1
|
Tilz RR, Chun KRJ, Deneke T, Kelm M, Piorkowski C, Sommer P, Stellbrink C, Steven D. Positionspapier der Deutschen Gesellschaft für Kardiologie zur Kardioanalgosedierung. KARDIOLOGE 2017. [DOI: 10.1007/s12181-017-0179-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
2
|
[Permanent junctional reciprocating tachycardia causing cardiomyopathy in an adult woman]. Herzschrittmacherther Elektrophysiol 2016; 27:404-407. [PMID: 27605234 DOI: 10.1007/s00399-016-0453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
A 35-year-old female was referred with progressive dyspnoea and elevated heart rate. Surface electrocardiography (ECG) showed supraventricular tachycardia (SVT) with long RP interval and inverse P waves. ECG revealed left ventricular dilation and severe systolic dysfunction. An electrophysiological (EP) examination was performed due to incessant SVT despite betablocker medication. Permanent junctional reciprocating tachycardia (PJRT) was diagnosed and successfully ablated. During follow-up, the patient's symptoms abated and ECG parameters normalized. PJRT is usually found in infants and children, but should also be considered as a rare cause of incessant SVT and tachycardiomyopathy in adults.
Collapse
|
3
|
Sawan N, Eitel C, Thiele H, Tilz R. [Ablation of supraventricular tachycardias : Complications and emergencies]. Herzschrittmacherther Elektrophysiol 2016; 27:143-50. [PMID: 27206630 DOI: 10.1007/s00399-016-0422-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Catheter ablation is an established treatment of supraventricular tachycardias (SVT) with high success rates of > 95 %. Complication rates range from 3 to 5 %, with serious complications occurring in about 0.8 %. There are general complications caused either by the vascular access or the catheters (e. g. hematomas, hemo-pneumothorax, embolism, thrombosis and aspiration) und specific ablation related complications (e. g. AV block during ablation of the slow pathway). The complication risk is elevated in elderly and multimorbid patients. Furthermore, the experience of the treating physician and the respective team plays an essential role. The purpose of this article is to give an overview on incidences, causes and management as well as prevention strategies of complications associated with catheter ablation of SVT.
Collapse
Affiliation(s)
- N Sawan
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - C Eitel
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - H Thiele
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - R Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| |
Collapse
|
4
|
[Typical atrial flutter: Diagnosis and therapy]. Herzschrittmacherther Elektrophysiol 2016; 27:46-56. [PMID: 26846223 DOI: 10.1007/s00399-016-0413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Typical, cavotricuspid-dependent atrial flutter is the most common atrial macroreentry tachycardia. The incidence of atrial flutter (typical and atypical forms) is age-dependent with 5/100,000 in patients less than 50 years and approximately 600/100,000 in subjects > 80 years of age. Concomitant heart failure or pulmonary disease further increases the risk of typical atrial flutter.Patients with atrial flutter may present with symptoms of palpitations, reduced exercise capacity, chest pain, or dyspnea. The risk of thromboembolism is probably similar to atrial fibrillation; therefore, the same antithrombotic prophylaxis is required in atrial flutter patients. Acutely symptomatic cases may be subjected to cardioversion or pharmacologic rate control to relieve symptoms. Catheter ablation of the cavotricuspid isthmus represents the primary choice in long-term therapy, associated with high procedural success (> 97 %) and low complication rates (0.5 %).This article represents the third part of a manuscript series designed to improve professional education in the field of cardiac electrophysiology. Mechanistic and clinical characteristics as well as management of isthmus-dependent atrial flutter are described in detail. Electrophysiological findings and catheter ablation of the arrhythmia are highlighted.
