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Biomedical subjects

Luc J Jordaens

Publications and source records attributed to Luc J Jordaens.

At least 19 recordsLinked to original sources
PubMed2007

Spectral pulsed-wave tissue Doppler imaging lateral-to-septal delay fails to predict clinical or echocardiographic outcome after cardiac resynchronization therapy.

AIMS: The current study sought to assess if pre-implantation lateral-to-septal delay (LSD) > or =60 ms assessed by spectral pulsed-wave myocardial tissue Doppler imaging (PW-TDI) could predict successful long-term outcome after cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Sixty patients (72% males, mean age 59 +/- 10 years) who were referred for CRT according to the ACC/ESC guidelines were enrolled in the study. All patients underwent spectral PW-TDI before and 1 year after CRT. Two left ventricular (LV) dyssynchrony time intervals, T(O) and T(P) (time to onset and peak of LV myocardial velocity, respectively), LSD were recorded. Left ventricular dyssynchrony was defined as LSD > or =60 ms. Clinical response was defined as an improvement in >1 NYHA class plus improvement in 6-min walk distance (6MWD) > or =25%, echocardiographic response was defined as a > or =15% reduction in LV end-systolic volume (LV-ESV). One year after CRT, 50 patients (83%) were clinical responders and 47 patients (78%) were echocardiographic responders. Both T(O) and T(P) LV dyssynchrony indices failed to predict echocardiographic CRT outcome. In addition, there were no significant differences between 'synchronous' and 'dyssynchronous' patient populations at baseline or follow-up in either clinical (NYHA class and 6MWD) or echocardiographic (LV ejection fraction, LV end-diastolic, and end-systolic) variables. CONCLUSION: The great majority of patients referred for CRT benefit clinically from it. However, spectral PW-TDI failed to predict CRT outcome. When PW-TDI dyssynchrony was applied for selection of proper CRT patients, up to 80-86% of the patients with synchronous LSD that had proven clinical and echocardiographic benefit from CRT would have been denied CRT.

Cardiac Pacing, Artificial↗
PubMed2006

Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials.

AIMS: Cardiac resynchronization therapy (CRT) has been shown to improve symptoms and exercise tolerance in patients with advanced heart failure (HF). However, studies were underpowered to address its effect on overall mortality. To evaluate whether CRT alone (without a combined defibrillator function) reduces overall mortality as compared with optimal pharmacological therapy, and how it affects the mode of death in patients with advanced HF. METHODS AND RESULTS: Public domain databases were systematically searched. Randomized controlled studies that evaluated the effects of CRT alone in patients with advanced HF and a depressed left ventricular systolic performance were selected for this analysis. Trials, which did not independently report data on CRT alone or had a follow-up period of less than 3 months, were excluded. Five studies were identified and analyzed. They included a total of 2371 patients, 1028 controls and 1343 CRT-treated patients. Pooled analysis demonstrated that CRT alone, as compared with optimal medical therapy, significantly reduced all-cause mortality by 29% [16.9 vs. 20.7%; odds ratio (OR), 0.71; 95% confidence interval (CI), 0.57-0.88] and mortality due to progressive HF by 38% (6.7 vs. 9.7%; OR, 0.62; 95% CI, 0.45-0.84). No effect on sudden cardiac death (SCD) was observed with CRT (6.4 vs. 5.9%; OR, 1.04; 95% CI, 0.73-1.22). CONCLUSIONS: CRT alone as compared with optimal medical therapy reduces all-cause mortality in patients with advanced HF. It predominantly reduces worsening HF mortality, not affecting SCD.

Aged↗
PubMed2006

Evaluation of morphology discrimination for ventricular tachycardia diagnosis in implantable cardioverter-defibrillators.

