E.F.D. Wever

St. Antonius Ziekenhuis, Nieuwegen, Utrecht, Netherlands

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Publications (91)370.59 Total impact

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    N Lahrouchi · E F D Wever · J C Balt

    Full-text · Article · Aug 2014 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    N Lahrouchi · E F D Wever · J C Balt

    Full-text · Article · Aug 2014 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    ABSTRACT: Objective The purpose of the present study was to determine the incidence of ventricular arrhythmias before and after alcohol septal ablation (ASA). Background In patients with hypertrophic obstructive cardiomyopathy (HOCM), gradient reduction by ASA is an alternative for surgical myectomy. However, concerns exist about whether the induction of a myocardial scar during ASA may create substrate for ventricular arrhythmias. Methods The study group consisted of 44 patients in whom ASA was performed for symptomatic, drug-refractory hypertrophic cardiomyopathy. Continuous rhythm monitoring was obtained by implantable loop recorder (n=30) or pacemaker (n=14). Occurrence of ventricular and supraventricular arrhythmias before and after ASA was noted, retrospectively. Results The ASA procedure was considered successful (resting gradient <30 mm Hg, and provoked gradient <50 mm Hg at 4 months in combination with NYHA Class functional status ≤2) in 30 (68%) patients. Rhythm monitoring before ASA was available in 28 patients. The median duration of rhythm monitoring after ASA was 3.0 years (IQR 1.3–4.3). Sustained VT/VF within 30 days after ASA occurred in three patients (7%), including 2 cases of procedural VF, while no VT/VF was observed before ASA (p=0.10). No sustained VT/VF was observed >30 days after ASA. No cardiac deaths occurred during follow-up. Conclusions In a low-risk cohort of patients who underwent ASA, in which continuous rhythm monitoring was performed, sustained VT or VF within 30 days occurred in 3 patients (7%) while no VT/VF was observed before ASA. During long-term follow-up, no sustained VT or VF was observed >30 days after ASA.
    No preview · Article · Jul 2014 · Heart (British Cardiac Society)
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    ABSTRACT: Recently, a multi-electrode catheter system using phased radiofrequency (RF) energy was developed specifically for atrial fibrillation (AF) ablation: the pulmonary vein ablation catheter (PVAC), the multi-array septal catheter (MASC), and the multi-array ablation catheter (MAAC). Initial results of small trials have been promising: shorter procedure times and low adverse event rates. In a large single-centre registry, we evaluated the adverse events associated with multi-electrode ablation catheter procedures with PVAC alone, or combined with MASC and MAAC. In all, 634 consecutive patients with AF had 663 procedures with multi-electrode ablation catheters, 502 patients with the PVAC alone, 128 patients with PVAC/MASC/MAAC, 29 redo procedures with the PVAC or PVAC/MASC/MAAC, and 4 patients had a complicated transseptal puncture. Major and minor adverse events during 6 month follow-up were registered. In 15 cases (2.3%), major adverse events were seen within the first month after the procedure. These included complicated transseptal puncture (4), stroke (2), transient ischaemic attack (5), acute coronary syndrome (2), femoral pseudoaneurysm (1), and arteriovenous fistulae (1). Minor adverse events were seen in 10.7% at 6 months, mostly due to femoral haematoma (3.9%), and non-significant PV stenosis (5.2%). There was no difference in the occurrence of major adverse events between PVAC alone, or PVAC/MASC/MAAC ablation. Ablation with phased RF and multi-electrode catheters is accompanied by a major adverse event rate of 2.3% within 1 month and a minor event rate of 10.7% at 6 months.
