Stellingen behorende bij het proefschrift
20/20:
Twenty years after the first catheter
ablation of atrial fibrillation
Towards freedom from procedure related complications and atrial fibrillation recurrence
1. Knowledge of potential and device-specific symptomatic and asymptomatic complications is important for patient counselling and selection – “Primum non nocere”. (This Thesis)
2. Ablation with the redesigned PVAC-Gold catheter is associated with a higher incidence of asymptomatic cerebral embolism (ACE) and a higher number of micro-embolic signals on transcranial Doppler compared to cooled ablation. Since the purpose of the redesign was to reduce the high incidence of ACE, it can be stated that the device has not been improved in this regard. (This Thesis)
3. A prediction model for cryoballoon ablation based on time-to-isolation, nadir balloon temperature and the number of freeze attempts can help to avoid a 30-min waiting period and adenosine testing in selected patients leading to a significant reduction of the total procedural duration. (This Thesis)
4. When applying a box lesion in persistent AF ablation, a larger box lesion surface area as a ratio of total left atrial surface area is protective for AF/AT recurrence after ablation for persistent AF. (This Thesis)
5. Improving safety of catheter ablation should be a primary goal in the further development of this therapy. (Camm AJ, Europace 2012; 14:1385-1413)
6. Given the potential to reduce AF episodes by weight reduction, AF catheter ablation should be offered to obese patients in conjunction with lifestyle modifications for weight reduction. (Hindricks et al.
European Heart Journal (2020) 00, 1-125)
7. AF catheter ablation should be considered before a trial of AAD in patients with paroxysmal AF episodes or may be considered in patients with persistent AF without risk factors for recurrence. (Hindricks et al.
European Heart Journal (2020) 00, 1-125)
8. The phenotypic classification of AF into paroxysmal, persistent, longstanding persistent, and permanent AF is clinically useful, but does not reflect the underlying pathophysiology and substrate characteristics of the atria. (Laish-Farkash, Journal of cardiovascular electrophysiology. 2015;26(12):1295-7)
9. The journey of a thousand miles begins with one step. (Lao-Tzu, 604-507 BC). Een voorwaarde van
onderweg zijn is echter, alles te accepteren wat die weg je brengt.
10. Try not to resist the changes that come your way. Instead let life live through you. And do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come? (Rumi, 1207-1273). I believe I am ‘the change’ here, seeking acceptance.