BACKGROUND: To reduce inappropriate therapy from implantable cardioverter-defibrillators (ICDs), electrogram morphology discrimination has been developed to improve arrhythmia discrimination without compromising device safety. OBJECTIVES: The purpose of this study was to determine the accuracy of the morphology discrimination algorithm for detecting ventricular tachycardia (VT). METHODS: Stored electrograms of 795 tachyarrhythmias from 106 patients with a St. Jude Medical ICD (51 single-chamber and 55 dual-chamber) were analyzed by the investigators. The data were analyzed for morphology discrimination alone, sudden onset and stability, and morphology discrimination in combination with sudden onset and stability. Data were corrected for multiple episodes within a patient with the generalized estimating equation method. RESULTS: Using the nominal template match of 60%, morphology discrimination alone provided sensitivity and specificity of 78% and 95% for single-chamber ICDs and 63% and 92% for dual-chamber ICDs, respectively. Based on the receiver operator characteristic curve, the optimal-match percent threshold was 80% to 85% but at the expense of specificity. Morphology discrimination combined with sudden onset and stability increased sensitivity to 98% with specificity of 86% in single-chamber devices. In dual-chamber devices, the loss in sensitivity is compensated by rate branch analysis, yielding a sensitivity of 98%. CONCLUSION: Arrhythmia discrimination based on electrogram morphology has the potential to reject atrial tachyarrhythmias. However, there is a risk for underdetection of ventricular tachyarrhythmias if arrhythmia discrimination is primarily based on morphology. To guarantee patient safety in single-chamber devices, the morphology discrimination algorithm must be programmed in combination with established detection algorithms. In dual-chamber devices, loss of sensitivity is compensated by the V > A rate branch.

Algorithms↗
PubMed2006

One-year follow-up in a prospective, randomized study comparing radiofrequency and cryoablation of arrhythmias in Koch's triangle: clinical symptoms and event recording.

AIMS: To rely solely on clinical symptoms of recurrent palpitations to evaluate the success of interventional procedures can be misleading. This study was designed to assess the efficacy of event recording in evaluating long-term success in patients treated for atrioventricular nodal reentrant tachycardia (AVNRT) or right posteroseptally located accessory pathways (RPS) either by radiofrequency (RF) or by cryoablation (CA). METHODS AND RESULTS: Sixty-three patients with AVNRT and eight with RPS were randomized. Patients were encouraged to activate an event recorder in the case of recurrent palpitations for the first 3 months. One year after the procedure, patients were asked specific arrhythmia related questions. Thirty-six patients underwent RF and 35 CA. Acute success was finally achieved in 34 (94%) patients in the RF and 33 (94%) in the CA groups. Assessment of long-term success demonstrated a similar proportion of palpitations in the RF and CA groups: 11 (31%) vs. 17 (49%). Only 12 patients activated the event recorder, four patients in RF, including one patient with chest pain, and eight in the CA group. Analysis of recordings revealed recurrent AVNRT or circus movement tachycardia in four patients (one RF and three CA), atrial fibrillation in one RF patient, and sinus tachycardia in six (one RF and five with CA). In addition, a complete 12 lead ECG of a recurrent arrhythmia was made in three RF and two CA patients (in-hospital or after the event recording). A total of seven patients underwent a second procedure (four RF and three CA). Without the event recorder, seven patients would have been misclassified as having recurrent arrhythmia. CONCLUSION: Event recording enhances the sensitivity of detecting arrhythmia recurrences in evaluating therapy efficacy and should be considered in every interventional follow-up study. Analysis of recordings showed that CA is as effective as RF in the treatment of AVNRT and RPS at long-term follow-up.

Arrhythmias, Cardiac↗
PubMed2006

Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia.

BACKGROUND: Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation. OBJECTIVES: The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation. METHODS: Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible. RESULTS: Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days). CONCLUSION: RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.

Body Surface Potential Mapping↗
PubMed2006

Targets and endpoints in ablation therapy for atrial fibrillation in the light of pathophysiological mechanisms.

Atrial fibrillation (AF), an important public health problem is a complex and multifactorial arrhythmia. Non-pharmacological treatment for symptomatic patients is of increasing importance. The different catheter ablation techniques in AF treatment developed during recent years, all based on different pathophysiological insights, are discussed. The non-standardized use of different follow-up methods after ablation make interpretation and comparison of results difficult.

Atrial Fibrillation↗
PubMed2006

Use of advanced mapping and remote magnetic navigation to ablate left ventricular fascicular tachycardia.

Ablation of idiopathic left ventricular, or fascicular tachycardia can be aided by electroanatomical mapping. The addition of a floppy, magnetically enabled ablation catheter may improve maneuvering as well as decrease mechanically induced arrhythmias and mechanical block. We describe a case of fascicular tachycardia in which both these modalities were used in a sequential fashion. Integration of these modalities should prove even more helpful.

Catheter Ablation↗
PubMed2006

Left ventricular lead placement within a coronary sinus side branch using remote magnetic navigation of a guidewire: a feasibility study.