    Preview · Article · Apr 2012 · Europace
  • Ruben Uijlings · Jippe C Balt · Paul Boom · Eric Wever

    No preview · Article · Apr 2012 · Journal of Cardiovascular Medicine
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    ABSTRACT: In patients with paroxysmal atrial fibrillation (PAF) the pattern of atrial fibrillation (AF) episodes and the total AF burden, may be related to the efficacy of pulmonary vein isolation (PVI). We evaluated (pre)-procedural factors explaining the long-term outcome after PVI, using a ring-shaped multielectrode ablation catheter [pulmonary vein ablation catheter (PVAC)]. A total of 120 consecutive patients with PAF were treated with the PVAC. The patients' histories were obtained by a questionnaire and the clinical charts. Follow-up was performed at 3, 6, 12, 18, and 24 months with serial electrocardiogram, and multiple day Holter at 6, 12, and 24 months, as well as event recording in case of unexplained palpitations. At 1 year, 66 of 120 (55%, 95% confidence interval (CI) [46-63%]) patients were free of any left atrial (LA) arrhythmia without class I or III anti-arrhythmics after a single procedure. At 2 years, freedom from LA arrhythmia slightly declined further to 58 of 119 (49%, 95% CI [40-58%]). The only pre-procedural predictor of long-term success was a shorter duration of the longest episode of AF (hazard ratio (HR) 0.77 95% CI [0.64-0.92]). The only procedural predictor of long-term success was no need for direct current cardioversion (DCCV) for AF (HR 0.36 95% CI [0.21-0.61]). Since other characteristics in these PAF patients were very homogeneous, no further clinical predictors were observed. Freedom from LA arrhythmia after PVI for PAF with PVAC is 49% after 2-year follow-up, with little decline between year 1 and 2. Predictors of long-term failure were a longer duration of the longest episode of AF in the pre-procedural questionnaire, and a procedural DCCV for AF.
    Preview · Article · Feb 2012 · Europace
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    ABSTRACT: After pulmonary vein isolation (PVI), patients need to be followed to analyze the effect of the treatment. We evaluated the influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after a single PVI at 12 months. Consecutive patients with paroxysmal atrial fibrillation (AF) underwent successful PVI with phased radiofrequency and pulmonary vein ablation catheter. Follow-up was performed with electrocardiogram at 3, 6, and 12 months and 7-day Holter at 12 months. Symptomatic patients received additional event recording. The 7-day Holters at 12 months were evaluated for documented left atrial tachyarrhythmia recurrences, and each individual day with AF was categorized. At 12 months after the procedure, 21 of the 96 (22%) patients had AF on their 7-day Holter. In the patients with AF recurrence, there was an increase in sensitivity from 53% of a 1-day Holter up to 88% with 4-day Holter, and 100% of a 7-day Holter. Monitoring with duration of less than 4 days resulted in significantly less detection of patients with AF compared to 7-day Holter. A 4-day Holter at 12 months has an 88% sensitivity for arrhythmia detection, and appears to provide a sufficient monitoring time. Prolonging the monitoring time to 7 days does not significantly increase the yield.
    No preview · Article · Sep 2011 · Pacing and Clinical Electrophysiology
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    ABSTRACT: BACKGROUND: Early arrhythmia recurrences after pulmonary vein isolation (PVI) for atrial fibrillation (AF) are accepted as part of the blanking period. Their relevance for long-term efficacy is not well-known. We evaluated patients, who came to hospital with a documented recurrence of AF, or had a registered episode of AF on the 24-hour Holter 6weeks after PVI and compared it with long-term outcome. METHODS: One hundred consecutive patients with paroxysmal AF were treated with the PVAC. In the 3-month blanking period patients who came to hospital with a documented recurrence of AF on ECG were recorded. 6weeks after procedure a 24-hour Holter was performed. After 3months patients were asked if they felt a relapse. Follow-up was performed at 3, 6, and 12months with ECG, 7-day Holter at 6 and/or 12months, and event recording if needed. RESULTS: Within the blanking period, 25/100 (25%) patients had a documented recurrence of AF while 46/100 (46%) patients felt a relapse. After the blanking period up to 12months, 53/100 (53%) patients were free of AF without anti-arrhythmic drugs. Multivariate regression analyses revealed that absence of AF in the blanking period (OR 0.22 95%CI [0.05-0.98]) and absence of a relapse of symptoms suspect for AF during the blanking period (OR 0.21 95%CI [0.06-0.52]) were independent predictors of successful long-term outcome. CONCLUSIONS: Poor long-term outcome is strongly related to patients who experienced palpitations with ECG documented AF, AF on the 24-hour Holter at 6weeks after PVI and a relapse in the blanking period.
