Kevin Vernooy

Maastricht Universitair Medisch Centrum · Cardiology

Background Sleep-disordered breathing (SDB) is present in approximately half of patients with atrial fibrillation (AF) scheduled for catheter ablation (CA) and coincides with an elevated nocturnal hypoxemia. Purpose To evaluate determinants of nocturnal hypoxemic burden metrics and its association with AF recurrence after CA in patients undergoing...

Background Heart failure with preserved ejection fraction (HFpEF) frequently coexists with atrial fibrillation (AF). The diagnosis of HFpEF in AF is difficult because some diagnostic criteria for HFpEF may be associated with AF instead of HFpEF per se. Left atrial pressure (LAP) ≥15 mmHg has been used to confirm the diagnosis of HFpEF. Purpose We...

Aims To test, whether a neural network-based classifier could aid in distinguishing photoplethysmographic (PPG) pulse waveforms of ventricular from those of supraventricular origin. Methods Thirty patients undergoing invasive electrophysiological studies for documented narrow complex tachycardias between May and December 2021 at a university medic...

Background In patients with atrial fibrillation (AF), significant advances have been made in identifying biomarkers representing diverse pathophysiological pathways, such as inflammation, myocyte injury, collagen deposition, and fatty-fibrotic infiltration. Data on clinical determinants of biomarkers in patients with AF, however, are lacking. Obje...

Background Cardiac Resynchronization Therapy (CRT) is the standard treatment for patients with dyssynchronous heart failure. Despite the effectiveness of conventional biventricular pacing (BiVP), 6-16% of patients develop ventricular tachyarrhythmias (VTAs) within a year of implantation. The relationship between BiVP and the development of VTAs is...

Background The recent MyPACE trial demonstrated significant improvement of quality-of-life, physical activity, and atrial fibrillation (AF) burden with accelerated pacing as compared to the standard 60bpm back-up rate setting in patients with heart failure with preserved ejection fraction (HFpEF) and indication for pacemaker therapy. We hypothesize...

Background Non-invasive quantification of electrophysiological properties of the atria is increasingly used for outcome prediction in atrial fibrillation (AF) patients. Data on the benefit of the current classification of AF compared to AF burden based on single lead ECG measurements to predict AF recurrences are scarce. Objective This study sough...

Background Guidelines recommend opportunistic screening for atrial fibrillation (AF) in high-risk populations, including chronic obstructive pulmonary disease (COPD) patients. Purpose We aimed to assess the feasibility and yield of a photoplethysmography (PPG) smartphone app-based pathway for AF detection within a COPD outpatient clinic. Methods...

Background The HARTCAP-AF study compared the efficacy and safety outcomes in forty-one ablation-naive patients with persistent atrial fibrillation (AF) randomized to thoracoscopic hybrid ablation (HA) or stand-alone catheter ablation (CA). One-year results have shown that thoracoscopic HA has superior rhythm outcomes than CA, without increasing com...

Background AV node ablation combined with permanent pacing is an established therapy for rate control in patients with symptomatic atrial fibrillation (AF) refractory or intolerant to pharmacological rate or rhythm control and not eligible for rhythm control by left atrial catheter ablation. The threshold for performing this so-called "pace-and-abl...

Background In left bundle branch area pacing(LBBAP) a basal septal lead position is usually aimed for. However, in clinical practice LBBAP leads might be implanted in a non-basal position. A basal lead position is characterized by a paced monophasic R-wave in lead V6, whereas a non-basal position leads to a paced Rs/rS pattern in lead V6(1). Becaus...

Background Patients with heart failure with preserved ejection fraction (HFpEF) and pacemakers have been shown to benefit from moderately accelerated pacing rates compared to the standard 60bpm. HFpEF patients often present with prolonged P-wave duration (PWD) and atrial fibrillation. Right atrial appendage pacing (RAAP) lengthens PWD, RA septal (R...

Background AV node ablation combined with permanent pacing is an established therapy for rate control in patients with symptomatic atrial fibrillation (AF) refractory or intolerant to pharmacological rate or rhythm control and not eligible for rhythm control by left atrial catheter ablation. The threshold for performing this so-called "pace-and-abl...

