E Andries’s research while affiliated with OLVG and other places

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Publications (32)


Figure 1 Lead II and V1 in patient 4 showing PR interval alternans caused by alternating atrioventricular conduction over the slow atrioventricular pathway (PR interval 360 ms) and fast atrioventricular pathway (PR interval 140 ms). Paper speed 25 mm/s. 
Table 1 Clinical characteristics of the patients 
Figure 2 Twelve lead electrocardiogram of patient 2 during complaints of palpitations and neck pounding. A narrow QRS tachycardia of 135 beats/min is seen. P waves that are partially hidden in the terminal part of the QRS complex are present in most leads. The electrical axis of the P waves is compatible with a sinus node origin. Paper speed 25 mm/s. 
Figure 3 Simultaneous recording of the precordial leads V1 to V6 and bipolar electrograms from the high right atrium (HRA) and the coronary sinus (CS), showing how the atria (A) and ventricles (V) are nearly simultaneously activated during sinus tachycardia at 136 beats/min with atrioventricular conduction over the slow pathway. 
Neck pounding during sinus rhythm: A new clinical manifestation of dual atrioventricular nodal pathways
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  • Full-text available

June 1998

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470 Reads

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4 Citations

Heart (British Cardiac Society)

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J Primo

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To determine the clinical and electrophysiological characteristics of patients with paroxysmal palpitations and neck pounding during sinus rhythm. Clinical, electrocardiographic, and electrophysiological characteristics of six patients with paroxysmal palpitations and neck pounding during sinus rhythm were studied in basal conditions and when symptomatic. Response to treatment was observed. Baseline ECGs were normal (four patients) or had first degree atrioventricular block with intermittent PR shortening. During symptoms, narrow QRS rhythms were seen without visible P waves (three patients) or with P waves partially hidden in the QRS complex (three patients). Dual atrioventricular nodal pathways were found in all five patients who had electrophysiological studies. In these patients the slow pathway conduction time was long enough (mean (SD), 425 (121) ms) for ventricular activation after slow pathway conduction during sinus rhythm to coincide with the next atrial depolarisation, causing neck pounding during exercise (four patients) or at rest (two patients). Tachycardia was not induced in any patient. Medical treatment aggravated symptoms in three patients. A pacemaker was successfully used in two. Neck pounding during sinus rhythm is a clinical manifestation of dual atrioventricular nodal pathways. Medical treatment may aggravate symptoms but a pacemaker may offer definitive relief.

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Herniation Of The Left Atrial Appendage Due To Partial Congenital Absence Of The Left Pericardium

February 1996

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8 Reads

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7 Citations

Acta clinica Belgica

Partial congenital absence of the left pericardium is a rare abnormality which may provoke serious complications. We report the case of a young adult, suffering from chest pain due to incarceration of atrial tissue. Based on this case report the clinical, pathophysiological and diagnostic features of this condition are described.


At what time are implantable defibrillator shocks delivered? Evidence for individual circadian variance in sudden cardiac death

October 1995

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9 Reads

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35 Citations

European Heart Journal

As in myocardial infarction and transient ischaemia, out-of-hospital sudden cardiac death has an increased morning incidence. However, sudden death occurring in hospital is evenly distributed over the 24 h period suggesting that there might be subgroups of patients with atypical circadian patterns of sudden death. Patients who received an implantable defibrillator constitute an ideal group for studies of circadian patterns of sudden death since this generation of devices are able to store the exact time when defibrillation occurred. The distribution of sudden death aborted by the implantable defibrillator was analysed during the 24 h period for 87 presumed appropriate shocks delivered in a group of 22 patients, 18 men and four women, 58.7 +/- 11.9 years old and with a mean left ventricular ejection fraction of 39.4 +/- 17.6%. Each patient received an average of 4.42 +/- 3.04 shocks during a mean follow-up of 9.4 +/- 5.6 months. Apart from a clear tendency for shocks to occur during the morning hours (42% of total shocks), five of 16 patients who received multiple shocks also showed a trend to repeat the shocks around the same period during the day. Our results support the accepted view that changes in autonomic tone in the early morning play a role in the circadian variations of sudden death. Sudden death not only occurs more frequently in the morning hours, but it also clusters in certain periods for individual patients.