Collapse
|
5
|
Schächinger V, Nef H, Achenbach S, Butter C, Deisenhofer I, Eckardt L, Eggebrecht H, Kuon E, Levenson B, Linke A, Madlener K, Mudra H, Naber C, Rieber J, Rittger H, Walther T, Zeus T, Kelm M. Leitlinie zum Einrichten und Betreiben von Herzkatheterlaboren und Hybridoperationssälen/Hybridlaboren. KARDIOLOGE 2015. [DOI: 10.1007/s12181-014-0631-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Al-Ghamdi B, Shafquat A, Mallawi Y. Arrhythmogenic right ventricular cardiomyopathy/dysplasia in Saudi Arabia: a single-center experience with long-term follow-up. Ann Saudi Med 2014; 34:415-26. [PMID: 25827699 PMCID: PMC6074561 DOI: 10.5144/0256-4947.2014.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a rare genetic disorder that primarily involves the right ventricle (RV). It is characterized by progressive replacement of RV myocardium by fibrofatty tissues. It commonly presents with ventricular tachycardia (VT) of RV origin and may result in RV failure. The aim of this study is to evaluate the clinical characteristics of adult patients with ARVC/D treated at the Heart Centre, King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia. DESIGN AND SETTINGS This is a retrospective study of patients with ARVC/D diagnosed and treated at the KFSH&RC Heart Centre in Riyadh. PATIENTS AND METHODS Twenty-two cases with ARVC/D with regular follow-up at our Heart Centre from January 2007 to May 2010 were included in this study. The diagnosis of ARVC/D was made according to the revised International Task Force Criteria. The clinical data were collected from patients' charts and electronic medical records. RESULTS The majority of patients were males (18; 82%). The diagnosis of ARVC/D was definite in 18 patients (82%), borderline in 2 (9%), and possible in 2 (9%). The mean age at diagnosis was 33.3 years. The follow-up period ranged from 29 to 132 months, with a mean follow-up period of 84 months. Ten patients presented with sustained VT, and 3 were survivors of cardiac arrest. Electrocardiogram abnormalities were present in 16/22 patients (72.7%). Echocardiographic changes meeting major diagnostic criteria were seen in 16 patients (76%). Cardiac magnetic resonance imaging was performed in 11 patients, and showed changes compatible with major diagnostic criteria in 7 patients (64%). Implantable cardioverter defibrillators (ICDs) were implanted in 17 patients; 8 had appropriate ICD shocks and 5 had inappropriate ICD shocks. Antitachycardia pacing was effective in terminating most of the VT/ventricular fibrillation episodes. CONCLUSION ARVC/D is a rare but increasingly recognized heart muscle disease seen in Saudi Arabia and other parts of the world. It is associated with a highly nonspecific presentation. VT of RV origin is a common presentation for this disease. Antiarrhythmic medications and ICD implantation are the main management options.
Collapse
Affiliation(s)
- Bandar Al-Ghamdi
- Dr. Bandar Al-Ghamdi, MBC 16 Heart Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia, T: +966-11-442-4838,
| | | | | |
Collapse
|
7
|
Abstract
Tachycardias including atrial fibrillation often require hospitalisation. A diagnostic algorithm from the surface ECG allows discrimination between supraventricular and ventricular tachycardias. For acute treatment, only a few antiarrhythmic drugs such as adenosine, ajmaline and amiodarone, and in case of hemodynamic instability electrocardioversion are required. For long-term treatment catheter ablation is the option of choice for almost all patients with supraventricular tachycardias, atrial flutter, idiopathic ventricular tachycardias and for many patients with symptomatic atrial fibrillation. Chronic antiarrhythmic drug therapy is less often used. In patients with ventricular tachyarrhythmias in the setting of severe structural heart disease, risk stratification must be performed and ICD therapy is often indicated. Anticoagulant therapy according to risk score analysis is often indicated in patients with atrial fibrillation.