Background The QRS area shows promise as a vectorcardiographic (VCG) marker for electrical dyssynchrony in patient selection for cardiac resynchronization therapy (CRT). Nevertheless, little information is known about the underlying cardiac electrical substrate it may reflect. Purpose The aim of this study was to compare the VCG QRS area with meas...

Background Integration of a patient’s non-invasive imaging data in a digital twin (DT) of the heart can provide valuable insight into the myocardial disease substrates underlying left ventricular (LV) mechanical discoordination. However, when generating a DT, model parameters should be identifiable to obtain robust parameter estimations. In this st...

International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommenda...

Background Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the...

Aims Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial...

Background Coronary artery calcification (CAC) is associated with poor outcome in critically ill patients. A deterioration in cardiac conduction and loss of myocardial tissue could be an underlying cause. Vectorcardiography (VCG) and cardiac biomarkers provide insight into these underlying causes. The aim of this study was to investigate whether a...

Identifying electrical dyssynchrony is crucial for cardiac pacing and cardiac resynchronization therapy (CRT). The ultra-high-frequency electrocardiography (UHF-ECG) technique allows instantaneous dyssynchrony analyses with real-time visualization. This review explores the physiological background of higher frequencies in ventricular conduction and...

Aims Simulator training has been recently introduced in electrophysiology (EP) programmes in order to improve catheter manipulation skills without complication risks. The aim of this study is to survey the current use of EP simulators and the perceived need for these tools in clinical training and practice. Methods and results A 20-item online que...

Implantable devices form an integral part of the management of patients with heart failure (HF) and provide adjunctive therapies in addition to cornerstone drug treatment. Although the number of these devices is growing, only few are supported by robust evidence. Current devices aim to improve haemodynamics, improve reverse remodelling, or provide...

Vectorcardiographic QRS area is a promising tool for patient selection and implantation guidance in cardiac resynchronization therapy (CRT). Research has mainly focused on the role of QRS area in patient selection for CRT. Recently, QRS area has been proposed as a tool to guide left ventricular lead placement in CRT. Theoretically, vector-based ele...

Aims To characterize acute lesions during cardiac magnetic resonance (CMR)-guided radiofrequency (RF) ablation of cavo-tricuspid isthmus (CTI)-dependent atrial flutter by combining T2-weighted imaging (T2WI), T1 mapping, first-pass perfusion, and late gadolinium enhancement (LGE) imaging. CMR-guided catheter ablation offers a unique opportunity to...

Aims Identifying heart failure (HF) patients who will benefit from cardiac resynchronization therapy (CRT) remains challenging. We evaluated whether virtual pacing in a digital twin (DT) of the patient’s heart could be used to predict the degree of left ventricular (LV) reverse remodelling post-CRT. Methods and results Forty-five HF patients with...

Background and Aims Data on repolarization parameters in CRT is scarce. We investigated the association of baseline T-wave area, with both clinical and echocardiographic outcomes of CRT in a large, multi-center cohort of CRT recipients. Also, we evaluated the association between baseline T-wave area and QRS area. Methods In this retrospective stud...

Aims Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period. Methods and results Two hundred ten consecutive patients referred...

Background In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments fr...

Background: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization when compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy (CRT). We sought to compare the occurrence of sustained vent...

Background/Introduction Atrial fibrillation has a complex pathophysiology such as inflammation, myocyte injury, collagen and lipid infiltration. Different biomarkers reflect these pathophysiological pathways. The biomarker Bone Morphogenetic Protein 10 (BMP10) is a secreted protein, expressed by myocytes, and is required for myocyte growth and deve...

Background Presently, only indirect evidence indicates that women may benefit more from CRT than men. Since some gender-specific baseline variables are related to CRT benefit, it is unclear whether gender by itself is predictive of CRT benefit after correction for all these differences. We aimed to examine the impact of gender-specific differences...

Background In 2021, a new and stricter ECG-based definition of LBBB was proposed and implemented in the European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy (CRT). Aim To investigate the association between the 2021 and the 2013 LBBB definitions with CRT-induced left ventricular (LV) reverse remod...

Background Among techniques to improve CRT efficacy, longer QLV (activation time at the left ventricular (LV) pacing site (LVPS)) has been proposed to correlate to response to cardiac resynchronization therapy (CRT), supporting that pacing close to the latest LV electrically activated site (LEAS) improves CRT efficacy. A QLV cut-off of > 95 ms has...