BACKGROUND: A novel magnetic navigation system (MNS) allowing remote guidance of catheters and guidewires might assist in implantation of left ventricular (LV) pacing leads. OBJECTIVE: To assess the feasibility of deploying a LV pacing lead into a coronary sinus (CS) side branch using a magnetically guided wire and of performing the procedure without a CS guiding sheath. METHODS: Twenty-one patients were included in this study. Nine underwent CRT device implantation using a MNS to steer the guidewire (MNS group) while 12 patients were conventionally implanted (control group). In 6 patients in the MNS group, the procedure was performed using a CS guiding sheath. In 3 others, the decision was to perform the procedure without a CS sheath. In these patients the wire was advanced manually, while the external magnets oriented it toward the CS os. In the CS, "vector based" navigation was used to guide the wire to the desired side branch. RESULTS: In all 9 patients in the MNS group, the target vessel could be successfully engaged by the magnetically guided wire. In 7, the LV lead was lodged in the target vessel. In 2 patients, the LV lead was repositioned in an anterolateral side branch due to instability or inability to engage the vessel with it. Mean total procedure time was 164 +/- 58 minutes (without sheath 229 +/- 52 vs with sheath 132 +/- 26 minutes; P = 0.007). Mean fluoroscopy time was 28 +/- 9 minutes. For control patients, the procedure and fluoroscopy time were similar (144 +/- 41 minutes and 26 +/- 12 minutes, respectively). No major complications occurred. CONCLUSION: LV lead implantation can be performed using a remote magnetically steered guidewire. Though the lead could be implanted without a CS guiding sheath, longer procedure times were required.

Cardiac Pacing, Artificial↗
PubMed2005

Outcome in patients with an ICD incorporating cardiac resynchronisation therapy: differences between primary and secondary prophylaxis.

BACKGROUND: The incidence of ventricular tachyarrhythmias in ICD patients with cardiac resynchronisation therapy (CRT-D) is not well studied. AIM: To analyse event free survival in CRT-D patients with a primary or a secondary prophylactic ICD indication. METHODS: Prospective, single centre. Eighty-six patients, 44% with a primary prophylactic indication. Actuarial event-free rates for mortality and arrhythmias were calculated. RESULTS: Baseline clinical characteristics were not significantly different between primary and secondary prophylaxis. Primary prophylaxis patients were more likely to be in NYHA class III. Over 21 months, 724 ventricular events with therapy occurred in 36 patients (42%). The actuarial event-free rates, at 1 and 3 years, from appropriate ICD therapy were higher (P<0.001) for primary (79.0% and 67.8%) than for secondary prophylaxis (45.6% and 27.0%). Appropriate ICD therapy occurred more in NYHA class II compared to class III (P=0.016). Underlying disease (ischemic versus non-ischemic) and functional class did not play a role in multivariate analysis. CONCLUSION: Important arrhythmic events in patients with heart failure, and CRT-D occur at a very high rate when the indication is secondary prophylaxis. Patients with primary prophylaxis have an annual event rate of 10%, even though they tend to have a worse heart failure class.

Aged↗
PubMed2005

Defibrillation efficacy testing: long-term follow-up and mortality.

AIMS: Extensive defibrillation threshold testing is no longer necessary to perform as devices have become more effective. We assessed the lowest effective defibrillation (LED) level at implantation and before hospital discharge and related this to outcome. METHODS AND RESULTS: One hundred and twenty-seven consecutive patients with biphasic shock and active can devices were studied at intraoperative and predischarge testing. A subgroup of 67 patients had > or = 3 VF inductions at implant. Improvement was defined when LED decreased by > or = 3 J. The LED was significantly higher at implantation compared with predischarge (P < 0.001). Improvement was seen in 73/127 patients (58%). In the group with > or = 3 VF inductions, an implantation LED > 9 J was related to a lower LVEF (P < 0.01); 34/67 patients (51%) had improvement in LED. During follow-up, 18/127 patients died, four received heart transplantation. No different outcome was observed in patients with and without improvement. However, for those with > or = 3 VF inductions, an independent predictor of mortality was implantation LED > 9 J without improvement on the second test. Safety margin < 10 J was not related to mortality. CONCLUSION: Repeated defibrillation efficacy testing before hospital discharge may confirm that a relatively high defibrillation energy is required. This is related to a higher mortality in long-term follow-up.