Collapse
Affiliation(s)
- J Tebbenjohanns
- Kardiologie, Rhythmologie, Angiologie und Intensivmedizin, Medizinische Klinik I, Klinikum Hildesheim, Senator-Braun-Allee 33, 31135, Hildesheim, Deutschland,
| | | |
Collapse
|
8
|
Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation. Clin Res Cardiol 2013; 103:97-106. [DOI: 10.1007/s00392-013-0625-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
|
9
|
De Roy LJM, Goethals P, Jordaens LJL. Do we need more or better electrophysiology centres? Europace 2013; 15:1687-9. [PMID: 23960090 DOI: 10.1093/europace/eut242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Luc J M De Roy
- Brussels Heart Centre, Dept Cardiology, Boulevard du Jardin Botanique 32, 1000 Brussels, Belgium
| | | | | |
Collapse
|
10
|
Rillig A, Schmidt B, Feige B, Wissner E, Metzner A, Arya A, Mathew S, Makimoto H, Wohlmuth P, Ouyang F, Kuck KH, Tilz RR. Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome. Clin Res Cardiol 2013; 102:885-93. [PMID: 23896973 DOI: 10.1007/s00392-013-0602-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 07/17/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists. METHODS AND RESULTS In this pilot study, CPVI combined with LAI-ablation were performed using a RNS and 3D-mapping system in 42 patients with persistent (n = 24, 57.1 %) or longstanding persistent AF. Ablation was performed using either a 3.5 mm irrigated tip catheter (ITC) with 6 (group-A, n = 16; max. 40 W, contact force 10-40 g) or (after a steam pop occurred in one patient) with a 4 mm ITC with 12 irrigation holes (group-B, n = 26; max. 30 W, contact force 10-30 g). Epicardial ablation was performed manually whenever bidirectional LAI-block could not be obtained with a maximum of 20 endocardial RF-applications. LAI-conduction block was achieved in all patients using RNS; in six patients (14.3 %), additional epicardial ablation was required to achieve LAI-block. A steam pop occurred during LAI-ablation resulting in cardiac tamponade in one patient in group-A. After a median follow-up period of 21 months, arrhythmia recurrence was seen in in 23/42 patients (18 patients with AF and 5 patients with atrial tachycardia) and repeat procedure was performed in 12 (28.6 %) patients; recovered LAI-conduction was found in 5/12 (41.7 %) patients. The RNS-group was compared to a historical group of 20 patients with manual LAI-ablation. Using RNS, LAI-block was more often achieved (42 (100 %) vs 16 (80 %), p < 0.01) and epicardial ablation was required in a significantly smaller number of patients (6 (14.3) vs 10 (50 %), p < 0.01). CONCLUSIONS LAI-ablation using RNS appears to be feasible in all patients. At repeat procedure, LAI-conduction can frequently occur; power and contact-force adaption appears to be mandatory to reduce the risk of complications. Using RNS, instead of a manual approach for LAI-line ablation may facilitate creation of a bidirectional LAI-block.
Collapse
Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Neuberger HR, Tilz RR, Bonnemeier H, Deneke T, Estner HL, Kriatselis C, Kuniss M, Luik A, Sommer P, Steven D, von Bary C, Voss F, Eckardt L. A survey of German centres performing invasive electrophysiology: structure, procedures, and training positions. Europace 2013; 15:1741-6. [PMID: 23736806 DOI: 10.1093/europace/eut149] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To provide a nationwide survey (and reference for the future) on cardiac electrophysiologists, types and numbers of invasive electrophysiological procedures, and training opportunities in 2010. METHODS AND RESULTS German cardiology centres performing invasive electrophysiology were identified from quality reports and contacted to fill a questionnaire. A majority of 122 centres (65%) responded. Electrophysiology (ablation procedures and device therapy) was mainly part of a cardiology department (82%), and only in 9% independent (own budget). In only 58% of the centres, (at least) two physicians were present during catheter ablations. Although in 2010, women represented 59.4% of physicians <35 years old, only 26% of physicians in electrophysiology training were female. In total, 33 420 catheter ablations were performed with a median number of 180 per centre. Atrial fibrillation (AF) was the most common arrhythmia invasively treated (35%). At least 50 AF ablations were performed in 53% of the centres. Of the centres performing AF ablations, consecutive left atrial arrhythmias were treated by catheter ablation only in 75%, and only 44% had in-house surgical backup. Only one-fourth of the 122 centres fulfilled all requirements for training centre accreditation according to the European Heart Rhythm Association and the German Cardiac Society. CONCLUSION The results indicate a high number of electrophysiology centres and procedures in Germany. Atrial fibrillation was the most common arrhythmia invasively treated. An increasing demand for catheter ablation is likely, but training opportunities are limited. Women are clearly underrepresented. A co-operation of higher and lower volume electrophysiology centres may be necessary for training purposes.