Background Late gadolinium enhancement (LGE) MRI is considered the standard for noninvasive assessment of 3D scar architecture. Intraprocedural integration of 3D scar models improve the outcome of catheter ablation for ventricular tachycardia (VT). A pixel signal intensity (PSI) cut-off of 40 to 60% has been widely used for conventional bright-bloo...

His bundle pacing and left bundle branch pacing, together referred to as conduction system pacing, have (re)gained considerable interest over the past years as it has the potential to preserve and/or restore a more physiological ventricular activation when compared with right ventricular pacing and may serve as an alternative for cardiac resynchron...

Background Invasive measurements of left ventricular (LV) hemodynamic performance can evaluate acute response to cardiac resynchronization therapy (CRT). Objective The study sought to determine which metric, maximum rate of LV pressure rise (LV dP/dtmax) or LV stroke work (LVSW), is more strongly associated with long-term prognosis. Methods CRT p...

Background 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....

Purpose: Pericardial fat (PF) and epicardial adipose tissue (EAT) may enhance the proinflammatory response in corona virus-19 (COVID-19) patients. Higher PF and EAT volumes might result in multiorgan failure and explain unfavorable trajectories.The aim of this study was to examine the association between the volume of PF and EAT and multiorgan fai...

Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials le...

The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology h...

Background and aims Chronic obstructive pulmonary disease (COPD) negatively impacts the efficacy of heart rhythm control treatments in patients with atrial fibrillation (AF). Although COPD is recognized as a risk factor for AF, practical guidance about how and when to screen for COPD is not available. Herein, we describe the implementation of an in...

Aims To test the feasibility of postprocedural photoplethysmography (PPG) rhythm telemonitoring during the first week after atrial fibrillation (AF) ablation and its predictive value for later AF recurrence. Methods PPG rhythm telemonitoring during the first week after the ablation procedure was offered to a total of 382 consecutive patients under...

Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance (CMR)-guided ablation therapy offers a unique opportunity and incentive to investigate acute ablation lesions. Until present, human studies only used T2-weighted imaging (T2WI) and late gadolinium enhancement (LGE) to assess acute ablation lesions. Purpo...

Background: Implantable cardioverter-defibrillators (ICDs) are effective in detecting and treating ventricular arrhythmias. Studies on ICD therapy for different indications (primary and secondary prevention) and possible predictors of ICD therapy are limited. In this study, the incidence and type of ICD therapy were related to the indication and t...

Background: Implantation of a permanent pacemaker and atrioventricular (AV) node ablation (pace-and-ablate) is an established approach for rate and symptom control in elderly patients with symptomatic atrial fibrillation (AF). Left bundle branch area pacing (LBBAP) is a physiological pacing strategy that might overcome right ventricular pacing-ind...

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Aims: Focus of pacemaker therapy is shifting from right ventricular (RV) apex pacing (RVAP) and biventricular pacing (BiVP) to conduction system pacing. Direct comparison between the different pacing modalities and their consequences to cardiac pump function is difficult, due to the practical implications and confounding variables. Computational m...

Background: Atrial fibrillation (AF) is common in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and has a negative impact on outcome. Reliable data on prevalence, incidence, and detection of AF from contemporary, prospective HFmrEF/HFpEF studies are scarce. Methods: This was a prespecified sub-analysis from a pr...

Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) frequently coexists with atrial fibrillation (AF). The gold-standard test for HFpEF diagnosis remains invasive assessment of left ventricular end-diastolic pressures but noninvasive diagnostic scoring systems have been develope...

Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a novel remote on-demand mobile health (mHealth) infrastructure supporting teleconsultations. During the COVID-19 pandemic, social media (SoMe) communication on Twitter contributed to the rapid dissemination and implementation of this health care innovation into 41...

Funding Acknowledgements Type of funding sources: None. Introduction Chronic obstructive pulmonary disease (COPD) is a well-recognized risk factor for atrial fibrillation (AF) and negatively impacts symptom burden and AF rhythm control treatment. Nevertheless, there are currently no guideline recommendations or practical guides about whether or no...