Adult↗
PubMed2005

Sixteen multidetector row computed tomography of pulmonary veins: 3-months' follow-up after treatment of paroxysmal atrial fibrillation with cryothermal ablation.

The aim of the study was to assess pulmonary veins (PVs) for the presence of stenosis 3 months after cryothermal ablation (CA) with a new method of electrical isolation of PVs using contrast-enhanced 16 multidetector row computed tomography (MDCT). Twenty four patients with symptomatic atrial fibrillation underwent CA in 46 PVs. MDCT of PVs was performed before the treatment and after 3-months' follow-up. Following cryoablation, 13/24 (54%) patients showed clinical improvement and had reduced attacks of atrial fibrillation. The dimensions of the treated PVs remained unchanged: the coronal ostial diameter was 19.1+/-2.4 preprocedural versus 18.6+/-2.4 mm at follow-up, p>0.05; the ratio of the coronal and axial diameters at the ostium was 1.2+/-0.2 versus 1.2+/-0.1, p>0.05, respectively, and the coronal diameter of the proximal 10 mm was 17.1+/-2.5 mm versus 16.5+/-2.2 mm, p>0.05, respectively. CA is a promising technique for electrical isolation of PVs that has not been associated with stenosis at the orifice and the proximal 10 mm of the PVs after 3-months' follow-up. MDCT is a noninvasive, fast and comfortable method for assessment of PVs in a three-dimensional manner prior to ablative treatment and during the follow-up.

Atrial Fibrillation↗
PubMed2005

The presence of contractile reserve has no predictive value for the evolution of left ventricular function following atrio-ventricular node ablation in patients with permanent atrial fibrillation.

AIMS: Transcatheter ablation of the atrio-ventricular (AV) node followed by ventricular pacing has been shown to improve symptoms and quality of life (QOL) of patients with permanent atrial fibrillation (AF). In a considerable number of patients, cardiac function deteriorates after AV node ablation. We aimed to determine whether the absence of contractile reserve assessed by low dose dobutamine stress echocardiography (LDDSE) could identify those patients whose left ventricular (LV) function deteriorates after AV node ablation. METHODS: All 25 patients studied had permanent AF for at least 12 months. LVEF was determined 6 days and 3 months after AV node ablation by radionuclide ventriculography (RNV), at a paced rate of 80 beats/min. Deterioration in cardiac function was defined as a decrease in LVEF>5%. LDSE was performed in all patients before and after ablation. The presence of contractile reserve was defined as an improvement in regional function of >or=1 grade at low dose dobutamine in at least 4 segments. QOL measurements were taken using Minnesota, NHBP and MPWB questionnaires. RESULTS: LVEF showed no improvement in the overall group (52.8+/-11.1% vs. 51.8+/-9.8%, p=NS). QOL showed significant improvement in all questionnaires (Minnesota: 4.1+/-2.1 vs. 2.5+/-2, p=0.001; NHBP: 54.8+/-43.3 vs. 34.2+/-34.3, p=0.002; MPWB: 22.2+/-4.6 vs. 19.4+/-6.2, p=0.03). There was no significant difference in change of LVEF between patients with and without contractile reserve (-0.4+/-8.7 vs. 1.6+/-11.3, p=NS). However, patients with a preserved LVEF at baseline showed more frequently a reduced LVEF after AV node ablation (62.2+/-10.4% vs. 47.5+/-7.6%, p=0.001). CONCLUSIONS: (1) The absence of contractile reserve does not predict deterioration of cardiac function after AV node ablation. (2) AV node ablation results in a significant improvement in QOL, which is not necessarily associated with improvement of LVEF. (3) Higher baseline LVEF predicts deterioration of cardiac function. These data suggest that although AV node ablation is an excellent way of controlling symptoms, it should be avoided in patients with normal LV function.

Adult↗
PubMed2004

Usefulness of transesophageal echocardiography using a combined probe when converting atrial fibrillation to sinus rhythm.