    No preview · Article · Aug 2011 · International journal of cardiology
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    ABSTRACT: We evaluated the effect of pulmonary vein (PV) anatomical characteristics on PV isolation (PVI) and long-term efficacy of ablation with phased radiofrequency (RF) energy and pulmonary vein ablation catheter (PVAC) multi-electrode catheter. Before the procedure, PV anatomy was visualized by magnetic resonance imaging (MRI). Consecutive patients with paroxysmal atrial fibrillation were treated with the PVAC with successful acute isolation. Follow-up was performed at 3, 6, and 12 months with electrocardiogram and 7-day Holter recording at 6 and/or 12 months. Symptomatic patients received additional event recording. In 110 patients a pre-procedure cardiac MRI was performed. Ninety-seven (88%) had a separate left superior PV and separate left inferior PV, all patients had a separate right superior PV and separate right inferior PV. Fourteen (13%) had a left PV with common trunk and 27 (25%) had a separate right middle PV (RMPV). After a follow-up of 1 year, 57 of 110 (52%) patients were free of AF without anti-arrhythmic drug. No specific anatomical variable that was related to long-term failure could be found. There was a trend for patients with larger veins (>24 mm) or separate RMPV to have a lower efficacy. The number of applications per vein or procedure did not influence long-term outcome. In patients who have undergone PVI with phased RF energy and PVAC multi-electrode ablation, long-term efficacy is not significantly affected by PV anatomy or number of applications, although a trend for reduced efficacy is seen for PV with diameter >24 mm, and presence of RMPV.
    Preview · Article · Jul 2011 · Europace
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    ABSTRACT: Ablation for persistent atrial fibrillation (AF) remains a difficult and time-consuming procedure with varying degrees of success. We evaluated the long-term effects of a novel approach for ablation of persistent AF using multi-electrode catheters. In 89 patients with longstanding persistent AF (>1 year), multi-electrode ablation was performed with a pulmonary vein ablation catheter (PVAC), a multi-array septal catheter (MASC), and a multi-array ablation catheter (MAAC) for ablation of complex-fractionated atrial electrograms (CFAE) at the septum, left atrial (LA) roof, floor, posterior wall, and mitral isthmus. Follow-up was performed at 6 and 12 months with electrocardiogram, 7 days Holter, and occasionally ambulant event recordings. Average procedure and fluoroscopy times were 112 ± 32 and 21 ± 10 min. The pre-specified endpoint of pulmonary vein isolation and LA CFAE ablation was reached in all patients. No procedural complications were observed. At 12 months after a single treatment 44 of 89 (49%) remained in sinus rhythm, including direct current cardioversion in 12 patients. At 12 months, after a redo PVAC/MASC/MAAC, an additional 6 of 15 patients (40%) were free of AF. In 18 of 89 (20%) patients AF was changed to paroxysmal. In this single centre study, ablation for longstanding persistent AF with the PVAC/MASC/MAAC resulted in 56% freedom of AF at 1 year after 1.2 ± 0.4 procedures. This approach is time efficient and has a favourable safety profile.
