Project 10

Translationa and Clinicall Electrophysiology

Translational and Clinical Electrophysiology Part I

Our research projects are aimed at developing innovative diagnostic tools and therapies by implementing basic electrophysiology into daily clinical practice. Main research topics are mechanisms of (post-operative) atrial fibrillation, dysrhythmias in patients with congenital heart disease, channelopathies and development of electro-anatomical mapping techniques.
Atrial fibrillation (AF) is associated with significant morbidity and mortality. The prevalence of AF will continue to rise and AF will persist to pose a major burden on public health costs. Anti-arrhythmic drugs are often not effective in eliminating AF episodes and ablative therapy is also not so successful as first assumed. The expected epidemic of AF necessitates research in order to develop preventive strategies, to improve existing treatment modalities and design novel therapies. After the discovery that paroxysms of AF can be triggered by pulmonary vein foci, isolation of the pulmonary veins was introduced as a potential curative treatment modality. It is in general assumed that in patients with persistent AF, AF has progressed from a trigger-driven to a substrate mediated arrhythmia. In these patients, persistence of AF no longer depends on the presence of a trigger ('true fibrillation')  but is maintained by an arrhythmogenic substrate. Although animal studies have provided extensive insights into the various mechanisms that can explain perpetuation of AF, it is unknown which specific electropathological changes are relevant for the development of a substrate of persistent AF in humans. Also, it is unknown whether different cardiac diseases result in different electro-pathological alterations. Particularly in patients with congenital heart disease, there are no mapping
data available. Clinical mapping data of AF are scarce and the available studies are often limited to parts of the atria or a small number of beats. Theoretically, multi-site high density mapping can be used to localize sources generating AF in patients with trigger-driven AF and to identify areas perpetuating AF in patients with substrate mediated-AF. Based on the premise that AF can be eliminated by ablation of either the trigger or the substrate perpetuating AF it is expected that multi-site high density mapping is a suitable tool to diagnose AF thereby allowing individualization of AF treatment.

Clinical Electrophysiology Part I

Clinical outcomes of catheter ablation procedures for the treatment of cardiac arrhythmias
Many patients are suffering from cardiac arrhythmias which could lead to life-threatening conditions. Catheter ablation is a well-established therapy and has been introduced in the 1980s for the treatment of these arrhythmias.  During the past decades, it became a first-line therapy for several types of arrhythmias. With an increasing eligible population suffering from arrhythmias, the safety of procedures is crucial to determine which patients should be considered for ablation. Further developments are necessary to minimize complications as much as possible.
In the past significant improvements have been made to increase safety and efficacy of ablation procedures, such as the introduction of irrigated-tip catheters, the use of intracardiac echocardiography, and cryo-energy ablation. New technological developments are currently available and could potentially improve the safety and outcome of ablation procedures. One of the innovations is the remote magnetic navigation system that allows remote manipulation of the catheter in the heart. It has been suggested that this system improves patient safety and offers advantages for targeting complex cardiac arrhythmias. Another development is the introduction of catheters that could measure the force that the catheter applies to the myocardium. This provides crucial information for appropriate lesion formation and improves the efficacy of the ablation procedures.
The clinical electrophysiology department at the Erasmus MC aims to investigate novel innovations to improve safety and efficacy of catheter ablation procedures. The Erasmus MC plays an important role in the international publications on the remote magnetic navigation system and other technological developments for catheter ablation procedures.

Principal InvestigatorNMS de Groot, T Szili-Torok
Co InvestigatorsAJJC Bogers, BJJM Brundel ,M Götte, F Zijlstra
PhD Candidates

JMT Arinze, P Bhagirath, JME van der Does, M de Graaf, CA Houck, P Knops, EAH Lanters, D de Marion, EMJP Mouws, A. Rhagab, C Serban, GDS Sitorius, CP Teuwen, B. Abdikivanani, S. Rout, D. Veen, E. Starreveld, R. Kharbanda, R. Bhagwandien, J de Heide, Z. Kis, M. Martirosyan, L.J. de Vries