Publications by authors named "Maesen B"
Background: Focal pulsed-field ablation (F-PFA) integrated in electroanatomical mapping (EAM) systems allows tailored lesion sets in patients with atrial fibrillation (AF).
Objective: To determine feasibility, safety and 6-months outcome of F-PFA for a tailored substrate-based catheter ablation (CA) approach in patients with AF and advanced atrial substrate.
Methods: Consecutive patients with AF and advanced atrial substrate treated by a F-PFA system (Cardiofocus) through contact-force sensing catheters integrated in EAM systems were prospectively enrolled.
Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines.
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- * A meta-analysis of 951 studies identified 19 relevant studies, revealing that patients at high to extreme risk saw a greater increase in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores compared to intermediate risk patients.
- * Although TAVI had a positive effect on HrQoL, the impact of frailty on post-TAVI outcomes showed mixed results between randomized and non-randomized studies, highlighting the need for further investigation.
Aims: Both isolated thoracoscopic and hybrid thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favourable outcomes in the management of patients with (long-standing) persistent AF, as compared with catheter ablation. However, it is currently unknown whether there is a difference in short- and long-term outcomes when comparing these two minimally invasive surgical AF ablation procedures. Therefore, a systematic review and meta-analysis were performed to investigate these two techniques, with a specific emphasis on long-term freedom from atrial tachyarrhythmias (ATAs).
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- This study investigates how gender affects decision-making for oral anticoagulation in patients with atrial fibrillation (AF), using a large dataset of over 16 million patients from UK primary care between 2005-2020.
- It found that in patients aged 40-75 without prior strokes, women had a lower adjusted rate of primary outcomes (death, ischemic stroke, or thromboembolism) compared to men, primarily due to lower mortality rates in women.
- The study concludes that omitting gender from clinical risk scores could streamline the process of determining which AF patients should receive oral anticoagulation.
Article Synopsis
- Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and can lead to more frequent late-POAF recurrences, yet its impact on long-term outcomes isn't well understood.
- This study aimed to understand the extent of POAF burden in the early postoperative period and its relationship with late-POAF recurrences over 2.5 years of continuous monitoring after surgery.
- Results indicated that higher early-POAF burden, particularly the duration of the longest POAF episode, is significantly linked to an increased risk of experiencing late-POAF episodes, suggesting early POAF monitoring could help predict long-term outcomes.
Objectives: Our goal was to investigate sinus node dysfunction (SND) as a rare complication following surgical and catheter atrial fibrillation (AF) ablation in patients with an aberrant sinus node artery (SNA).
Methods: We used a retrospective analysis of 3 patients with an aberrant SNA who underwent different AF ablation procedures: 1 concomitant to aortic valve replacement, 1 thoracoscopic hybrid AF ablation and 1 catheter AF ablation.
Results: All patients experienced temporary SND perioperatively.
Article Synopsis
- Left atrial appendage closure (LAAC) during heart surgery for atrial fibrillation (AF) patients may lower long-term stroke risk and mortality, but mixed evidence exists regarding its effectiveness in non-AF patients.
- A review of 25 studies indicated that while LAAC reduced early stroke risk by 19% and late stroke risk by 13%, it showed no advantages for patients without AF.
- Overall, LAAC appears beneficial in patients with preoperative AF, suggesting it could reduce long-term mortality and stroke rates, but there’s insufficient evidence to recommend it for those without AF.
Article Synopsis
- Dark-blood late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is more effective than bright-blood LGE CMR for accurately defining ablation scars in the left atrium of patients undergoing atrial fibrillation ablation.
- This study examined the optimal signal intensity threshold of dark-blood LGE CMR to identify these scars, utilizing image intensity ratios (IIRs) from 54 patients.
- The results suggest an optimal IIR threshold of 1.09, with recommendations to use a range of 1.00 to 1.10 due to interpatient variability in detecting LA ablation scars.
The number of individuals referred for coronary artery bypass grafting (CABG) with preoperative atrial fibrillation (AF) is reported to be 8% to 20%. Atrial fibrillation is a known marker of high-risk patients as it was repeatedly found to negatively influence survival. Therefore, when performing surgical revascularization, consideration should be given to the concomitant treatment of the arrhythmia, the clinical consequences of the arrhythmia itself, and the selection of adequate surgical techniques.
View Article and Find Full Text PDFBackground: Serum bone morphogenetic protein 10 (BMP10) blood levels are a marker for history of atrial fibrillation (AF) and for major adverse cardiovascular events in patients with AF, including stroke, AF recurrences after catheter ablations, and mortality. The predictive value of BMP10 in patients undergoing cardiac surgery and association with morphologic properties of atrial tissues are unknown.