Collapse
Affiliation(s)
- Hans-Ruprecht Neuberger
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische. Intensivmedizin, Universitätsklinikum des Saarlandes, D-66421 Homburg/Saar, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
von Bodman G, Brömsen J, Kopf C, Füller M, Block M. [Two patients with palpitations. Always benign?]. MMW Fortschr Med 2013; 155:60-2. [PMID: 23668180 DOI: 10.1007/s15006-013-0437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Hein W, Ellringmann U, Vollmann D, Rostock T, Schott P. [Recurrent failed ICD therapy of ventricular tachycardia]. Med Klin Intensivmed Notfmed 2012; 107:641-4. [PMID: 23070331 DOI: 10.1007/s00063-012-0150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
Abstract
Implantable cardioverter defibrillators (ICD) are used as standard therapy to prevent sudden cardiac death in heart failure patients. Today, physicians in emergency and intensive care medicine are often confronted with problems of ICD therapy in these patients. We report a case of a patient suffering from recurrent ventricular tachycardia (VT) requiring antiarrhythmia treatment with amiodarone. With an increasing drug loading, the VT cycle length was progressively prolonged resulting in a slow VT undetectable for the ICD. Subsequently, the patient was scheduled for VT ablation after which the patient became free of arrhythmia recurrences.
Collapse
Affiliation(s)
- W Hein
- Abteilung Kardiologie und internistische Intensivmedizin, Klinikum Werra-Meißner Eschwege, Elsa-Brändström-Straße 1, Eschwege, Germany.
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Marx M, Bergler-Klein J, Binder T, Wojta J, Gössinger HD. Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation. Clin Res Cardiol 2011; 101:217-25. [PMID: 22102100 DOI: 10.1007/s00392-011-0383-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of oxidative stress after radiofrequency ablation of atrial fibrillation (AF) has not yet been well characterized. We sought to evaluate the time course of biomarkers of oxidative stress and inflammation after AF ablation and their association with clinical variables. METHODS Thirty consecutive patients (57.9 ± 1.7 years, 63% males) with paroxysmal AF underwent pulmonary vein isolation and ablation of complex fractionated atrial electrograms. Biomarkers were determined in blood samples before ablation and 6 h, 1, 2, 7, 30, 90 and 180 days post-ablation. RESULTS The pro-oxidant enzyme myeloperoxidase and oxidized low-density lipoprotein reflecting oxidant damage of lipoproteins increased 2.9 ± 0.2-fold and 1.2 ± 0.1-fold, respectively, and were significantly up-regulated until day 2 post-ablation. The anti-oxidant enzyme copper/zinc superoxide dismutase did not change significantly. Inflammatory markers significantly increased (high-sensitivity C-reactive protein (hs-CRP): 41 ± 8-fold; interleukin-6: 4.4 ± 0.7-fold) for 7 and 2 days, respectively. The increase of myeloperoxidase and hs-CRP was interrelated and both predicted early recurrence of AF within the first post-ablation week (both p < 0.05). The increase of both markers was associated with the amount of delivered radiofrequency energy (p < 0.05). The up-regulation of hs-CRP correlated with troponin T (p = 0.008), while myeloperoxidase and troponin T were borderline associated (p = 0.054). However, the oxidative and inflammatory responses did not predict long-term ablation outcome (p > 0.05). CONCLUSIONS Markers of oxidative stress showed a significant up-regulation during the first 2 days after AF ablation. Their up-regulation was linked to inflammation, delivered radiofrequency energy, and early recurrence of AF, but did not predict long-term ablation outcome.
Collapse
Affiliation(s)
- Bernhard Richter
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Pott C, Dechering DG, Muszynski A, Zellerhoff S, Bittner A, Wasmer K, Mönnig G, Eckardt L. [Class I antiarrhythmic drugs: mechanisms, contraindications, and current indications]. Herzschrittmacherther Elektrophysiol 2010; 21:228-238. [PMID: 21113605 DOI: 10.1007/s00399-010-0090-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Class I antiarrhythmic drugs are sodium channel inhibitors that act by slowing myocardial conduction and, thus, interrupting or preventing reentrant arrhythmia. Due to proarrhythmic effects and the risk of ventricular tachyarrhythmia, class I antiarrhythmics should not be administered in patients with structural heart disease. Nevertheless, there remains a broad spectrum of arrhythmias--among the most common being atrial fibrillation--that can successfully be treated with class I antiarrhythmic drugs. This review gives an overview on the classification, antiarrhythmic mechanisms, indications, side effects, and application modes of class I antiarrhythmic drugs.