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Personal grant from the Dutch Heart Foundation. Background In the normal human heart, the polarity of the T-wave is concordant with the QRS complex. This phenomenon is often explained by longer repolarization of earlier activated regions. Patients with de...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Left bundle branch area pacing(LBBAP) has been introduced as a more physiological pacing alternative to anti-bradycardia pacing and as an alternative to biventricular pacing in cardiac resynchronization therapy (CRT). LBBAP is the common...

Funding Acknowledgements Type of funding sources: None. Background In patients with atrial fibrillation (AF), expiratory airflow limitation adds to overall morbidity and may impair the response to heart rhythm control strategies. Purpose We aimed to determine the prevalence of expiratory airflow limitation in patients scheduled for AF ablation an...

Funding Acknowledgements Type of funding sources: None. Purpose Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients undergoing atrial fibrillation (AF) ablation. Currently, it remains unclear whether all AF patients should be systematically screened for SDB, or whether pre-selection of patients requiring screening can be improve...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): unrestricted grant from Abbott-Netherlands to the University Medical Center Groningen Introduction Atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) commonly co-exist and both conditions are typically characterized by i...

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation; Health Foundation Limburg Background The pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF) is heterogeneous and incompletely understood. Identifying phenotypes of HFpEF is a promising approach to determine the...

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): a.o. The European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, gran...

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) and atherosclerosis often coexist due to a shared risk profile. Prior to an AF ablation, computed tomography (CT) scans are routinely performed to assess pulmonary vein anatomy. Often coronary plaques are described as incidental findings. According to curre...

Funding Acknowledgements Type of funding sources: None. Introduction This study sought to examine the prognostic role of quantifying areas of interest in preinterventional cardiac magnetic resonance (CMR) in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). Background The role of preinterventional...

Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a multicentre international project initiated to implement remote care delivery for patients with atrial fibrillation (AF) through teleconsultations supported by an on-demand photoplethysmography (PPG)-based heart rate/rhythm monitoring app. Purpose The current sub...

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work is part of Personalize AF. This project received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 860974, This work was also supported by the Swiss Nati...

Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) has been established as an effective therapeutic option to achieve rhythm control in patients with atrial fibrillation (AF). However, AF recurrence occurs in approximately 45% of the patients undergoing CA. The association between AF recurrence after CA and l...

Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a digital care pathway, which consists of a structured teleconsultation ("Tele") preceded by an app-based on-demand heart rate and rhythm monitoring infrastructure ("Check") and the consecutive integration of the app-derived findings in a comprehensive atrial fibril...

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): This work was supported by the National Institute for Research of Metabolic and Cardiovascular Diseases project (Programme EXCELES, ID Project No. LX22NPO5104) — Funded by the European Union — Next Generation EU and a personal grant from the Dutch Heart Fo...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO) Background Left bundle branch area pacing (LBBAP) has been introduced as an alternative, more physiological pacing strategy to biventricular pacing (BiVP). LBBAP can result in selective LBB pacing (sLBB...

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation. Background Biventricular pacing (BiVP) is the standard treatment for patients with dyssynchronous heart failure. Despite the effectiveness of BiVP, 6% of patients develop ventricular tachyarrhythmia’s (VTAs) within one year following impla...

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing‐induced cardiomyopathy. This clinical practice guideline is intende...

Cardiac Resynchronization Therapy (CRT) is an established technique to improve morbidity and mortality in selected heart failure patients [...]

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intende...

Background: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP. O...

The conduction system of the human heart is composed of specialized cardiomyocytes that initiate and propagate the electric impulse with consequent rhythmic and synchronized contraction of the atria and ventricles, resulting in the normal cardiac cycle. Although the His–Purkinje system (HPS) was already described more than a century ago, there has...

Background The “double fire” (DF) atrioventricular (AV) nodal response is a rare mechanism of two ventricular electrical activations following a single atrial beat due to dual AV node physiology. DF AV nodal response is often misdiagnosed and may lead to unnecessary and sometimes risky interventions. Case summary We describe a series of three case...

Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last years with the advent of tools which have facilitated implantation....

Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implanta...

Aims: The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. Methods and results: A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60...

Aims: We aimed to investigate the impact of the 2021 ESC guideline changes in left bundle branch block(LBBB) definition on cardiac resynchronization therapy(CRT) patient selection and outcomes. Methods: The MUG(Maastricht-Utrecht-Groningen) registry, consisting of consecutive patients implanted with a CRT device between 2001 and 2015 was studied...