Diagnosis and treatment of tachycardias with a long BP interval

March 1995

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8 Reads

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1 Citation

Revista Portuguesa de Cardiologia

The differential diagnosis of tachycardias with a long RP interval is reviewed and the methods of treatment of these arrhythmias catheter ablation are described. Electrocardiographic and electrophysiologic criteria for the correct diagnosis of atrial tachycardia, circus movement tachycardia using retrogradely an accessory pathway with decremental conduction properties and the uncommon form of atrioventricular nodal reentrant tachycardia are discussed. First results of our institution of radiofrequency catheter ablation of atrial tachycardias and circus movement tachycardias using retrogradely an accessory pathway with decremental conduction properties are presented. We concluded that both electrocardiographic and electrophysiologic criteria give a better understanding of the mechanism and arrhythmic site which are important markers for a safe and successful ablation procedure.


[Radiofrequency catheter ablation of atrial tachycardia]

March 1995

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10 Reads

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4 Citations

Bratislavske Lekarske Listy

Radiofrequency catheter ablation has proved to be highly effective for the treatment of supraventricular tachycardia originating in the AV node or related to atrioventricular accessory pathways. However, experience with ablation of atrial tachycardia is more limited. The purpose of our study was to analyse the success and safety of radiofrequency ablation of atrial tachycardias. Ten symptomatic patients with drug refractory atrial tachycardia. Symptoms included palpitations, dizziness, chest pains, shortness of breath, syncope. Five patients had reduced left ventricular ejection fraction (tachycardiomyopathy). Radiofrequency device - Medtronic ATAKRR with temperature monitoring. Temperature ranges from 50 degrees C to 70 degrees C were considered optimal to ablation. Ablation catheter - 7 F CardiorhythmR with a 4 mm2 deflectable tip. Heparin was given intravenously during the procedure (5000 IU bolus + 1000 IU/h). Acetylsalicylic acid 160 mg/day for 1 month after the procedure. Antiarrhythmic drugs were discontinued after the procedure. The sites for ablation were defined during tachycardia by the earliest endocardial atrial activation as compared to the onset of the surface P wave. Criteria of success: Abolition of the tachycardia followed by the inability to reinduce the tachycardia. Clinical, ECG and 2D ECHO evaluation in the outpatient's clinic. No complications occurred during the procedure. No reccurrences of the tachycardia were observed during the follow-up. All 5 patients with reduced ejection fraction before ablation had normal left ventricular function during follow-up. Radiofrequency catheter ablation is a safe and effective treatment for drug refractory atrial tachycardia.


New Developments and Treatment Strategies in Patients with Supraventricular Tachyarrhythmias

February 1995

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9 Reads

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3 Citations

Acta clinica Belgica

The mechanisms, clinical presentation and therapy of supraventricular tachycardias are discussed. The therapy has changed from palliation by means of anti-arrhythmic drugs into definitive cure by ablation of the arrhythmia substrate. Radiofrequency energy causes tissue damage by heating and appears to be a safe method for catheter ablation of supraventricular tachycardias. We report a 97% success rate for radiofrequency ablation of 195 accessory atrioventricular pathways thereby curing these patients from circus-movement tachycardia and paroxysmal atrial fibrillation. Complications occurred in 3% of patients. One hundred seventy-two patients with atrioventricular nodal reentrant tachycardia, caused by reentry within dual AV-nodal pathways, were treated by selectively ablating one of the pathways with non-inducibility of the arrhythmia afterwards in 97% of the cases. Nine percent of patients had a recurrence but were successfully treated in a second session. The procedure was complicated by complete AV-block in 4% of patients. The disappointing medical treatment of atrial fibrillation and the fact that atrial fibrillation can be the cause of a reversible form of heart failure (tachycardiomyopathy), induced the clinical application of alternative forms of treatment. Ablation of the normal atrioventricular conduction system by using radiofrequency energy was performed with a 100% success rate in 121 patients. After implantation of a ventricular pacemaker it is possible to control and regulate the ventricular rhythm leading to rate control and amelioration of ventricular performance.


