المؤلفون: Wesselink, R., Neefs, J., van den Berg, N. W. E., Meulendijks, E. R., Terpstra, M. M., Kawasaki, M., Nariswari, F. A., Piersma, F. R., van Boven, W. J. P., Driessen, A. H. G., de Groot, J. R.

المصدر: Wesselink , R , Neefs , J , van den Berg , N W E , Meulendijks , E R , Terpstra , M M , Kawasaki , M , Nariswari , F A , Piersma , F R , van Boven , W J P , Driessen , A H G & de Groot , J R 2022 , ' Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial ' , BMJ Open , vol. 12 , no. 3 , e056829 ....

الوصف: Objectives To determine the association between left atrial epicardial conduction time (LAECT), fibrosis and atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation of persistent AF. Setting Single tertiary care centre in the Netherlands. Participants Patients with persistent AF from the randomised Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery (AFACT)-trial were included. Patients eligible for thoracoscopic AF ablation were included, full inclusion and exclusion criteria were previously published. All patients underwent thoracoscopic ablation, encompassing pulmonary vein isolation with an additional roof and trigone lesion. In patients with conduction block across the roof and trigone lesion, LAECT was measured. LAECT was defined as the time to local activation at one side of the roofline on pacing from the opposite side. Collagen fibre density was quantified from left atrial appendage histology. Outcome measures Primary outcome: AF recurrence during 2 years of follow-up. Results 121 patients were included, of whom 35(29%) were women, age was 60.4±7.8 and 51% (62) had at least one AF recurrence during 2 years of follow-up. LAECT was longer in patients with versus without AF recurrence (182±43 ms vs 147±29 ms, p<0.001). LAECT was longer in older patients, in patients with a higher body mass index (BMI) and in patients using class IC antiarrhythmic drugs. LAECT was shorter in patients with higher collagen fibre density. A previously failed catheter ablation, LAECT and BMI were independently associated with AF recurrence. Conclusion LAECT is correlated with collagen fibre density and BMI and is independently associated with AF recurrence in patients with persistent AF. In these patients, LAECT appears to reflect substrate characteristics beyond clinical AF type and left atrial volume. Trial registration number NCT01091389.

العلاقة: https://research.vumc.nl/en/publications/9df59270-d7a6-465c-a84a-96dcf25f8248Test

الإتاحة: https://doi.org/10.1136/bmjopen-2021-056829Test
https://research.vumc.nl/en/publications/9df59270-d7a6-465c-a84a-96dcf25f8248Test
http://www.scopus.com/inward/record.url?scp=85126077941&partnerID=8YFLogxKTest

المؤلفون: Piersma, F. R., Neefs, J., Berger, W. R., van den Berg, N. W. E., Wesselink, R., Krul, S. P. J., de Groot, J. R.

المصدر: Netherlands Heart Journal ; volume 30, issue 7-8, page 370-376 ; ISSN 1568-5888 1876-6250

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Introduction Atrial fibrillation (AF) is the most common arrhythmia and imposes a high burden on the healthcare system. A nurse-led AF outpatient clinic may alleviate the burden on the cardiology outpatient clinic by triaging patients who need care by a cardiologist or general practitioner (GP). However, care and referral patterns after initial assessment in a nurse-led AF outpatient clinic are unknown. We examined the proportion of AF patients assessed in a nurse-led clinic without outpatient follow-up by a cardiologist. Methods All patients with AF referred to our tertiary medical centre underwent cardiac work-up in the nurse-led AF outpatient clinic and were prospectively followed. Data on patient characteristics, rhythm monitoring and echocardiography were collected and described. Odds ratio (OR) for continuing care in the nurse-led AF outpatient clinic was calculated. Results From 2014 to 2018, 478 consecutive individual patients were referred to the nurse-led AF outpatient clinic. After the initial cardiac work-up, 139 patients (29.1%) remained under nurse-led care and 121 (25.3%) were referred to a cardiologist and 218 (45.6%) to a GP. Patients who remained under nurse-led care were significantly younger, were more symptomatic, more often had paroxysmal AF and had less comorbidities than the other two groups. After multivariable testing, CHA 2 DS 2 -VASc score ≥ 2 was associated with discontinued nurse-led care (OR 0.57, 95% confidence interval 0.34–0.95). Conclusion After initial cardiac assessment in the nurse-led outpatient clinic, about half of the newly referred AF patients were referred back to their GP. This strategy may reduce the burden of AF patients on secondary or tertiary cardiology outpatient clinics.

