Publications by authors named "Frank van Rosmalen"

9 Publications

  • Page 1 of 1

Corrected QT interval prolongation after ganglionated plexus ablation: myth or reality?-Authors' reply.

Europace 2021 Jun 23. Epub 2021 Jun 23.

Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.

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http://dx.doi.org/10.1093/europace/euab148DOI Listing
June 2021

Does pulmonary vein isolation prolong QT-interval?- Authors' reply.

Europace 2021 Jun 15. Epub 2021 Jun 15.

Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.

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http://dx.doi.org/10.1093/europace/euab153DOI Listing
June 2021

Incidence, prevalence, and trajectories of repetitive conduction patterns in human atrial fibrillation.

Europace 2021 03;23(23 Suppl 1):i123-i132

Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.

Aims: Repetitive conduction patterns in atrial fibrillation (AF) may reflect anatomical structures harbouring preferential conduction paths and indicate the presence of stationary sources for AF. Recently, we demonstrated a novel technique to detect repetitive patterns in high-density contact mapping of AF. As a first step towards repetitive pattern mapping to guide AF ablation, we determined the incidence, prevalence, and trajectories of repetitive conduction patterns in epicardial contact mapping of paroxysmal and persistent AF patients.

Methods And Results: A 256-channel mapping array was used to record epicardial left and right AF electrograms in persistent AF (persAF, n = 9) and paroxysmal AF (pAF, n = 11) patients. Intervals containing repetitive conduction patterns were detected using recurrence plots. Activation movies, preferential conduction direction, and average activation sequence were used to characterize and classify conduction patterns. Repetitive patterns were identified in 33/40 recordings. Repetitive patterns were more prevalent in pAF compared with persAF [pAF: median 59%, inter-quartile range (41-72) vs. persAF: 39% (0-51), P < 0.01], larger [pAF: = 1.54 (1.15-1.96) vs. persAF: 1.16 (0.74-1.56) cm2, P < 0.001), and more stable [normalized preferentiality (0-1) pAF: 0.38 (0.25-0.50) vs. persAF: 0.23 (0-0.33), P < 0.01]. Most repetitive patterns were peripheral waves (87%), often with conduction block (69%), while breakthroughs (9%) and re-entries (2%) occurred less frequently.

Conclusion: High-density epicardial contact mapping in AF patients reveals frequent repetitive conduction patterns. In persistent AF patients, repetitive patterns were less frequent, smaller, and more variable than in paroxysmal AF patients. Future research should elucidate whether these patterns can help in finding AF ablation targets.
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http://dx.doi.org/10.1093/europace/euaa403DOI Listing
March 2021

Pulmonary vein isolation in a real-world population does not influence QTc interval.

Europace 2021 03;23(23 Suppl 1):i48-i54

Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.

Aims: We aimed to examine whether routine pulmonary vein isolation (PVI) induces significant ventricular repolarization changes as suggested earlier.

Methods And Results: Five-minute electrocardiograms were recorded at hospital's admission (T-1d), 1 day after the PVI-procedure (T+1d) and at 3 months post-procedure (T+3m) from a registry of consecutive atrial fibrillation (AF) patients scheduled for routine PVI with different PVI modalities (radiofrequency, cryo-ablation, and hybrid). Only patients who were in sinus rhythm at all three recordings (n = 117) were included. QT-intervals and QT-dispersion were evaluated with custom-made software and QTc was calculated using Bazett's, Fridericia's, Framingham's, and Hodges' formulas. Both QT- and RR-intervals were significantly shorter at T+1d (399 ± 37 and 870 ± 141 ms) and T+3m (407 ± 36 and 950 ± 140 ms) compared with baseline (417 ± 36 and 1025 ± 164 ms). There was no statistically significant within-subject difference in QTc Fridericia (T-1d 416 ± 28 ms, T+1d 419 ± 33 ms, and T+3m 414 ± 25 ms) and QT-dispersion (T-1d 18 ± 12 ms, T+1d 21 ± 19 ms, and T+3m 17 ± 12 ms) between the recordings. A multiple linear regression model with age, sex, AF type, ablation technique, first/re-do ablation, and AF recurrence to predict the change in QTc at T+3m with respect to QTc at T-1d did not reach significance which indicates that the change in QTc does not differ between all subgroups (age, sex, AF type, ablation technique, first/re-do ablation, and AF recurrence).

Conclusion: Based on our data a routine PVI does not result in a prolongation of QTc in a real-world population. These findings, therefore, suggest that there is no need to intensify post-PVI QT-interval monitoring.
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http://dx.doi.org/10.1093/europace/euaa390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943360PMC
March 2021

A Novel Tool for the Identification and Characterization of Repetitive Patterns in High-Density Contact Mapping of Atrial Fibrillation.

Front Physiol 2020 15;11:570118. Epub 2020 Oct 15.

Department of Physiology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.

Introduction: Electrical contact mapping provides a detailed view of conduction patterns in the atria during atrial fibrillation (AF). Identification of repetitive wave front propagation mechanisms potentially initiating or sustaining AF might provide more insights into temporal and spatial distribution of candidate AF mechanism and identify targets for catheter ablation. We developed a novel tool based on recurrence plots to automatically identify and characterize repetitive conduction patterns in high-density contact mapping of AF.

Materials And Methods: Recurrence plots were constructed by first transforming atrial electrograms recorded by a multi-electrode array to activation-phase signals and then quantifying the degree of similarity between snapshots of the activation-phase in the electrode array. An AF cycle length dependent distance threshold was applied to discriminate between repetitive and non-repetitive snapshots. Intervals containing repetitive conduction patterns were detected in a recurrence plot as regions with a high recurrence rate. Intervals that contained similar repetitive patterns were then grouped into clusters. To demonstrate the ability to detect and quantify the incidence, duration and size of repetitive patterns, the tool was applied to left and right atrial recordings in a goat model of different duration of persistent AF [3 weeks AF (3 wkAF, = 8) and 22 weeks AF (22 wkAF, = 8)], using a 249-electrode mapping array (2.4 mm inter-electrode distance).