Cardiac depolarization and repolarization in Wolff-Parkinson-White syndrome

December 1994

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13 Reads

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8 Citations

American Heart Journal

Delta wave and QRS complex polarities have been extensively studied in preexcitation syndromes. However, only limited data exist about ventricular depolarization and repolarization in the setting of maximal preexcitation in relation to the site of insertion of the accessory pathway. Therefore this study was designed to systematically analyze cardiac depolarization and repolarization in patients with maximal preexcitation. We analyzed the polarity of the QRS complex and T wave on the frontal plane on the conventional 12-lead electrocardiogram in 118 patients with maximal preexcitation. Fast atrial pacing was used to provoke maximal ventricular preexcitation. The 32 patients with a left lateral accessory pathway showed right-axis deviation of the QRS complex (110 +/- 20 degrees) with a left-axis deviation of the T-wave axis (-40 +/- 25 degrees). The 54 patients with a posteroseptal accessory pathway had a left axis of the QRS complex (-50 +/- 20 degrees) with a right-axis deviation of the T-wave axis (95 +/- 15 degrees). The 11 patients with a right lateral accessory pathway had a left axis of the QRS complex (-40 +/- 20 degrees) and a right axis of the T wave (110 +/- 10 degrees). In 7 patients with a left anterolateral accessory pathway and 14 patients with a right anteroseptal accessory pathway, the axis of the QRS complex was 50 +/- 25 degrees and 45 +/- 20 degrees, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia

June 1994

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25 Reads

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63 Citations

The 12-lead surface electrocardiogram is a simple and useful tool for the differential diagnosis of regular wide QRS complex tachycardia. However, criteria do not as yet exist to discriminate between ventricular tachycardia and supraventricular tachycardia with anterograde conduction over an accessory pathway (preexcited tachycardia). Therefore, we designed a new stepwise approach with three criteria for the electrocardiographic differential diagnosis between ventricular tachycardia and preexcited tachycardia and prospectively studied 267 regular tachycardias with electrophysiologically proven mechanism and a wide QRS complex (≥ 0.12 s): 149 consecutive ventricular tachycardias and 118 consecutive preexcited regular tachycardias. Underlying heart disease was old myocardial infarction in 133 of 149 (89%) ventricular tachycardias. The patients presenting with preexcited tachycardia had no additional structural heart disease. Atrial fibrillation with preexcited QRS complex was not included. The criteria favoring ventricular tachycardia were: (1) presence of predominantly negative QRS complexes in the precordial leads V4 to V6, (2) presence of a QR complex in one or more of the precordial leads V2 to V6, and (3) AV relation different from 1:1 (more QRS complexes than P waves). The final sensitivity and specificity of these three consecutive steps to diagnose ventricular tachycardia were 0.75 and 1.00, respectively. This new stepwise approach is sensitive and highly specific for the differential diagnosis between ventricular tachycardia in coronary artery disease and preexcited regular tachycardia.


Citations (16)


... three studies compared only specificity and did not included control group (Jastrzębski et al., 2018), while the others by Steurer and Verechei, reported sensitivity and specificity (75% and 100%; 73% and 74.6%), respectively (Steurer et al., 1994;Vereckei et al., 2023). ...

Reference:

Discrimination between ventricular tachycardia and wide‐QRS preexcited tachycardia
The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia
  • Citing Article
  • June 1994

... According to the National Heart, Lung, and Blood Institute Quality Assessment Tool for Case Series Studies [11] a maximum of 9 criteria apply for case series as shown in Supplementary Table 2. One study fulfilled 9 criteria [12], 5 studies fulfilled 8 criteria [13,[15][16][17][18], 2 studies fulfilled 7 criteria [19][20], one study fulfilled 6 criteria [22] and another 5 criteria [5]. Both authors (AC and RP) were in agreement regarding study classification. ...

Tanscoronary chemical ablation of arrhythmias
  • Citing Article
  • October 1992

Pacing and Clinical Electrophysiology

... From this equation, two time constants were calculated and were defined as the times required for the LV pressure to decay to 1/e (T 1/e ) and half (T 1/2 ) of its value at LV peak-negative dP/dt. 8 To avoid erroneous changes in time constant induced by a shift of the starting point or of the endpoint of the time constant analysis, 9 we also calculated individual time constants (T 1/e and T 1/2 ) from curve fits with identical starting point (the lower pressure at which LV peak-negative dP/dt occurred) and endpoint (the pressure that equalled the higher LVEDP plus 5 mmHg) as proposed by Paulus et al. 9 The correlation coefficients of the exponential fits were all above 0.995. ...