Collapse
MESH Headings
- Administration, Oral
- Adrenergic beta-Antagonists/therapeutic use
- Anti-Arrhythmia Agents/adverse effects
- Anti-Arrhythmia Agents/classification
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/chemically induced
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/mortality
- Atrial Fibrillation/drug therapy
- Atrial Fibrillation/mortality
- Contraindications
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Electrocardiography/drug effects
- Female
- Heart Failure/complications
- Heart Failure/drug therapy
- Humans
- Infusions, Intravenous
- Myocardial Infarction/complications
- Myocardial Infarction/drug therapy
- Pregnancy
- Randomized Controlled Trials as Topic
- Sodium Channel Blockers/adverse effects
- Sodium Channel Blockers/classification
- Sodium Channel Blockers/therapeutic use
- Tachycardia, Atrioventricular Nodal Reentry/drug therapy
- Tachycardia, Supraventricular/drug therapy
- Tachycardia, Ventricular/drug therapy
Collapse
Affiliation(s)
- C Pott
- Medizinische Klinik C - Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer Str. 33, 48149, Münster, Deutschland.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Feasibility and safety of transradial approach for catheter ablation of idiopathic left ventricular tachycardia. Clin Res Cardiol 2010; 100:37-43. [DOI: 10.1007/s00392-010-0201-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
|
18
|
Frühauf M, Eitel C, Bollmann A, Piorkowski C, Wetzel U, Schliephake F, Arya A. Should transesophageal echocardiography be done in all patients who underwent catheter ablation of atrial fibrillation? A case report and review of the literature. Clin Res Cardiol 2010; 99:125-8. [PMID: 19915883 DOI: 10.1007/s00392-009-0091-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/28/2009] [Indexed: 11/30/2022]
|
19
|
Röther J, Laufs U, Böhm M, Willems S, Scheller B, Borggrefe M, Darius H, Endres M, Zeymer U, Diener HC, Grond M, Hacke W, Forsting M, Schumacher M, Hennerici M. Konsensuspapier „Peri- und postinterventioneller Schlaganfall bei Herzkatheterprozeduren“. DER KARDIOLOGE 2009. [DOI: 10.1007/s12181-009-0214-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Two concomitant arrhythmias in a transplanted heart. Clin Res Cardiol 2009; 98:571-2. [PMID: 19585165 DOI: 10.1007/s00392-009-0042-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
|
21
|
|
22
|
Gonska BD, Bauerle HJ, Japha T. [Atrial fibrillation ablation: who comes into consideration?]. Herzschrittmacherther Elektrophysiol 2009; 20:76-81. [PMID: 19513777 DOI: 10.1007/s00399-009-0043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Atrial fibrillation ablation is, since the introduction of the guidelines in 2006 and which were updated in 2007, now a standard procedure in many electrophysiological centers. Pulmonary vein isolation has proven itself as a way to eliminate focal triggers. From pathophysiological studies of atrial fibrillation development, it is known that ablation performed early in paroxysmal atrial fibrillation has the highest chance for success. In patients with persistent or permanent atrial fibrillation, success rates are lower and repeat interventions are needed more often. Therefore, continuation of antiarrhythmic drug therapy is often necessary in these patient groups. Thus, the curative use of ablation for atrial fibrillation is only possible with the current techniques for patients with paroxysmal atrial fibrillation.
Collapse
Affiliation(s)
- B-D Gonska
- Medizinische Klinik 3, St. Vincentius-Kliniken Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Südendstrasse 32, Karlsruhe, Germany.
