{"id":10279,"date":"2026-04-09T10:23:56","date_gmt":"2026-04-09T10:23:56","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/robin-wesselink\/"},"modified":"2026-04-23T07:35:24","modified_gmt":"2026-04-23T07:35:24","slug":"robin-wesselink","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/robin-wesselink\/","title":{"rendered":"Robin Wesselink"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":12756,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-10279","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Clinical, electrophysiological and structural aspects of atrial remodeling","samenvatting":"Deel 2: Elektrofysiologische aspecten van atriale remodelering\nIn hoofdstuk 5 evalueren we de invasief gemeten linker atrium epicardiale conductie tijd (LAECT) als marker voor recidief boezemfibrilleren na thoracoscopische ablatie. In pati\u00ebnten met persisterend boezemfibrilleren werden de rechter pulmonaal venen ge\u00efsoleerd, en werd er een gedeeltelijke daklijn en daarmee verbonden trigoonlijn aangebracht. Geleidingsblokkade van deze lesies werd bevestigd. LAECT was gedefinieerd als de tijd tot lokale activatie aan de ene kant van de daklijn, na pacen vanaf de overzijde van de daklijn. LAECT was langer in oudere pati\u00ebnten, in pati\u00ebnten met een hoog BMI (body mass index) en in pati\u00ebnten die een klasse IC antiaritmicum gebruikten. Het meten van LAECT als invasieve marker is afhankelijk van de integriteit van de daklijn, en de klinische toepasbaarheid wordt daardoor beperkt.\n\nDit probleem wordt opgelost door epicardiale mapping van de atriale golffront in hoofdstuk 6. We laten zien dat de complexiteit van boezemfibrilleren toeneemt met veronderstelde progressie van paroxysmaal naar persisterend AF. We hebben de complexiteit van boezemfibrilleren uitgedrukt in de boezemfibrilleren cycluslengte, golffrontsnelheid, aantal doorbreek-golven en de fractioneringsindex. De complexiteit van boezemfibrilleren was hoger in persisterend vergeleken met paroxysmaal boezemfibrilleren. Bovendien was boezemfibrilleren complexer in pati\u00ebnten met reeds bestaand boezemfibrilleren, ten opzichte van pati\u00ebnten die aan het begin van de procedure in sinusritme waren, en bij wie boezemfibrilleren is opgewekt met hoogfrequente stimulatie. Deze metingen bevestigen dat de activatiecomplexiteit van boezemfibrilleren in overeenstemming is met elektrische en structurele remodelering. Bovendien was een toegenomen cycluslengteverschil tussen rechter en linker boezem geassocieerd met een hoger risico op recidief boezemfibrilleren. De complexiteit van boezemfibrilleren weerspiegelt dus elektrische en structurele remodelering van het atriale substraat.","summary":"Atrial fibrillation is the most common cardiac arrhythmia, with an increasing incidence due to ageing of the general population. The increasing number of patients, frequent hospital visits and high (re)hospitalization rate impose a high burden on healthcare capacity and budgets. Atrial fibrillation is a complex, multifactorial and progressive disease. Despite modern therapeutic interventions, recurrences remain common. The pathophysiological processes in AF need to be unraveled to enable optimization of patient selection and treatment. Therefore, the aim of this thesis was to identify clinical, electrophysiological and pathophysiological characteristics associated with recurrent AF after thoracoscopic ablation.\n\nPart 1: Clinical aspects of atrial remodeling\nIn chapter 2 we analyzed the differences between women and men undergoing thoracoscopic ablation. Women referred for thoracoscopic ablation were four years older than men, and had fewer cardiovascular risk factors, fewer myocardial infarctions and fewer vascular disease. After two year follow-up, women had more 15% more recurrences than men, which was driven by a higher proportion of atrial tachycardia\u2019s as recurrence, with similar rates of AF. Sex was an independent risk factor for recurrent AF after correction for several established risk factors. Moreover, additional risk factors, such as persistent AF, old age and an enlarged left atrium, seem to impact females more severely than males. Upon histological analysis, women had more endo- and epicardial fibrosis compared to males, which may reflect a more progressed atrial substrate.