Objectives: This study sought to study the correlation between BMP10 levels and preoperative clinical traits, occurrence of early and late postoperative atrial fibrillation (POAF), and atrial fibrosis in patients undergoing cardiac surgery.
Article Synopsis
- Atrial fibrillation (AF) ablation has become a well-established treatment method in the last 30 years, supported by evidence showing it is safe and effective.
- In response to advancements in research and technology, new guidelines have been released over the years, the latest being necessary to provide updated recommendations for patient care.
- This revised consensus involves collaboration among major cardiac electrophysiology societies from Europe, Asia-Pacific, and Latin America to ensure comprehensive guidelines for AF treatment.
Objectives: Thoracoscopic hybrid ablation is an effective and safe rhythm control strategy for patients with complex forms of atrial fibrillation. Its effect on left atrial function has not yet been studied.
Methods: In a retrospective single-centre analysis of patients undergoing thoracoscopic hybrid ablation, the left atrial emptying fraction was calculated using the biplane modified Simpson method in the apical 2- and 4-chamber views on transthoracic echocardiography.
Background: Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with late atrial fibrillation (AF) recurrences (late-POAF) and increased morbidity and long-term mortality.
Objectives: This study sought to determine device-detected POAF incidence and to identify clinical variables associated with POAF, both in patients with and without preoperative AF history.
Methods: A total of 133 consecutive patients undergoing cardiac surgery were prospectively enrolled and continuously monitored with an implantable loop recorder for 2.
Hybrid atrial fibrillation ablation.
Ann Cardiothorac Surg
January 2024
In this state-of-the art review on hybrid atrial fibrillation (AF) ablation, we briefly focus on the pathophysiology of AF, the rationale for the hybrid approach, its technical aspects and the efficacy and safety outcomes after hybrid AF ablation, both from meta-analyses and randomized control trial data. Also, we performed a systematic search to provide a provisional overview of real-world hybrid AF ablation efficacy and safety outcomes. Furthermore, we give an insight into the 'Maastricht approach', an approach that allows us to tailor the ablation procedure to the individual patient.
View Article and Find Full Text PDFBackground: Surgical ablation for atrial fibrillation at the time of isolated coronary artery bypass grafting is reluctantly attempted. Meanwhile, complete revascularization is not always possible in these patients. We attempted to counterbalance the long-term benefits of surgical ablation against the risks of incomplete revascularization.
View Article and Find Full Text PDFObjectives: The use of cerebral embolic protection (CEP) during transcatheter aortic valve implantation (TAVI) has been studied in several randomised trials. We aimed to perform a systematic review and Bayesian meta-analysis of randomised CEP trials, focusing on a clinically relevant reduction in disabling stroke.
Methods: A systematic search was applied to three electronic databases, including trials that randomised TAVI patients to CEP versus standard treatment.
Background: Atrial cardiomyopathy (atCM) is an emerging prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not been quantified.
View Article and Find Full Text PDFBackground: The combination of information obtained from pre-procedural cardiac imaging and electro-anatomical mapping (EAM) can potentially help to locate new ablation targets. In this study we developed and evaluated a fully automated technique to align left atrial (LA) anatomies obtained from CT- and MRI-scans with LA anatomies obtained from EAM.
Methods: Twenty-one patients scheduled for a pulmonary vein (PV) isolation with a pre-procedural MRI were enrolled.
Objectives: Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the management of patients on DOACs in the perioperative phase.
Methods: A general literature review was conducted on the pharmacology of DOACs and for recommendations on the management of cardiac surgical patients on DOACs.
Article Synopsis
- This study developed a machine learning model to predict new-onset postoperative atrial fibrillation (POAF) in patients after coronary artery bypass grafting (CABG).
- Four machine learning algorithms were used to analyze data from 394 patients, with the Random Forest model ultimately showing the best predictive performance based on several key clinical factors.
- Key predictive features identified included patient age, preoperative creatinine levels, time of aortic cross-clamping, body surface area, and Logistic Euro-Score, emphasizing the importance of tailored evaluations in clinical settings.
Background: Although catheter ablation (CA) is successful for the treatment of paroxysmal atrial fibrillation (AF), results are less satisfactory in persistent AF. Hybrid ablation (HA) results in better outcomes in patients with persistent atrial fibrillation (persAF), as it combines a thoracoscopic epicardial and transvenous endocardial approach in a single procedure.
Objectives: The purpose of this study was to compare the effectiveness and safety of HA with CA in a prospective, superiority, unblinded, randomized controlled trial.