Tilt training as a treatment for reflex syncope: a multimodal approach!?

Purpose: Reflex syncope is a burdensome disease with considerable repercussions on the quality of life. Tilt training is a therapeutic option, but evidence on this topic is scarce and outdated. Hyperventilation is oftentimes associated with reflex syncope.

Effectiveness of photoplethysmography-based rhythm monitoring after atrial fibrillation ablation using a smartphone application: DIGITOTAL study.

Background: Recurrence after atrial fibrillation (AF) ablation is frequent. Monitoring with long-term electrocardiograms (ECGs) is constrained by limited monitoring time, measurement dispersion, and cost. Selected photoplethysmography (PPG) smartphone applications have demonstrated excellent accuracy for AF detection and could mitigate these limitations.

Atrial arrhythmia and heart failure in adult patients with congenital heart disease: a retrospective cohort study.

Background: Atrial arrhythmias (AA) and heart failure (HF) are major causes of hospitalisation in adult congenital heart disease (ACHD). This study aimed to evaluate the temporal relationship between AA and HF onset, the association between HF and the success of radiofrequency ablation (RFA), and how HF influences outcomes in patients with AA.

Methods: In this single-centre retrospective cohort study, data from 3995 patients with ACHD were analysed.

Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation.

Aims: Photoplethysmography- (PPG) based smartphone applications facilitate heart rate and rhythm monitoring in patients with paroxysmal and persistent atrial fibrillation (AF). Despite an endorsement from the European Heart Rhythm Association, validation studies in this setting are lacking. Therefore, we evaluated the accuracy of PPG-derived heart rate and rhythm classification in subjects with an established diagnosis of AF in unsupervised real-world conditions.

The autonomic nervous system in atrial fibrillation-pathophysiology and non-invasive assessment.

The autonomic nervous system plays a crucial role in atrial fibrillation pathophysiology. Parasympathetic hyperactivity result in a shortening of the action potential duration, a reduction of the conduction wavelength, and as such facilitates reentry in the presence of triggers. Further, autonomic remodeling of atrial myocytes in AF includes progressive sympathetic hyperinnervation by increased atrial sympathetic nerve density and sympathetic atrial nerve sprouting.

Smartphone-based atrial fibrillation screening in the general population: feasibility and impact on medical treatment.

Aims: The aim of this study is to determine the feasibility, detection rate, and therapeutic implications of large-scale smartphone-based screening for atrial fibrillation (AF).

Methods And Results: Subjects from the general population in Belgium were recruited through a media campaign to perform AF screening during 8 consecutive days with a smartphone application. The application analyses photoplethysmography traces with artificial intelligence and offline validation of suspected signals to detect AF.

Evolution of ventricular and valve function in patients with right ventricular pacing - A randomized controlled trial comparing leadless and conventional pacing.

Background: Leadless pacemakers (PMs) were recently introduced to overcome lead-related complications. They showed high safety and efficacy profiles. Prospective studies assessing long-term safety on cardiac structures are still missing.

Detecting Paroxysmal Atrial Fibrillation From an Electrocardiogram in Sinus Rhythm: External Validation of the AI Approach.

Background: Atrial fibrillation (AF) may occur asymptomatically and can be diagnosed only with electrocardiography (ECG) while the arrhythmia is present.

Objectives: The aim of this study was to independently validate the approach of using artificial intelligence (AI) to identify underlying paroxysmal AF from a 12-lead ECG in sinus rhythm (SR).

Methods: An AI algorithm was trained to identify patients with underlying paroxysmal AF, using electrocardiographic data from all in- and outpatients from a single center with at least 1 ECG in SR.

Individualized QT interval (QTi) is a powerful diagnostic tool in long QT syndrome: results from a large validation study.

Aims: Diagnosis of Long QT syndrome (LQTS) is based on prolongation of the QT interval corrected for heart rate (QTc) on surface ECG and genotyping. However, up to 25% of genotype positive patients have a normal QTc interval. We recently showed that individualized QT interval (QTi) derived from 24 h holter data and defined as the QT value at the intersection of an RR interval of 1,000 ms with the linear regression line fitted through QT-RR data points of each individual patient was superior over QTc to predict mutation status in LQTS families.

