PhD defence J. (John) de Heide

Below is a brief summary of the dissertation: 

Electrophysiology focuses on the treatment of cardiac arrhythmias and the prevention of sudden cardiac death. Atrial fibrillation is the most common cardiac arrhythmia in adults, with a high risk of stroke. Direct oral anticoagulants (DOACs) are increasingly used instead of vitamin K antagonists (VKAs) due to a more favourable risk profile regarding bleeding complications. Our studies on thrombo-embolic and bleeding complications in patients undergoing electrical cardioversion (ECV) or AF catheter ablation highlighted this. Untreated sleep apnea increases the risk of AF recurrence one year after ablation, but commonly used ESS and STOP-Bang questionnaires are not suitable for these patients. Ambulatory sleep detection can provide direction for a diagnosis.

The use of pacemakers and ICDs is increasing, and complications such as bleeding and infections remain a concern. In our study on hematomas and infections, the use of DOACs had similar bleeding risks as VKAs. The use of antibiotic prophylaxis and antibacterial envelopes in high-risk patients is recommended, and risk assessment can be effectively done with the PADIT score.

We investigated two eHealth applications. Computer-generated personalized discharge information with lifestyle guidelines improved the uniformity and efficiency of care. Smartphone photography of wounds by patients was successful in 93% of cases, and the photos were well interpretable. Both patient-centered eHealth applications can be part of integrated care, giving patients more control over self-management after the treatment of arrhythmias or the implantation of a pacemaker or ICD. Both interventions are easy to implement and can also reduce the hospital's ecological footprint.