Radiofrequency catheter ablation (RFCA) has become an important treatment option in the management of supraventricular arrhythmias such as atrioventricular (nodal) re-entry tachycardia, atrial... Show moreRadiofrequency catheter ablation (RFCA) has become an important treatment option in the management of supraventricular arrhythmias such as atrioventricular (nodal) re-entry tachycardia, atrial tachycardia, atrial flutter and atrial fibrillation (AF). Particularly in the management of AF the number of RFCA procedures performed is growing rapidly. Three-dimensional electroanatomical mapping combined with non-invasive imaging is currently a state of the art technique to guide RFCA for complex arrhythmias such as AF ablation, providing information on anatomical landmarks and arrhythmogenic substrate with higher accuracy and with less radiation exposure than fluoroscopy or conventional catheter based mapping. Importantly, accurate characterization of the arrhythmogenic substrate and the underlying mechanisms of the arrhythmia as well as visualization of anatomical landmarks are pivotal to optimize the results of RFCA. Comprehensive pre-procedural evaluation may help to identify the appropriate substrate as well as to identify patients with a high likelihood to benefit from a RFCA procedure. Show less
Koopman, Jacob J.E.; Bodegom, David van; Westendorp, Rudi G.J.; Jukema, Johan Wouter 2014
Background: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension,... Show moreBackground: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community. Methods: In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA. Results: Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1–1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA. Conclusion: Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors. Show less
In recent years, a number of new cardiac interventional procedures have been introduced. Catheter ablation procedures for atrial fibrillation (AF) have been refined and are now considered a good... Show moreIn recent years, a number of new cardiac interventional procedures have been introduced. Catheter ablation procedures for atrial fibrillation (AF) have been refined and are now considered a good treatment option in patients with drug-refractory AF. In cardiac pacing, cardiac resynchronization therapy (CRT) is now standard of care for patients with drug-refractory heart failure. At the same time, CRT may also be beneficial in patients with heart failure after long-term right ventricular (RV) apical pacing. Finally, new percutaneous procedures for valvular heart disease have been introduced for patients that are deemed inoperable. At the same time, various imaging modalities have been further developed and important advances have been made in the integration of different imaging modalities. The aim of the present thesis was to explore the role of multimodality imaging in cardiac interventional procedures. In Part I, the integration of different imaging modalities during catheter ablation procedures for AF was studied. In addition, the effects of these procedures on left atrial and left ventricular (LV) size and function were investigated. Part II studied the effects of RV apical pacing on LV dyssynchrony and mechanics, and the effect of upgrade to CRT. Finally, in Part III the role of imaging in new percutaneous procedures for valvular heart disease was explored. Show less
Ventricular tachyarrhythmias, the major cause of sudden unexpected cardiac arrest, occur specifically in patients with structural heart disease. In general, all types of structural heart disease... Show moreVentricular tachyarrhythmias, the major cause of sudden unexpected cardiac arrest, occur specifically in patients with structural heart disease. In general, all types of structural heart disease may lead to chronic heart failure, a severe condition with an additional high risk of atrial- and ventricular tachyarrhythmias. The thesis starts with a general overview (chapter 1) of the epidemiology, pathofysiology, prognosis and therapeutical options of heart failure. In this overview all subjects of study of the following chapters are introduced and explained. Next, attention is focused on clinical ventricular tachyarrhythmias. Chapter 2-5 of this thesis aim at evaluating the diagnostic approach, the therapeutical option of radiofrequency catheter ablation and the risk of recurrences in patients who had presented with a (malignant) ventricular tachyarrhythmia. The second part of this thesis (chapter 6-9) evaluates the effect of cardiac resynchronization therapy -a novel treatment option in patients suffering from heart failure- on the occurrence of atrial- and ventricular tachyarrhythmias. In addition the effect of cardiac resynchroniation therapy on patients with diabetes mellitus is evaluated. Show less
Clinical mapping studies demonstrate that cardiac arrhythmias are often encountered at specific anatomical sites. The anatomical development of the heart and the cardiac conduction system are... Show moreClinical mapping studies demonstrate that cardiac arrhythmias are often encountered at specific anatomical sites. The anatomical development of the heart and the cardiac conduction system are narrowly related. The thesis starts with a Chapter 1 that provides a general overview of the basics of cardiac development, development of the cardiac conduction system, markers for the developing cardiac conduction system and anatomical predilection sites for the occurrence of clinical arrhythmias. Next, attention is focused on clinical arrhythmias in adults in relation to cardiac anatomy, the treatment of these arrhythmias and imaging techniques used to visualise the substrate. Subsequently, in part I (Chapter 2-4) of the thesis, a developmental origin of clinical arrhythmias is hypothesized. The developing cardiac conduction system is studied and a developmental origin of clinical arrhythmias is hypothesized based on the spatial expression pattern of the conduction system marker CCS-lacZ in murine embryos. Furthermore, incorporation of the primitive pulmonary vein in the left atrium is studied in sequential developmental stages in humans. In part II (Chapter 5-10), the treatment of clinical arrhythmias that are initiated and/or perpetuated at specific anatomical locations in the heart (particularly the pulmonary veins) guided by imaging techniques for visualisation of the substrate, is described. Show less
