1
|
Wolff C, Langenhan K, Wolff M, Efimova E, Zachäus M, Darma A, Dinov B, Seewöster T, Nedios S, Bertagnolli L, Wolff J, Paetsch I, Jahnke C, Bollmann A, Hindricks G, Bode K, Halm U, Arya A. Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study. Europace 2024; 26:euae107. [PMID: 38646922 PMCID: PMC11068270 DOI: 10.1093/europace/euae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
AIMS High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning. METHODS AND RESULTS A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032). CONCLUSION The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.
Collapse
Affiliation(s)
- Charlotte Wolff
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Katharina Langenhan
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Marc Wolff
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Elena Efimova
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Markus Zachäus
- Department of Gastroenterology, Helios Park Clinic, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | | | - Jan Wolff
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, German Heart Centre, Berlin, Germany
| | - Kerstin Bode
- Department of Electrophysiology, Leipzig Heart Centre, Medical Faculty, Leipzig University, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Ulrich Halm
- Department of Gastroenterology, Helios Park Clinic, Leipzig, Germany
| | - Arash Arya
- Department of Cardiology, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
2
|
Jahnke C, Darma A, Lindemann F, Oebel S, Hilbert S, Bode K, Stehning C, Smink J, Paetsch I. Electrophysiological cardiovascular MR: procedure-ready mesh model generation for interventional guidance based on non-selective excitation compressed sensing whole heart imaging. Sci Rep 2024; 14:8974. [PMID: 38637577 PMCID: PMC11026457 DOI: 10.1038/s41598-024-59230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Fully CMR-guided electrophysiological interventions (EP-CMR) have recently been introduced but data on the optimal CMR imaging protocol are scarce. This study determined the clinical utility of 3D non-selective whole heart steady-state free precession imaging using compressed SENSE (nsWHcs) for automatic segmentation of cardiac cavities as the basis for targeted catheter navigation during EP-CMR cavo-tricuspid isthmus ablation. Fourty-two consecutive patients with isthmus-dependent right atrial flutter underwent EP-CMR radiofrequency ablations. nsWHcs succeeded in all patients (nominal scan duration, 98 ± 10 s); automatic segmentation/generation of surface meshes of right-sided cavities exhibited short computation times (16 ± 3 s) with correct delineation of right atrium, right ventricle, tricuspid annulus and coronary sinus ostium in 100%, 100%, 100% and 95%, respectively. Point-by-point ablation adhered to the predefined isthmus line in 62% of patients (26/42); activation mapping confirmed complete bidirectional isthmus block (conduction time difference, 136 ± 28 ms). nsWHcs ensured automatic and reliable 3D segmentation of targeted endoluminal cavities, multiplanar reformatting and image fusion (e.g. activation time measurements) and represented the basis for precise real-time active catheter navigation during EP-CMR ablations of isthmus-dependent right atrial flutter. Hence, nsWHcs can be considered a key component in order to advance EP-CMR towards the ultimate goal of targeted substrate-based ablation procedures.
Collapse
Affiliation(s)
- Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Frank Lindemann
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | | | - Jouke Smink
- Philips Research Laboratories, Best, The Netherlands
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
| |
Collapse
|
3
|
Verma A, Essebag V, Neuzil P, Dyrda K, Balt J, Dinov B, Darma A, Arya A, Sacher F, Reddy VY, Boersma L, Grigorov I, De Potter T. Cryocure-VT: the safety and effectiveness of ultra-low-temperature cryoablation of monomorphic ventricular tachycardia in patients with ischaemic and non-ischaemic cardiomyopathies. Europace 2024; 26:euae076. [PMID: 38582974 PMCID: PMC10998960 DOI: 10.1093/europace/euae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
AIMS The ultra-low-temperature cryoablation (ULTC) ablation system using -196°C N2 cryogen has been reported to create lesions with freeze duration-dependent depth titratable to over 10 mm with minimum attenuation by scar. Cryocure-VT (NCT04893317) was a first-in-human clinical trial evaluating the safety and efficacy of a novel, purpose-built ULTC catheter in endocardial ablation of scar-dependent ventricular tachycardias (VTs). METHODS AND RESULTS This prospective, multi-centre study enrolled patients referred for de novo or second ablations of recurrent monomorphic VT of both ischaemic and non-ischaemic aetiologies. Primary safety and efficacy endpoints of the study were freedom from device- or procedure-related major adverse events (MAEs) up to 30 days post-ablation, acute non-inducibility of clinical VTs at the end of the procedure, and freedom from sustained VT or implantable defibrillator intervention at 6 months. Ultra-low-temperature cryoablation was performed in 64 patients (age 67 ± 11 years, 78% ischaemic, ejection fraction = 35 ± 10%) at 9 centres. The primary acute effectiveness endpoint was achieved in 94% (51/54) of patients in whom post-ablation induction was attempted. There were no protocol-defined MAEs; four procedure-related serious adverse events resolved without clinical sequelae. At 6-month follow-up, 38 patients (60.3%) remained VT-free, and freedom from defibrillator shock was 81.0%, with no significant difference between ischaemic and non-ischaemic cohorts. In 47 patients with defibrillator for at least 6 months prior to the ablation, the VT burden was reduced from median of 4, inter-quartile range (IQR, 1-9) to 0, IQR (0-2). CONCLUSION In this first-in-human multi-centre experience, endocardial ULTC ablation of monomorphic VT appears safe and effective in patients with both ischaemic-cardiomyopathy and non-ischaemic-cardiomyopathy. CLINICAL TRIAL REGISTRATION NCT04893317.