We studied the feasibility and efficacy of transesophageal echocardiography (TEE) combined with transesophageal cardioversion (TEC). Secondary aims were to study left atrial flow velocities before and 1 and 5 minutes after TEC, biochemical markers of myocardial damage, and patient tolerability. TEC after a short period of anticoagulation and exclusion of a clot with TEE was safe. TEC was well tolerated and efficacious. The use of a combined probe for TEE and TEC therefore can save time and be more effective. A custom-made probe for combined TEE plus TEC was used. TEC was performed with a step-up protocol (20 J to between 30 and 50 J) and with biphasic shocks. Presence of spontaneous echo contrast was scored. Cumulative energy needed to achieve sinus rhythm was calculated. Discomfort was scored on a scale of 0 to 10. Twenty-six patients underwent combined TEE/TEC. Sinus rhythm was achieved in 24 of 26 patients (92%) with a mean cumulative energy of 42.3 J. Sixteen of 26 patients were cardioverted with a 20-J shock, and 6 of these patients had early recurrence of atrial fibrillation. All biochemical markers were unaffected, and TEE/TEC was well tolerated. Left atrial appendage velocity decreased significantly after TEC. Thus, the use of a TEE/TEC probe offers effective cardioversion with low energy levels, is well tolerated, and hemodynamics during and immediately after cardioversion can be monitored. Early cardioversion after exclusion of a clot with this combined probe is time saving and cost effective.

Adult↗
PubMed2004

Guiding and optimization of resynchronization therapy with dynamic three-dimensional echocardiography and segmental volume--time curves: a feasibility study.

OBJECTIVE: To assess a new approach for guiding and hemodynamic optimization of resynchronization therapy, using three-dimensional (3D) transthoracic echocardiography. BACKGROUND: Resynchronization therapy for heart failure provides the greatest hemodynamic benefit when applied to the most delayed left ventricular (LV) site. Currently, the ideal LV pacing site is selected according to acute invasive hemodynamic assessment and/or tissue Doppler imaging. METHODS: A total of 16 patients with advanced heart failure and an implanted biventricular pacemaker were included in this study. Transthoracic apical LV images at equidistant intervals were obtained using a prototype, fast-rotating second harmonic transducer to reconstruct 3D LV datasets during sinus rhythm (SR), right ventricular (RV) apical and biventricular pacing mode. A semi-automated contour analysis system (4D LV analysis, TomTec, Germany) was used for segmental wall motion analysis and identification of the most delayed contracting segment and calculation of global LV function. RESULTS: Data acquisition duration was 10 s and analyzable 3D images were obtained in 12 patients. Of these patients, data during SR were available in 9 and during biventricular pacing in 11. The greatest contraction delay during SR was found in the anterior and antero-septal segments in five of nine patients. Biventricular pacing resulted in reduction of the contraction delay in seven of eight patients. The global LV function did not change significantly. CONCLUSION: 3D echocardiography with appropriate analytic software allows detection of the most delayed LV contracting segment and can be used to select the optimal pacing site during resynchronization therapy.

Aged↗
PubMed2004

Ice mapping during cryothermal ablation of accessory pathways in WPW: the role of the temperature time constant.

AIM: Cryothermal energy has the ability reversibly to demonstrate loss of function with cooling, ice mapping, at less deep temperatures. The purpose of this study was to investigate the time course of the temperature during ice mapping of accessory pathways. METHODS AND RESULTS: Thirteen patients with the Wolff-Parkinson-White (WPW) syndrome underwent cryoablation. After identification of a prospective ablation site, ice mapping was performed by cooling the tip to a minimum of -30 degrees C. Successful ice mapping was defined by loss of accessory pathway (AP) conduction. A total of 104 ice maps were analyzed. Successful ice mapping was demonstrated in 17 attempts. There was no significant difference in mapping temperature between successful and unsuccessful ice mapping (-29.4+/-3.2 degrees Celsius vs -30.4+/-1.7 degrees Celsius). The temperature time constant tau during successful ice mapping was significantly shorter compared with unsuccessful ice mapping (7.0+/-1.1 s vs 10.1+/-1.3 s; P<0.0001). The response time (RT) to mapping temperature of -30 degrees C was significantly prolonged in unsuccessful ice mapping attempts (35.8+/-4.5 s vs 53.5+/-11.0 s; P<0.0001). Significant correlations were found between successful ice mapping and the temperature time constant, and between RT and the temperature time constant (P<0.001). CONCLUSION: The ability to identify prospective ablation sites by ice mapping was demonstrated. Successful ice mapping attempts were characterized by a short temperature time constant and a short response time to mapping temperature with a sudden disappearance of pathway conduction.

Adult↗