    No preview · Article · Jul 2011 · Europace
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    ABSTRACT: Introduction: Similar to the effect of systemic hypertension on left ventricular disease in which both supra-ventricular tachyarrhythmia and ventricular arrhythmias are more common, it has been postulated that structural changes and enlargement of the right atrium and right ventricle in pulmonary hypertension (PHTN) may predispose patients with PHTN to arrhythmias. The incidence and clinical relevance of supra-ventricular arrhythmias and ventricular arrhythmias in PHTN have not been thoroughly evaluated. Methods: Using the Nationwide Inpatient Sample (NIS) 2007, patients aged 18 or more discharged with a diagnosis of PHTN were identified using ICD-9-clinical modification codes 415.0 and 416.x. All discharges with primary diagnosis of atrial fibrillation (AF), atrial flutter (AFL) and paroxysmal supra-ventricular tachycardia (PSVT) was also identified using appropriate ICD-9 codes. Multivariate logistic regression was performed using appropriate survey commands in STATA to find the frequency and association between the above arrhythmias and PHTN. The analysis was adjusted for age, sex, race, hyperthyroidism, congestive heart failure, coronary artery disease, hypertension, valvular disorders and other relevant co-morbid conditions related to supra-ventricular arrhythmias. Results: In 2007, there were an estimated 575307 (1.76%) adult discharges with PHTN in NIS. Out of those, 199752 (34.7%) had AF, 19088 (3.3%) had AFL and 24667 (4.3%) with PSVT. The patients with PHTN had 3.6 times higher frequency for AF, 3.7 times higher frequency of AFL and 3.2 times higher frequency of PSVT when compared to those without PHTN. This persisted even after adjustment for various factors described above. There was significantly higher frequency of AF (Odds Ratio (OR) 1.97; 95% Confidence Interval (CI) 1.92-2.03), AFl (OR 1.68; 95%CI 1.59-1.76) and PSVT (OR 1.36; 95%CI 1.30-1.43) in patients with PHTN. AF was found to be independent predictor for mortality in patients with pulmonary hypertension (OR 1.13; 95%CI 1.06-1.23). Conclusion: This observational study shows increased frequency of AF, AFL and PSVT in patients with PHTN. Further prospective studies are needed to evaluate the causal relation.
    Full-text · Article · Jun 2011 · Europace
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    Full-text · Article · Jan 2011 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    Full-text · Article · Jan 2011 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    ABSTRACT: Torsade de pointes (TdP), a ventricular tachycardia (VT) with the peaks of QRS complexes twisting around the iso-electric baseline and progressive amplitude and polarity variations, is mostly associated with long (congenital or acquired) QT syndromes (LQTS) and long coupling intervals of the initiating complex. We describe a patient with variant, short-coupled TdP, a normal QTc interval and without demonstrable structural heart disease. Mechanisms remain unclear but there may be a relationship with autonomic nervous system imbalance. Since anti-arrhythmic drug efficacy is uncertain, ICD-implantation seems the first-line therapy. If ventricular arrhythmia recurs despite drug therapy, catheter-ablation of initiating premature ventricular beats may be warranted.
    No preview · Article · Jun 2010 · Acta cardiologica
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    M C Post · E G Mast · E Stel · E F D Wever
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    ABSTRACT: Abstract A 64-year-old male, with a history of a lateral myocardial infarction, presented with haemodynamically well-tolerated incessant therapy-resistant slow monomorphic ventricular tachycardia (mVT), despite implantable cardioverter defibrillator and antiarrhythmic drugs.
    Full-text · Article · Feb 2010 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    ABSTRACT: Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Left atrial tachycardias (LAT) after radiofrequency (RF) pulmonary vein isolation (PVI) are common and well documented. Cryoballoon ablation (CBA) is an alternative technique for PVI in patients with atrial fibrillation (AF). Feasibility, short and long term success rates of CBA have been described. Theoretically, LAT are less common after CBA than after RF PVI due to more homogeneous ablation lesions. However, the prevalence, the clinical course and the underlying electrophysiological mechanisms of LAT developed after CBA still remain unclear. Purpose: The aim of our study was to describe