\n\nIn chapter 3 we assessed the efficacy of thoracoscopic ablation in patients with a giant left atrium, defined as LAVI (left atrial volume divided by body surface area) \u2265 50 ml\/m2. At baseline, patients with a giant left atrium were older and had more persistent AF. After two years follow-up, 43% of patients with a giant left atrium remained free from AF recurrence, compared to 57% in patients with a smaller LA. Subgroup analysis revealed that males with relatively small left atrium have the highest efficacy after ablation, whereas the efficacy was similar for both sexes in the presence of a giant LA. Similarly, patients with paroxysmal AF and a small LA had the highest efficacy, while patients with persistent AF had similarly lower efficacy with or without giant LA. Procedural related serious adverse events were similar for both groups.\n\nPreviously published studies were ambivalent about the risk of a previously failed catheter ablation on recurrence after thoracoscopic ablation. Chapter 4 describes the results of a retrospective international multicenter trial comparing the efficacy of hybrid thoracoscopic ablation between patients with a failed catheter ablation and ablation na\u00efve controls. At baseline, patients with a failed catheter ablation had smaller left atria, less congestive heart failure and less persistent AF. Patients with a failed catheter ablation had 2,5 years longer duration of AF. Two propensity score based analyses demonstrated a 39 and 68% increased risk of recurrence for patients with a previously failed catheter ablation compared to ablation na\u00efve patients during one year follow-up. A failed ablation thereby acts as a marker for reduced efficacy. In a subgroup of patients, the density of collagen fibers was higher in patients with a failed catheter ablation, suggesting that these patients suffer from more progressed, subclinical, atrial fibrosis formation.\n\nPart 2: Electrophysiological aspects of atrial remodeling\nIn chapter 5 we evaluated the invasively measured left atrial epicardial conduction time (LAECT) as marker for AF recurrence after thoracoscopic ablation of AF. In patients with persistent AF, the right pulmonary veins were isolated, and a partial roofline, connected to a trigone line were ablated. Conduction block of these lesions was confirmed. LAECT was defined as the time to local activation at one side of the roofline upon pacing from the opposite side. LAECT was longer in older patients, in patients with a high body mass index, and in patients using class IC antiarrhythmics. Moreover, long LAECT, high BMI and a previously failed catheter ablation were independently associate with AF recurrence.\n\nMeasurement of LAECT as invasive electrophysiological marker depends upon an isolated roofline, and its clinical applicability is thereby limited. This issue is overcome by high density epicardial mapping of atrial fibrillation in chapter 6. This technique enables electrogram analysis and reconstruction of the AF wavefront. We demonstrate that the complexity of AF increases with supposed progression from paroxysmal to persistent AF. We expressed the complexity of AF as AF cycle length, wavefront velocity, no of breakthrough waves and fractionation index. The complexity of AF was higher in persistent compared to paroxysmal AF. Moreover, AF was more complex in patients with ongoing AF compared to patients in sinus rhythm at the start of the procedure, in whom AF was induced with high frequency stimulation. These measurements confirm a concurrence of the complexity of the AF activation patterns with structural and electrical remodeling. Moreover, an increased difference in AF cycle length between the left and right atrium was associated with increased recurrence of AF. The complexity of AF thereby reflects electrical and structural remodeling of the atrial substrate.","auteur":"Robin Wesselink","auteur_slug":"robin-wesselink","publicatiedatum":"26 mei 2023","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/robinwesselink?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604091020","isbn":"978-94-6469-330-0","doi_nummer":"","naam_universiteit":"Universiteit van Amsterdam","afbeeldingen":12756,"naam_student:":"","binnenwerk":"","universiteit":"Universiteit van Amsterdam","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10279","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=10279"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10279\/revisions"}],"predecessor-version":[{"id":10282,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10279\/revisions\/10282"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/12756"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=10279"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=10279"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}