الإتاحة: https://doi.org/10.1007/s12471-021-01651-xTest

المؤلفون: Wesselink, R, Neefs, J, Van Den Berg, N W E, Baalman, S W E, Berger, W R, Krul, S P J, Van Praag, E M, Terpstra, M M, Piersma, F R, Van Boven, W J P, Driessen, A H G, De Groot, J R

المصدر: European Heart Journal ; volume 39, issue suppl_1 ; ISSN 0195-668X 1522-9645

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الإتاحة: https://doi.org/10.1093/eurheartj/ehy564.465Test
http://academic.oup.com/eurheartj/article-pdf/39/suppl_1/ehy564.465/25567506/ehy564.465.pdfTest

المؤلفون: van den Berg, N. W. E., Neefs, J., Berger, W. R., Baalman, S. W. E., Meulendijks, E., Kawasaki, M., Kemper, E. M., Piersma, F. R., Veldkamp, M. W., Wesselink, R., Krul, S. P. J., de Groot, J. R.

المصدر: Netherlands Heart Journal ; volume 25, issue 12, page 664-668 ; ISSN 1568-5888 1876-6250

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الإتاحة: https://doi.org/10.1007/s12471-017-1053-5Test

المؤلفون: Piersma, F. R., Neefs, J., Berger, W. R., van den Berg, N. W. E., Wesselink, R., Krul, S. P. J., de Groot, J. R.

المصدر: Netherlands Heart Journal; Jul2022, Vol. 30 Issue 7/8, p370-376, 7p

مصطلحات موضوعية: ATRIAL fibrillation, CARDIOLOGISTS, MULTIVARIABLE testing, GENERAL practitioners, ODDS ratio, ARRHYTHMIA

مستخلص: Introduction: Atrial fibrillation (AF) is the most common arrhythmia and imposes a high burden on the healthcare system. A nurse-led AF outpatient clinic may alleviate the burden on the cardiology outpatient clinic by triaging patients who need care by a cardiologist or general practitioner (GP). However, care and referral patterns after initial assessment in a nurse-led AF outpatient clinic are unknown. We examined the proportion of AF patients assessed in a nurse-led clinic without outpatient follow-up by a cardiologist. Methods: All patients with AF referred to our tertiary medical centre underwent cardiac work-up in the nurse-led AF outpatient clinic and were prospectively followed. Data on patient characteristics, rhythm monitoring and echocardiography were collected and described. Odds ratio (OR) for continuing care in the nurse-led AF outpatient clinic was calculated. Results: From 2014 to 2018, 478 consecutive individual patients were referred to the nurse-led AF outpatient clinic. After the initial cardiac work-up, 139 patients (29.1%) remained under nurse-led care and 121 (25.3%) were referred to a cardiologist and 218 (45.6%) to a GP. Patients who remained under nurse-led care were significantly younger, were more symptomatic, more often had paroxysmal AF and had less comorbidities than the other two groups. After multivariable testing, CHA2DS2-VASc score ≥ 2 was associated with discontinued nurse-led care (OR 0.57, 95% confidence interval 0.34–0.95). Conclusion: After initial cardiac assessment in the nurse-led outpatient clinic, about half of the newly referred AF patients were referred back to their GP. This strategy may reduce the burden of AF patients on secondary or tertiary cardiology outpatient clinics. [ABSTRACT FROM AUTHOR]