| | | | | |
Collapse
|
23
|
Herren T, Gerber PA, Duru F. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a not so rare "disease of the desmosome" with multiple clinical presentations. Clin Res Cardiol 2009; 98:141-58. [PMID: 19205777 DOI: 10.1007/s00392-009-0751-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 01/08/2009] [Indexed: 02/07/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a rare but increasingly recognized form of a cardiomyopathy, involving primarily the right ventricle. Mutations in seven candidate genes coding for five desmosomal proteins (plakoglobin, plakophilin-2, desmoplakin, desmoglein-2, desmocollin-2), for the cardiac ryanodine receptor-2, for the transforming growth factor beta-3, and for the transmembrane protein 43, respectively, are pathogenetically important. A typical feature of the disease is the replacement of the right ventricular myocardium by fibrofatty infiltrates, leading to electrical instability including ventricular arrhythmias in the early stages, and reduced contractility and heart failure later on. The left ventricle may also be involved. Unfortunately, the disease is often diagnosed post mortem only, especially in young adults dying suddenly during exercise. Since the disease is inherited in up to 50% of cases, the screening of relatives is important. The implantable cardioverter defibrillator is an important therapeutic tool. Nevertheless, the mortality of the disease remains to be 2%-4% per year. Several clinical, electrocardiographic, and imaging parameters were identified as risk predictors for an adverse outcome. In this paper, we describe distinct clinical presentations of ARVC/D, review the genetic background of the disease, and discuss its diagnosis and treatment.
Collapse
Affiliation(s)
- Thomas Herren
- Department of Medicine, Limmattal Hospital, Schlieren, Switzerland.
| | | | | |
Collapse
|
24
|
Abstract
Atrial fibrillation and congestive heart failure are frequently associated with complex interactions. Patients with both diseases bear a sophisticated therapeutic challenge for the attending physician. The approach to treat atrial fibrillation differs for patients with and without heart failure in several aspects. Basic requirements are the treatment of the underlying diseases and prophylaxis of thromboembolic complications. Rate and rhythm control are the two main therapeutic strategies for atrial fibrillation according to the current guidelines. Large trials including the recently published AF-CHF study (Atrial Fibrillation - Congestive Heart Failure) failed to demonstrate a difference in mortality for both strategies. Thus, the therapeutic decision is mainly based on the patient's symptoms to improve quality of life. Rate control should be applied to asymptomatic patients or if rhythm control has already failed. If beta-blockers and digoxin have failed to control heart rate, His ablation with pacemaker implantation can be considered. In patients without heart disease, class I antiarrhythmic drugs and, in case of ineffectiveness, amiodarone or catheter ablation are recommended for rhythm control. First data concerning catheter ablation of atrial fibrillation in heart failure are promising and randomized studies are on the way. Rhythm control remains first-line therapy in recent-onset or highly symptomatic paroxysmal or persistent atrial fibrillation patients with and without heart failure.
Collapse
|
25
|
Current World Literature. Curr Opin Cardiol 2009; 24:95-101. [DOI: 10.1097/hco.0b013e32831fb366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Tebbenjohanns J, Willems S, Antz M, Pfeiffer D, Seidl KH, Lewalter T. Kommentar zu den „ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary“. KARDIOLOGE 2008. [DOI: 10.1007/s12181-008-0112-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Lewalter T, Tebbenjohanns J, Wichter T, Antz M, Geller C, Seidl KH, Gulba D, Röhrig F, Willems S. Kommentar zu „ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary“. DER KARDIOLOGE 2008. [DOI: 10.1007/s12181-008-0080-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Perrod S, Gasser SM. Long-range silencing and position effects at telomeres and centromeres: parallels and differences. Cell Mol Life Sci 2003; 60:2303-18. [PMID: 14625677 PMCID: PMC11138886 DOI: 10.1007/s00018-003-3246-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most of the human genome is compacted into heterochromatin, a form that encompasses multiple forms of inactive chromatin structure. Transcriptional silencing mechanisms in budding and fission yeasts have provided genetically tractable models for understanding heritably repressed chromatin. These silent domains are typically found in regions of repetitive DNA, that is, either adjacent to centromeres or telomeres or within the tandemly repeated ribosomal DNA array. Here we address the mechanisms of centromeric, telomeric and locus-specific gene silencing, comparing simple and complex animals with yeast. Some aspects are universally shared, such as histone-tail modifications, while others are unique to either centromeres or telomeres. These may reflect roles for heterochromatin in other chromosomal functions, like kinetochore attachment and DNA ends protection.
Collapse
Affiliation(s)
- S. Perrod
- Department of Molecular Biology, University of Geneva, 1211 Geneva, Quai Ernest-Ansermet 30, Switzerland
| | - S. M. Gasser
- Department of Molecular Biology, University of Geneva, 1211 Geneva, Quai Ernest-Ansermet 30, Switzerland
| |
Collapse
|