needed, further ablation using a cryoballoon and/or cryocatheter was performed until no reconduction was observed after repeat adenosine administration. The remaining 45 patients did not receive adenosine after the procedure. Acute PV isolation was achieved in 352 of 358 PVs (98.3%) of 86 of 90 patients (95.6%) using CB-2G. The adenosine group showed dormant reconduction in 5 of 45 patients (11%), 8 of 179 PVs (4.5%), including 1 left superior pulmonary vein, 3 left inferior pulmonary vein, 1 right superior pulmonary vein, and 3 right inferior pulmonary vein. The success rate for adenosine and without adenosine group was 84 and 79%, respectively, after a mean follow-up of 397 ± 47 and 349 ± 66 days, without any AF recurrence in patients in whom adenosine-induced dormant conduction was ablated. Adenosine testing after second-generation cryoballoon ablation study showed that reablation of initially isolated PVs increases the clinical success rate for AF. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Full-text · Article · May 2015 · Europace
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    Dataset: IJC riva

    Full-text · Dataset · Apr 2015
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    ABSTRACT: The purpose of this EP Wire was to assess the indications, techniques, and outcomes of left atrial appendage occlusion (LAAO) in Europe. Thirty-three European centres, all members of the European Heart Rhythm Association electrophysiology (EP) research network, responded to this survey by completing the questionnaire. The major indication for LAAO (94%) was the prevention of stroke in patients at high thrombo-embolic risk (CHA2DS2-VASc ≥ 2) and contraindications to oral anticoagulants (OACs). Twenty-one (64%) of the responding centres perform LAAO in their own institution and 80% implanted 30 or less LAAO devices in 2014. Two-dimensional transoesophageal echocardiography was the preferred imaging technique to visualize LAA before, during, and after LAAO in 79, 58, and 62% of the participating centres, respectively. Following LAAO, 49% of the centres prescribe vitamin K antagonists or novel OACs. Twenty-five per cent of the centres combine LAAO with pulmonary vein isolation. The periprocedural complications included death (range, 0-3%), ischaemic or haemorrhagic stroke (0-25%), tamponade (0-25%), and device embolization (0-20%). In conclusion, this EP Wire has demonstrated that LAAO is most commonly employed in patients at high thrombo-embolic risk in whom OAC is contraindicated. The technique is not yet very widespread and the complication rates remain significant. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    No preview · Article · Apr 2015 · Europace
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    Full-text · Article · Apr 2015 · International journal of cardiology
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    Dataset: Narendra

    Full-text · Dataset · Mar 2015
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    Full-text · Article · Mar 2015 · International Journal of Cardiology

Publication Stats

398 Citations
353.77 Total Impact Points

Institutions

  • 2012-2015
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
  • 2009-2015
    • Maastricht University
      • Department of Cardiology
      Maestricht, Limburg, Netherlands
  • 2014
    • University of Sydney
      • Westmead Clinical School
      Sydney, New South Wales, Australia
  • 2013
    • Children's Heart Center
      Las Vegas, Nevada, United States