Wide-range load shift of combined aortic valvuloplasty-arterial vasodilation slows isovolumic relaxation of the hypertrophied left ventricle

Circulation

... Similar to the subjects in those studies, our LVOTO group also showed diastolic dysfunction by conventional pulsed wave Doppler trans-mitral E & A velocities, which supports the view that LV systolic dysfunction develops in parallel with diastolic dysfunction (19,20) . Impaired relaxation in LVOTO as a consequence of LV hypertrophy has been demonstrated by others, but the patients in those studies had more severe LVOTO (21) . In a study including patients with severe AS, Bruch et al (22) demonstrated a high E/E ' septal ratio and a good correlation with invasive LV filling pressures. ...

Impaired relaxation of the hypertrophied left ventricle in aortic stenosis: Effects of aortic valvuloplasty and of postextrasystolic potentiation
  • Citing Article
  • May 1988

European Heart Journal

... It is possible that signs and symptoms of heart failure in a patient with a preserved EF (or even a reduced EF) may not actually be due to heart failure. 28 For example, the clinical picture might be due to obesity, lung disease, and/or deconditioning. Thus, it is important to demonstrate objectively that these patients have cardiac dysfunction. ...

Postextrasystolic potentiation worsens fast filling of the hypertrophied left ventricle in aortic stenosis and hypertrophic cardiomyopathy

Circulation

... In children, it is difficult to avoid toxicity even with serum level monitoring [69], and among patients with HCM in childhood, the majority had to discontinue therapy after a while because of side effects [7]. Apart from pulmonary, hepatic, skin and eye toxicity, long-term amiodarone therapy also reduces exercise tolerance and increases pulmonary artery pressure and pulmonary artery wedge pressure in patients with HCM [70]. Thus, although amiodarone may be effective shortterm therapy for ventricular arrhythmias and to control Figure 10 Nine-month infant with severe, non-syndrome-associated, hypertrophic cardiomyopathy, with a left ventricular outflow gradient of 100 mmHg and marked mitral valve reflux at presentation. ...

Effects of long-term treatment with amiodarone on exercise hemodynamics and left ventricular relaxation in patients with hypertrophic cardiomyopathy

Circulation

... Primary success rates in recent studies vary between 81 and 100% (average 90%) with an average recurrence rate of 17% [3][4][5][6][7][8][9] . The results with atrial flutter have not been as satisfactory as ablation of accessory pathways or atrioventricular reentry tachycardias [10][11][12][13][14][15] , presumably reflecting difficulties in making a complete line of block over an extended area with the currently available catheter design. Catheter ablation of atrial fibrillation is still experimental, but reported attempts are based on the creation of long lines of coagulation necrosis in specific patterns [16][17][18] . ...

New Developments and Treatment Strategies in Patients with Supraventricular Tachyarrhythmias
  • Citing Article
  • February 1995

Acta clinica Belgica

... This compares favorably with 80% reported by Goldberger et al. [9] and 86% reported by Poty et al. [11] The complication rate was 4.11%, and there was no mortality in this study. Wang et al. [10] had a rate of 7.7% while Malacký et al. [16] reporting 10 cases, had no complication. The rates in our series are, therefore, comparable to that obtained in other reputable centers worldwide. ...

[Radiofrequency catheter ablation of atrial tachycardia]
  • Citing Article
  • March 1995

Bratislavske Lekarske Listy

... The diagnosis of supraventricular tachycardia and in particular of atrioventricular reentrant tachycardia (AVRT) or atrioventricular nodal reentrant tachycardia (AVNRT) was based on standard criteria. 7,8 The diagnosis of atrial tachycardia was supported when a "VAAV" response to ventricular stimulation during tachycardia or the lack of VA linking M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 was identified. 9 Induced runs of atrial flutter or atrial fibrillation were included in the same group. ...

Atrioventricular nodal reentrant tachycardia: A review
  • Citing Article
  • May 1994

Canadian Journal of Cardiology

... Similarly, O'Leary et al. indicated that delta wave amplitude (DWA), the height of the delta wave in the frontal lead, aided in distinguishing WPW syndrome from FVP, which could be diagnosed at a cut-off value of 3.5 mV, with 85% sensitivity and 83% specificity [3]. Because of its abnormal repolarization, WPW syndrome exhibited distinct QRS and T axes at maximal pre-excitation, as identified by Steurer et al. in patients who had undergone catheter ablation [4]. This study hypothesized that the QRS-T angle, which is associated with repolarization anomalies, might be used to distinguish WPW syndrome from FVP. ...

Cardiac depolarization and repolarization in Wolff-Parkinson-White syndrome
  • Citing Article
  • December 1994

American Heart Journal