the occurrence and mechanisms of LAT after CBA in patients with paroxysmal AF. Methods: CBA was carried out in 181 patients (131 males) with paroxysmal AF. The mean age of the patients was 55textpm9.5 yrs, left atrial diameter was 42textpm5.9 mm. Patients with structural heart disease were not included. Daily transtelephonic ECG monitoring, 24-hour Holter-ECG were used to document recurrences. Redo ablation for LAT was performed in patients with symptomatic sustained drug-refractory tachycardia not earlier than 6 months after the initial procedure. Results: There were 16 (8.8%) patients with regular atrial tachycardias on at least one of the follow- up recordings during a mean follow-up period of 586textpm290 days. In two patients ECG tracings identified atrial fibrillation and were excluded from further analysis. Seven (3%) patients did not qualify for redo ablation. A redo procedure was performed in 7 (4.4%) patients. Reconnection to the pulmonary veins was present in all patients, and PVI was completed in all. Cavotricuspid isthmus (CTI) ablation was performed in 2 pts because of CTI dependent flutter. Stable LAT was diagnosed and ablated in 2 (1.1%) patients. LAT had a focal origin in 2 patients (1.1%). No any patients had macroreentrant LATtextquoterights. Conclusions: Although LATtextquoterights after CBA can occur, our data suggest that their prevalence is low. Patients requiring redo procedures for LAT after CBA are very uncommon. No macroreentrant tachycardias developed after CBA. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Cryo balloon catheter ablation is a new promising technique for circumferential isolation of pulmonary veins (PV). During ablation, a conventional circular mapping catheter for online monitoring of PV conduction cannot be placed in the vein since it would inhibit full balloon contact to the vein. The aim of this study was to analyse the online information on pulmonary vein conduction derived from a new circular mapping microcatheter placed in the pulmonary vein through the lumen of the cryo balloon. Cryo balloon PV isolation with simultaneous PV potential registration was performed in 10 consecutive patients with paroxysmal AF. A 6-pole mapping catheter with a shaft diameter of only 0.035 in. was advanced through the lumen of the cryo balloon catheter allowing online registration of pulmonary vein conduction during cryo application. PV potentials were recorded by six electrodes mounted on a circular ring (diameter 15mm) at the distal end of the catheter. Each cryo application was performed for 300 sec. Placement of the mapping catheter through the cryo balloon with adequate deployment of the circular ring in the pulmonary vein was achieved in 24/40 (60%) of the PVtextquotelefts. In the other 16 veins, a stiff guide wire was primarily used to facilitate stable positioning of the balloon at the PV ostium or early branching of the PVtextquoterights hindered full deployment of the mapping catheter together with the balloon. All 40 veins were successfully isolated with the balloon only. In the 24 veins with micro-catheter-based online PV potential registration, PV isolation was documented after a mean application time of the successful cryo freeze of only 56textpm43sec (range 12-168sec, median 44sec). Isolation of the PVs required a mean of 1.4textpm0.9 cryo applications (median 1). Minimum temperature during ablation was minus 55textpm9 textdegreeC. Acute pulmonary vein reconduction was observed in 2/4 veins in which conduction block had been documented after more than 70sec of cryo application (115 and 168sec). In the majority of pulmonary veins monitored by a circular mapping catheter, complete electrical isolation was achieved with one cryo balloon application after a medium application time of 56 sec. Late PV conduction block (>70 sec) seems to be a predictor for early recurrence of conduction. This new catheter technique provides new insights into the cryo balloon PV isolation process with potential impact on further ablation strategy. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Purpose: Ablation for chronic AF remains a long and difficult procedure. We evaluated the long term results of a novel standardized multi-electrode catheter approach with alternating bipolar and unipolar RF energy. Methods: Pts with recurrent chronic AF despite anti-arrhythmic drugs and cardioversion were treated with 3 catheters (PVAC, MASC and MAAC) with no additional imaging besides biplane fluoroscopy. The 10-polar PVAC was used for PV isolation, the 3-arm 12-polar MASC for septal CFAE ablation, and the 4-arm 8 polar MAAC for the LA roof, mitral isthmus, LA floor, and posterior wall CFAE ablation. Applications lasted 60 sec at 60textdegreeC target temperature at 10W maximum power with duty-cycled bipolar:unipolar RF energy (PVAC 4:1, MASC/MAAC 1:1). Follow-up visits were performed at 3, 6, and 12 mo with repetitive ECG and 7-day Holter recordings. Drugs were stopped at 3 mo if pts became asymptomatic. A second procedure was scheduled when AF recurred >2mo. PV MRI was performed before and >6 mo after the ablation. Results: Since July 2006, 40 pts (age 59textpm8 yr, 7 female) underwent the 3 catheter ablation procedure. Procedure and fluoroscopy time decreased from 174textpm51 and 54textpm46 min for the first to 100textpm13 and 19textpm17 min for the last twenty procedures. The number of applications for PVAC decreased from 29textpm8 to 23textpm5 min, but remained the same for MASC (7textpm3 min) and MAAC (8textpm5 min). Median FU was 10 mo (range 0-30 mo) with 27 pts>6 mo and 16 pts>12 mo. In 8 of 40 pts a second procedure was performed for early AF recurrence. A 7-day Holter in asymptomatic and/or ECG in symptomatic pts showed freedom of AF in 22/27 pts (81%) at 6 mo, and 11/16 pts (69%) at 12 mo. In all cases where a redo procedure was performed 1 or more PV reconnections were observed. Angiography during the second procedure as well as MRI follow-up showed no evidence for PV stenosis. No other complication like stroke, bleeding, tamponade, or phrenic nerve damage were observed throughout follow-up. Conclusions: A standardized multi-electrode catheter approach for chronic AF is feasible, time-efficient, and safe. Longterm results beyond 12 mo show 69% freedom of AF. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Introduction: Complex fractionated atrial electrograms (CFAEs) have been reported as targets for catheter ablation of atrial fibrillation (AF). However, the substrate responsible for CFAEs is not yet understood. The study aims to test the hypothesis that areas of CFAEs during AF correlate with low voltage areas in sinus rhythm (SR) which may indicate atrial fibrosis. Methods: This study included eight patients (age 64textpm7 yrs, 5 f) who underwent ablation of persistent AF. Prior to ablation, two consecutive high density left atrial (LA) electroanatomic maps, one in AF and the other in SR, were reconstructed in each patient. The SR map was analyzed for detection of low voltage sites (bipolar voltage <= 0.5mV). The AF map was analyzed using novel software (CFAE Software Module, Biosense Webster) for detection and characterization of CFAEs. Average Inter-potential Interval (AIPI) was used as an index of electrogram fractionation, with an AIPI <= 100ms indicating CFAEs. For the purpose of the study, the LA was divided into 15 areas: PV ostia (4), septum (2), posterior wall (2), lateral wall (2), anterior wall (2), roof (1), inferior wall (1), and base of appendage (1). Results: A total of 104textpm14 and 108textpm15 LA sites were sampled during SR and AF, respectively. Low voltage sites were found in 7.2textpm2.0 LA areas during SR, whereas CFAEs were located in 7.3textpm1.4 areas during AF (P=NS). When comparing the 120 paired LA areas (15 per patient) between SR and AF maps, we found a high agreement between areas with CFAEs and those with low voltage sites. Among the 60 areas with CFAEs, 52 (87%) harbored low voltage sites. Among the 62 areas with low voltage sites, 51 (82%) harbored CFAEs. Areas with CFAEs showed significantly lower regional voltage than areas without CFAEs (0.73textpm0.48 vs. 1.72textpm0.58 mV, p<0.001). Linear regression analysis revealed a significant correlation between the electrogram fractionation index AIPI and regional voltage (r = 0.68, p<0.001). Conclusions: Areas of CFAEs during AF correlate with low voltage areas in SR in the LA. Our results support the hypothesis that atrial fibrosis plays a role in the pathogenesis of CFAEs. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Purpose: Ganglionated plexi (GP) ablation is a new approach for the treatment of atrial fibrillation (AF). The purpose of this study was to prospectively assess acute and long-term successes of GP ablation for chronic AF. Methods: Radiofrequency ablation of the main clusters of GPs in the left atrium was performed in 89 patients with symptomatic, drug-refractory, chronic AF (71 men, 56textpm7 years of age). They had been in chronic AF for 3.4textpm3.2 years, 3.2textpm2.8 cardioversion procedures and 2.1textpm0.9 class I/III antiarrhythmic drugs had failed. Results: At the end of the ablation procedure AF had terminated in 21 of 89 patients (23.6%) by conversion