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المؤلفون: Baalman, S W E, Van Den Berg, N W E, Neefs, J, Berger, W R, Meulendijks, E R, De Bruin-Bon, R.H.A.C.M, Van Boven, W J P, Driessen, A H G, De Groot, J R

المصدر: European Heart Journal ; volume 40, issue Supplement_1 ; ISSN 0195-668X 1522-9645

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Background Left atrial (LA) strain has a prognostic value for atrial fibrillation (AF) recurrence after AF ablation. The value of LA strain as a predictor of AF recurrence after thoracoscopic AF surgery in patients in sinus rhythm (SR) or AF during echocardiography is unknown. Purpose To assess the association between LA strain and AF recurrence after thoracoscopic surgery for AF in both patients in SR and AF during baseline echocardiography. Methods Patients participating in the AFACT trial (n=240) with baseline transthoracic echocardiography (TTE) suitable for LA strain analysis were included in this subanalyses. All patients underwent thoracoscopic pulmonary vein isolation (PVI) with left atrial appendage (LAA) exclusion, and were randomized to ganglion plexus (GP) or no GP ablation. LA strain and mechanical dispersion (MD) of the LA reservoir, conduit and contraction phase were determined retrospectively from TTE images of both patients in AF and SR before thoracoscopic AF surgery. AF recurrence was defined as any recorded atrial tachyarrhythmia lasting >30 sec during a one year FU period. Results A total of 204 patients (58.6±7.8 years, 73% male, 57% persistent AF) were included. Of the 204 patients 121 (59%) were in SR and 83 (41%) were in AF during baseline TTE. Patients in SR during TTE had higher LA strain values and lower MD compared to patients in AF. Of all patients, those with AF recurrence had lower LA strain of the reservoir phase (13.0% vs. 16.6%; p=0.003) and contraction phase (7.4% vs. 11.5%; p=0.012). MD of the contraction phase was increased in patients with AF recurrence (65.1msec vs. 19.2 msec; p=0.003). Multivariable cox regression analysis showed an association between LA strain, MD and AF recurrence (figure). Conclusions Left atrial strain and mechanical dispersion prior to thoracoscopic AF surgery are associated with recurrence of AF. LA strain showed to be a valuable tool to add in the decision making for thoracoscopic AF surgery regardless rhythm during baseline ...

الإتاحة: https://doi.org/10.1093/eurheartj/ehz748.0786Test
http://academic.oup.com/eurheartj/article-pdf/40/Supplement_1/ehz748.0786/30203223/ehz748.0786.pdfTest

المؤلفون: Neefs, J, Wesselink, R, Terpstra, M M, Van Den Berg, N W E, Berger, W R, Meulendijks, E R, Krul, S P J, Piersma, F R, De Jong, J S S G, Van Boven, W J P, Driessen, A H G, De Groot, J R

المصدر: European Heart Journal ; volume 40, issue Supplement_1 ; ISSN 0195-668X 1522-9645