Is it feasible to outsource the remote monitoring of implantable cardiac defibrillators in a large tertiary hospital?

Aim: To provide a detailed description of the workflow at our telecardiology centre and to analyse the workload of real-world remote monitoring with the aim to assess the feasibility to outsource this service.

Methods: analysis was conducted on the telecardiology service provided at the University Hospitals of Leuven by extracting patient demographic data, general time usage and detailed information about the type of remote contacts. 10,869 contacts in 948 patients have been included.

Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF.

This study aims to compare the performance of physicians to detect atrial fibrillation (AF) based on photoplethysmography (PPG), single-lead ECG and 12-lead ECG, and to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians. Email invitations to participate in an online survey were distributed among physicians to analyse almost simultaneously recorded PPG, single-lead ECG and 12-lead ECG traces from 30 patients (10 in sinus rhythm (SR), 10 in SR with ectopic beats and 10 in AF). The task was to classify the readings as 'SR', 'ectopic/missed beats', 'AF', 'flutter' or 'unreadable'.

Quality of life outcomes in cryoablation of atrial fibrillation-A literature review.

Background: Cryoballoon ablation (CRYO) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) has become an established treatment option as alternative for radiofrequency catheter ablation (RFCA). As symptom relief is still the main indication for PVI, quality of life (QoL) is a key outcome parameter. This review summarizes the evidence about the evolution of QoL after CRYO.

Atrial Fibrillation Population Screening.

Atrial fibrillation (AF) is associated with adverse outcomes. Screening may lead to earlier recognition and treatment of asymptomatic AF. However, most evidence regarding AF applies to clinical AF, with symptoms or electrocardiographic diagnosis.

Durable Physiological Changes and Decreased Syncope Burden 12 Months After Unifocal Right-Sided Ablation Under Computed Tomographic Guidance in Patients With Neurally Mediated Syncope or Functional Sinus Node Dysfunction.

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Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study.

Background: Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery, yet the precise incidence and significance of arrhythmias after discharge home need to be better defined. Photoplethysmography (PPG)-based smartphone apps are promising tools to enable early detection and follow-up of arrhythmias.

Objective: By using a PPG-based smartphone app, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care.

Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy.

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular arrhythmia that is frequently encountered in an otherwise healthy patient population. Recent guidelines of the European Society of Cardiology underline the role of catheter ablation in the long-term management of these patients.

Case Summary: This case describes the clinical presentation and treatment options in a patient with typical slow/fast AVNRT, the most common subform of AVNRT, where antegrade conduction occurs over the slow pathway and retrograde conduction over the fast pathway.

Leadless pacemaker for patients following cardiac valve intervention.

Background: Permanent pacing is common after valve intervention. The presence of a conventional pacemaker in this population is recognized as a risk factor for infectious events. Therefore, a leadless pacing system could be the preferred strategy when permanent pacing is required after valve intervention.

Bacteraemia after leadless pacemaker implantation.

Background: Transvenous 3 permanent pacemaker-related infection is a severe condition associated with significant morbidity and mortality. Leadless pacemakers may be more resistant to bacterial seeding during bloodstream infection because of its small surface area and encapsulation in the right ventricle. This study reports the incidence and outcomes of bacteraemia in patients implanted with a Micra leadless pacemaker.

Determinants of the difficulty of leadless pacemaker implantation.

Background: The Micra Transcatheter Pacing System is implanted directly in the right ventricle (RV) through the femoral vein using a steerable transcatheter delivery system. The present study was done to identify determinants of difficult leadless pacemaker implant procedures including operator, patient, and RV anatomical characteristics.

Methods: All patients who underwent a Micra implant from July 2015 to December 2018 at our center were analyzed.

Leadless pacing with Micra TPS: A comparison between right ventricular outflow tract, mid-septal, and apical implant sites.

Background: With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long-term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid-septal, and apical implant positions.

Re-implantation after extraction of a cardiac implantable electronic device.

With increasing cardiovascular implantable electronic device (CIED) implantations, growing number of extractions of leads and devices are noted, mainly for complications such as infection and lead dysfunction. The optimal timing for re-implantation remains uncertain. We  investigated the time to eventual re-implantation of CIEDs in the University Hospitals Leuven, Belgium.