to sinus rhythm (9 of 21 patients, 42.8%) or transformation to atrial tachycardia (12 of 21 patients, 57.2%). During RF applications, before SR was stabilized, 7 patients (33.3%) had one to several short-term SR restoration episodes and then AF recurrence was taking place ("stop and restart" effect). During 13textpm7 months of follow-up after a single ablation procedure, 58.4% of patients were in sinus rhythm without antiarrhythmic drugs, 16.8% had AF, 13.5% had both AF and atrial flutter, 2.2% had persistent atrial flutter, and 9.1% had paroxysmal AF on antiarrhythmic drugs. The second ablation procedure was performed in 32.5% of patients. Rapid activity between PV-LA junctions and adjoining GP was prevailing. There were multiple macroreentrant circuits in the majority of patients with atrial flutter. At 16textpm9 months after the last ablation procedure, 71.9% of patients were in sinus rhythm without antiarrhythmic drugs, 19.1% had persistent AF, 7.9% had paroxysmal AF, and 1.1% had atrial flutter. Independent predictors of later arrhythmia recurrences were longer AF duration (OR 1.06), left atrial volume (OR 1.21), history of hypertension (OR 1.58). Conclusion: GP ablation in chronic AF leads to acute AF termination in 23.6% and long-term maintenance of sinus rhythm in 71.9% of cases. Rapid activity in the pulmonary veins and multiple macroreentrant circuits are common mechanisms of recurrent atrial arrhythmias. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study Mikhaylov E, Van Belle Y, Janse P, Szili-Torok T, Jordaens L. Prevalence and characteristics of atrial tachycardias after cryoballoon pulmonary vein ablation. Europace Journal 2009, 11(Supplement 2), Abstract 662.Dorwarth U, Wankerl M, Krieg J, Halbfass P, Hoffmann E. New insights into cryo balloon pulmonary vein isolation in AF by online PV potential registration with a new circular mapping microcatheter. Europace Journal 2009, 11(Supplement 2), Abstract 663.Mulder AAW, Wijffels MCEF, Wever EFD, Boersma LVA. Multi-electrode pulmonary vein isolation and left atrial CFAE ablation for chronic AF with bipolar and unipolar RF unipolar RF energy: Longterm results and follow-up. Europace Journal 2009, 11(Supplement 2), Abstract 664.Scherr D, Dalal D, Chilukuri K, Henrikson CA, Marine JE, Berger RD, Calkins H, Dong J. Electrogram Fractionation during Atrial Fibrillation Correlates with Low Left Atrial Voltage in Sinus Rhythm in Patients with Persistent Atrial Fibrillation undergoing Ablation. Europace Journal 2009, 11(Supplement 2), Abstract 665.Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N. Acute effects and long-term outcome of ganglionated plexi ablation for chronic atrial fibrillation. Europace Journal 2009, 11(Supplement 2), Abstract 666.Mont L, Tamborero D, Berruezo A, Guasch E, Nadal M, Matiello M, Andreu D, Brugada J. Circumferential Pulmonary Vein Ablation: does the use of a Circular Mapping Catheter improve results? A Randomized Study. Europace Journal 2009, 11(Supplement 2), Abstract 667. Introduction: To evaluate whether the use of a circular mapping (CM) catheter improved the outcome of circumferential pulmonary vein ablation (CPVA). We hypothesized that assessment of pulmonary vein (PV) antrum isolation using a CM catheter could improve the outcome of the procedure as compared to use of a single catheter in the left atria (LA) both to ablate and map the electrical signal. Methods: A series of 146 consecutive patients (83% males, 53textpm10 years, 53% paroxysmal AF) were randomized to two ablation strategies. In both, ipsilateral PV encirclement until disappearance or dissociation of the local electrogram within the surrounded area was performed by an irrigated tip catheter. In the first group, only the radiofrequency catheter was used, both to map and ablate (CPVA group, n=73). In the other group, a CM catheter was added to assess the electrical activity of the PV antrum (CPVA-CM group, n=73). In addition, ablation line along the LA roof was created in all patients. Procedure and fluoroscopic times were longer in the CPVA-CM group (p<0.05). Results: Severe procedure-related complications occurred in 1 (1.4%) and 3 (4.1%) patients in the CPVA and CPVA-CM groups, respectively (p=0.317). Procedural efficacy was lower in the CPVA group as compared to the CPVA-CM: after a mean follow-up of 9textpm3 months, 31 (42.5%) and 47 (64.4%) patients, respectively, were arrhythmia-free without antiarrhythmic medication (p=0.008). Conclusions: The use of a CM catheter to ensure the isolation of PV antrum improved the success of the CPVA although it increased some procedural requirements.