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Background Severely enlarged left atrial (LA) volume is associated with a considerable ineffective outcome of ablation for atrial fibrillation (AF). Therefore, in patients with AF and a giant atrial volume catheter ablation is not recommended. However, thoracoscopic AF ablation is being performed in patients with AF and giant LA, but with unknown efficacy. Purpose To determine efficacy of thoracoscopic AF ablation in patients with AF and a giant LA. Methods Patients underwent thoracoscopic AF ablation (paroxysmal AF) plus additional left atrial ablations (persistent AF) and were prospectively followed. Giant LA was defined as left atrial volume index (LAVI)≥50 ml/m2, outcome was also assessed for LAVI≥55 ml/m2. Follow-up was performed with ECGs and 24-hour Holters every three months. After a 3-month blanking period, all AADs were discontinued. Primary outcome was recurrence of any atrial tachycardia ≥30 sec during one year of follow-up. Results Between 2008–2017, 357 patients underwent thoracoscopic AF ablation. At baseline, giant LA was diagnosed in 72 (20.2%) patients (mean LAVI: 59.5±9.6 ml/m2), while 285 (79.8%) had a smaller left atrium (mean LAVI: 36.3±7.8 ml/m2), p<0.001. Giant LA patients were older (mean: 61.7±6.9 vs 59.3±9.0 years, p=0.03) and more often diagnosed with persistent AF (n=60, 83.3%) compared to control (n=164, 57.5%), p<0.001. Sex (female: n=19, 26.4% vs n=79, 27.7%, p=0.82) and history of AF (median: 4.0 [IQR: 2.0–6.0] vs 4.0 [IQR: 2.0–8.0] years, p=0.10) were equally distributed. Freedom of any atrial tachycardia did not differ significantly between both groups (n=43, 59.7% vs n=195, 68.4%, log rank p=0.91), figure. This was similar for the cut-off of LAVI≥55 ml/m2: n=24/43 (55.8%) vs n=214/314 (68.2%), p=0.15). AF recurred in 16 (22.2%) patients with giant LA compared to 55 (19.3%) patients, while atrial tachycardia recurred in 21 (29.2%) vs 56 (19.6%) patients, respectively, p=0.06. Kaplan-Meier analysis of AF recurrence i Conclusion Thoracoscopic AF ablation is an ...

الإتاحة: https://doi.org/10.1093/eurheartj/ehz747.0608Test
http://academic.oup.com/eurheartj/article-pdf/40/Supplement_1/ehz747.0608/30196653/ehz747.0608.pdfTest

المؤلفون: Kougioumtzoglou, A M, Neefs, J, Wesselink, R, Terpstra, M M, Van Den Berg, N W E, Berger, W R, Meulendijks, E R, Krul, S P J, Piersma, F R, De Jong, J S S G, Van Boven, W J P, Driessen, A H G, De Groot, J R

المصدر: European Heart Journal ; volume 40, issue Supplement_1 ; ISSN 0195-668X 1522-9645

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Purpose To evaluate the proportion of patients in whom parameters that define the diagnosis of HFpEF and HFmrEF persist versus normalize upon elimination of AF. Background Atrial fibrillation (AF) and heart failure with preserved or mid-range ejection fraction (HFpEF or HFmrEF) concur in many patients. Distinction between these two diagnoses remains challenging as one can cause or exacerbate the other. Adequate patient selection for invasive AF treatment is crucial to improve rhythm outcome. Methods Patients underwent thoracoscopic ablation, consisting of pulmonary vein isolation (PVI) alone or PVI with additional lines in the case of persistent AF. Patients were prospectively followed-up. HFmrEF or HFpEF was defined as left ventricular ejection fraction (LVEF) ≥40% or ≥50% respectively and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels >125 pg/ml. Patients who remained free from AF, or any atrial tachycardia of more than 30 seconds, at 6 months postoperatively, were included in this study. Patients with AF recurrences during this period were excluded. The primary outcome was the change of NT-proBNP at 6 month follow-up. Results From 2008 to 2017, 92 patients undergoing thoracoscopic AF ablation fulfilled the aforementioned criteria and were included. Of these patients, mean age was 61±8 years and 66 (72%) were male. Median NT-proBNP was 366 pg/ml (128–2916) and mean LVEF was 53±7%. Thirty (35%) patients had a LVEF of 40–49%. Six months after elimination of AF, NT-proBNP was <125 pg/ml (Figure 1A: median 87 (50–122) vs 459 (137 – 2916) pg/ml at baseline; p<0.001) in 26 patients (28%), whereas in the remaining patients NT-proBNP was unchanged (Figure 1B: median 298 (126–1568) vs. 318 (128–2387) pg/ml at baseline; p=0.011). Figure 1. NT-proBNP alterations after thoracoscopic AF ablation from baseline to 6 month follow-up. A. Patients with normalization of NT-proBNP. B. Patients with unchanged high levels of NT-proBNP. Conclusion In 28% of patients the diagnostic criteria of ...