Results: Recurrence plots identified frequent recurrences of activation patterns in all recordings and indicated a strong correlation between recurrence plot threshold and AF cycle length. Prolonged AF duration was associated with shorter repetitive pattern duration [mean maximum duration 3 wkAF: 74 cycles, 95% confidence interval (54-94) vs. 22 wkAF: 41 cycles (21-62), = 0.03], and smaller recurrent regions within repetitive patterns [3 wkAF 1.7 cm (1.0-2.3) vs. 22 wkAF 0.5 cm (0.0-1.2), = 0.02]. Both breakthrough patterns and re-entry were identified as repetitive conduction patterns.

Conclusion: Recurrence plots provide a novel way to delineate high-density contact mapping of AF. Dominant repetitive conduction patterns were identified in a goat model of sustained AF. Application of the developed methodology using the new generation of multi-electrode catheters could identify additional targets for catheter ablation of AF.
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http://dx.doi.org/10.3389/fphys.2020.570118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593698PMC
October 2020

Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort (MaastrICCht).

BMJ Open 2020 09 29;10(9):e040175. Epub 2020 Sep 29.

Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands.

Introduction: The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection.

Methods And Analysis: Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht.

Ethics And Dissemination: Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early.

Trial Registration Number: The Netherlands Trial Register (NL8613).
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http://dx.doi.org/10.1136/bmjopen-2020-040175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526030PMC
September 2020

Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry.

J Interv Card Electrophysiol 2021 Apr 30;60(3):395-406. Epub 2020 Apr 30.

Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.

Background: Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety.

Methods: The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared.

Results: Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991).

Conclusions: The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
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http://dx.doi.org/10.1007/s10840-020-00744-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134287PMC
April 2021

Ten-year follow-up after endocardial point-by-point cryoablation for paroxysmal atrial fibrillation.

Acta Cardiol 2021 Jun 1;76(4):425-430. Epub 2020 May 1.

Department of Cardiology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands.

Background: Since many years catheter ablation is widely used for the treatment of atrial fibrillation (AF), however, long-term follow-up data of ablation techniques are rare. This study presents a 10-year follow-up period in patients treated for paroxysmal AF (PAF) with point-by-point pulmonary vein isolation (PVI) using cryothermal energy (cryoPVI). The main objective is to investigate whether cryoPVI is able to create durable PVI.

Methods: All consecutive patients with PAF who underwent a point-by-point cryoPVI were included. Information from the index procedure, anti-arrhythmic drug (AAD) use, recurrence of arrhythmias and re-ablation, was retrospectively analysed. Re-ablations were specifically evaluated for reconnection of PVs.

Results: Seventy-three patients were included. Five (7%) were lost to follow-up and 55/73 (75%) reached 10-year follow-up (median follow-up duration: 11.3 years [10.0-12.4]). Thirteen (18%) did not reach 10-years follow-up (mean follow-up duration: 4.4 ± 3.3 years). All targeted PVs were successfully isolated during the index procedure. Only 10/68 patients (15%) kept sinus rhythm (SR) without the use of AAD or a re-ablation. Re-ablations were performed in 47/68 patients (69%). Reconnection was seen in 81% of the PVs.

Conclusions: Ostial point-by-point cryoPVI has the ability to provide acute electrical isolation of arrhythmogenic PVs based on abolition of all PV potentials, but fails in long-term isolation and prevention of AF-recurrence in most patients.
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http://dx.doi.org/10.1080/00015385.2020.1756087DOI Listing
June 2021

Automatic detection and visualisation of MEG ripple oscillations in epilepsy.

Neuroimage Clin 2017 17;15:689-701. Epub 2017 Jun 17.

Department of Clinical Neurophysiology and Magnetoencephalography Center, VU University Medical Center, Amsterdam, The Netherlands.

High frequency oscillations (HFOs, 80-500 Hz) in invasive EEG are a biomarker for the epileptic focus. Ripples (80-250 Hz) have also been identified in non-invasive MEG, yet detection is impeded by noise, their low occurrence rates, and the workload of visual analysis. We propose a method that identifies ripples in MEG through noise reduction, beamforming and automatic detection with minimal user effort. We analysed 15 min of presurgical resting-state interictal MEG data of 25 patients with epilepsy. The MEG signal-to-noise was improved by using a cross-validation signal space separation method, and by calculating ~ 2400 beamformer-based virtual sensors in the grey matter. Ripples in these sensors were automatically detected by an algorithm optimized for MEG. A small subset of the identified ripples was visually checked. Ripple locations were compared with MEG spike dipole locations and the resection area if available. Running the automatic detection algorithm resulted in on average 905 ripples per patient, of which on average 148 ripples were visually reviewed. Reviewing took approximately 5 min per patient, and identified ripples in 16 out of 25 patients. In 14 patients the ripple locations showed good or moderate concordance with the MEG spikes. For six out of eight patients who had surgery, the ripple locations showed concordance with the resection area: 4/5 with good outcome and 2/3 with poor outcome. Automatic ripple detection in beamformer-based virtual sensors is a feasible non-invasive tool for the identification of ripples in MEG. Our method requires minimal user effort and is easily applicable in a clinical setting.
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http://dx.doi.org/10.1016/j.nicl.2017.06.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486372PMC
April 2018
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