    No preview · Article · Jan 2010 · Europace
  • Eric Wever
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    ABSTRACT: The first revision of the the practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners has provided an important document. Atrial fibrillation is a growing problem in clinical practice. Harmonization of general practice with cardiological guidelines will undoubtedly have favourable results, with as consequences improvement of the diagnostic outcome and state of the art treatment at an earlier moment. It can be expected, that the revised version of the Dutch College of General Practitioners' practice guideline will greatly contribute to the dialogue between cardiologist and general practitioner and may perhaps lead to joint research.
    No preview · Article · Jan 2010 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Left atrial (LA) stretch-associated electrophysiological changes in patients with mitral stenosis (MS) predispose to atrial fibrillation. We hypothesized that the normalization of the pressure gradient by percutaneous transvenous mitral balloon valvotomy (PTMV) affects LA but not right atrial (RA) conduction, depending on the site of stimulation. Because direction-dependent (asymmetric) changes of conduction may contribute to arrhythmogenesis, we assessed conduction symmetry in MS patients and tested whether it is restored by PTMV. In nine patients with MS, atrial effective refractory period and local activation times (ATs) were determined during stimulation before and after PTMV, with up to four decapolar catheters (LA and RA). Eight patients with ventricular pre-excitation served as controls. ATs at basic cycle length were similar before and after PTMV. With stimulation from either atrium, they were about 45 ms in the ipsilateral atrium and about 115 ms in the contralateral atrium. With premature stimulation, ATs increased dramatically. The shortest ATs were found in the RA with RA stimulation (78 +/- 9 and 80 +/- 6 ns, before and after PTMV). PTMV caused a shortening in LA-ATs (following LA stimulation) from 118 +/- 14 to 82 +/- 5 ms (before and after; P < 0.05). Asymmetry in conduction properties was therefore normalized by PTMV. PTMV led to a decrease in RA-ATs (following LA stimulation) from 196 +/- 11 to 174 +/- 13 ms (P < 0.02). In addition, following RA stimulation, the dispersion in ATs in the LA decreased significantly by PTMV (from 66 +/- 10 to 34 +/- 7 ms; P < 0.02). MS is associated with LA conduction delay, increased LA dispersion of conduction, and conduction asymmetry. These changes are immediately reversible by PTMV.
    Full-text · Article · Nov 2009 · Cardiovascular Research
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    A J H H M van Oostrom · H W Mauser · E F D Wever
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    ABSTRACT: A 58-year-old man with a history of alcohol abuse and smoking presented with a subdural haematoma due to head trauma after alcohol intoxication. He was disorientated; general and specific cardiological and neurological examinationswere unremarkable. Cardiac troponin T (0.053 μg/l), N-terminal pro-B type natriuretic peptide (768 pg/ml) and serum ethanol (3316 mg/l) were elevated.
    Preview · Article · Oct 2009 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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    ABSTRACT: Pulmonary vein ablation with a single-tip catheter remains long and complex. We describe a typical case of a novel efficient technique with a decapolar ring catheter utilizing alternating unipolar/bipolar radiofrequency energy. Voltage analysis and electrical mapping demonstrate the potential for antrum ablation and pulmonary vein isolation.
    Full-text · Article · Sep 2009 · Europace

Publication Stats

2k Citations
370.59 Total Impact Points

Institutions

  • 2000-2014
    • St. Antonius Ziekenhuis
      • Department of Cardiology
      Nieuwegen, Utrecht, Netherlands
  • 2006
    • Medisch Centrum Alkmaar
      • Department of Cardiology
      Alkmaar, North Holland, Netherlands
  • 1992-2006
    • University Medical Center Utrecht
      • • Department of Cardiology
      • • Department of Cardiothoracic surgery
      Utrecht, Provincie Utrecht, Netherlands
  • 1999
    • University of California, San Francisco
      • Department of Medicine
      San Francisco, California, United States
  • 1993-1999
    • Utrecht University
      • Department of Cardiology
      Utrecht, Utrecht, Netherlands
    • National Heart, Lung, and Blood Institute
      Maryland, United States