الإتاحة: https://doi.org/10.1093/eurheartj/ehz748.0589Test
http://academic.oup.com/eurheartj/article-pdf/40/Supplement_1/ehz748.0589/30205988/ehz748.0589.pdfTest

المؤلفون: Kawasaki, M, Nariswari, N A, Van Den Berg, N W E, Neefs, J, Meulendijks, E R, Wesselink, R, Baalman, S W E, Van Boven, W J P, Driessen, A H G, De Groot, J R

المصدر: European Heart Journal ; volume 40, issue Supplement_1 ; ISSN 0195-668X 1522-9645

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine

الوصف: Background Atrial fibrosis is a hallmark of atrial fibrillation (AF) and serves as an important arrhythmogenic substrate. It is formed by fibroblasts in response to tissue dyshomeostasis induced by multiple factors such as ageing, hypertension and inflammation. How fibroblasts phenotypically transform into an active form with enhanced profibrotic capacity in AF pathophysiology remains elusive. The primary cilium is an antenna-like small organelle, that function as a sensor to transduce external stimuli to intracellular signaling thereby potentially mediating the fibroblast's profibrotic capacity. Their involvement in AF pathophysiology is not known. Objective To explore the role of fibroblasts' primary cilium in the formation of the atrial fibrosis in AF. Methods Left atrial appendages (LAA) were obtained from persistent AF patients (AF: n=10) and patients without AF undergoing cardiac surgery (control: n=10). Primary cilia were immunostained with anti-acetylated a-tubulin in cryosections of the LAA. The loss of cilia in fibroblasts isolated from fresh LAA (AF: n=3, control: n=3) was induced by RNAi targeting IFT88, an essential factor for cilia formation. Gene expression and protein levels in LAA were quantified by qPCR and western blot, respectively (AF: n=20, control: n=20). Results The ratio of fibroblasts with primary cilium was significantly decreased in LAA of AF cohort (AF: 14.7%±4.6 vs control: 25.9%±3.6, p<0.01). Correspondingly, the protein levels of acetylated a-tubulin, an exclusive component of cilia, were significantly decreased both in whole LAA and fibroblast fraction of AF cohort compared to control (p<0.05). The loss of primary cilia induced by RNAi in fibroblasts resulted in increased differentiation of fibroblasts into myofibroblasts and the expression of extracellular matrix genes in response to TGF -b1. Primary cilium is disassembled along with degradation of acetylated a-tubulin by HDAC6. Indeed, a negative correlation between the protein levels of acetylated a-tubulin and ...

الإتاحة: https://doi.org/10.1093/eurheartj/ehz745.0365Test
http://academic.oup.com/eurheartj/article-pdf/40/Supplement_1/ehz745.0365/30197699/ehz745.0365.pdfTest

المؤلفون: Van den Berg, N. W. E., Slieker, M. G., van Beynum, I. M., Bilardoo, C. M., de Bruijn, D., Clur, S. A., Cornette, J. M. J., Frohn-Mulder, I. M. E., Haak, M. C., van Loo-Maurus, K. E. H., Manten, G. T. R., Rackowitz, A. B. M. H., Rammeloo, L. A. J., Reimer, A., Rijlaarsdam, M. E. B., Freund, M. W.

المصدر: Van den Berg , N W E , Slieker , M G , van Beynum , I M , Bilardoo , C M , de Bruijn , D , Clur , S A , Cornette , J M J , Frohn-Mulder , I M E , Haak , M C , van Loo-Maurus , K E H , Manten , G T R , Rackowitz , A B M H , Rammeloo , L A J , Reimer , A , Rijlaarsdam , M E B & Freund , M W 2016 , ' Fluorinated steroids do not improve ....

العلاقة: https://research.vumc.nl/en/publications/44c95584-cfd7-4890-8bdd-4810c3055ef9Test

الإتاحة: https://doi.org/10.1016/j.ijcard.2016.09.119Test
https://research.vumc.nl/en/publications/44c95584-cfd7-4890-8bdd-4810c3055ef9Test