Collapse
Affiliation(s)
- Atul Verma
- Division of Cardiology, McGill University Health Centre, D13.173, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Centre, D13.173, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Montreal, QC, Canada
| | - Jippe Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Arash Arya
- Department for Internal Medicine, University Hospital Halle, Halle, Germany
| | - Frederic Sacher
- Bordeaux University Hospital, IHU LIRYC, University of Bordeaux, Bordeaux, France
| | - Vivek Y Reddy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, USA
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Heart Failure and Arrhythmias,Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| |
Collapse
|
4
|
Dilk P, Dinov B, Darma A, Bollmann A, Dagres N, Hindricks G, Arya A. Single catheter approach for treatment of premature ventricular contractions. Clin Cardiol 2024; 47:e24250. [PMID: 38450791 PMCID: PMC10918703 DOI: 10.1002/clc.24250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Catheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters. HYPOTHESIS We hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates. METHODS Sixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates. RESULTS Patients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5-69,0 minutes] vs. 90 minutes [IQR 60-120 minutes]; p = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5-446 seconds] vs. 310 seconds [IQR 190-640 seconds]; p = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm² [IQR 74.4-334.5 cGycm²] vs. 368.4 cGycm² [IQR: 126-905.4 cGycm²]; p value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; p: 0.287). CONCLUSION A single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup.
Collapse
Affiliation(s)
- Patrick Dilk
- Department for ElectrophysiologyHeart Centre LeipzigLeipzigGermany
| | - Borislav Dinov
- Department of Cardiology and AngiologyUniversity Hospital of GiessenGiessenGermany
| | - Angeliki Darma
- Department for ElectrophysiologyHeart Centre LeipzigLeipzigGermany
| | - Andreas Bollmann
- Department for ElectrophysiologyHeart Centre LeipzigLeipzigGermany
| | - Nikolas Dagres
- Department for ElectrophysiologyDeutsches Herzzentrum der CharitéBerlinGermany
| | - Gerhard Hindricks
- Department for ElectrophysiologyDeutsches Herzzentrum der CharitéBerlinGermany
| | - Arash Arya
- Department for ElectrophysiologyUniversity HalleHalleGermany
| |
Collapse
|
5
|
Garcia Garcia J, Arya A, Dinov B, Bollmann A, ter Bekke RMA, Vernooy K, Dagres N, Hindricks G, Darma A. Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease. Europace 2023; 26:euad367. [PMID: 38127308 PMCID: PMC10755192 DOI: 10.1093/europace/euad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period. METHODS AND RESULTS Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy. CONCLUSION While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
Collapse
Affiliation(s)
- Joaquin Garcia Garcia
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Halle University, Halle (Saale), Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Rachel M A ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| |
Collapse
|
6
|
Löbe S, Stellmach P, Darma A, Hilbert S, Paetsch I, Jahnke C, Bollmann A, Hindricks G, Kircher S. Left atrial total emptying fraction measured by cardiovascular magnetic resonance imaging predicts low-voltage areas detected during electroanatomical mapping. Europace 2023; 25:euad307. [PMID: 37960936 PMCID: PMC10643989 DOI: 10.1093/europace/euad307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/15/2023] Open
Abstract
AIMS Low-voltage areas (LVAs) found during left atrial (LA) electroanatomical mapping are increasingly targeted by radiofrequency catheter ablation (RFCA) on top of pulmonary vein isolation to improve arrhythmia-free survival in patients with atrial fibrillation (AF). However, pre-procedural prediction of LVAs remains challenging. The purpose of the present study was to describe the association between parameters of LA function and dimensions, respectively, derived from pre-procedural cardiovascular magnetic resonance (CMR) imaging, and the presence of LVAs on LA voltage mapping. METHODS AND RESULTS Patients who underwent first-time RFCA for paroxysmal or persistent AF and who were in stable sinus rhythm during pre-procedural CMR imaging were included in this study. Cardiovascular magnetic resonance-derived parameters of LA function and dimensions were calculated. Low-voltage areas were defined as areas with bipolar voltage amplitudes of ≤0.5 mV on electroanatomical mapping. In total, 259 consecutive patients were included in this analysis. Low-voltage areas were found in 25 of 259 patients (9.7%). Compared with those without LVAs, patients with LVAs were significantly older, were more likely to be female, had a higher CHA2DS2-VASc score, had larger LA volumes, and had a lower LA total emptying fraction (TEF). In multivariate analysis, only LA TEF [odds ratio (OR) 0.885, 95% confidence interval (CI) 0.846-0.926, P < 0.001] and the CHA2DS2-VASc score (OR 1.507, 95% CI 1.115-2.038, P = 0.008) remained independently associated with the presence of LVAs. CONCLUSION Left atrial TEF and the CHA2DS2-VASc score were independently associated with the presence of LVAs found during LA electroanatomical mapping. These findings may help to improve pre-procedural prediction of pro-arrhythmogenic LVAs and to improve peri-procedural patient management.
Collapse
Affiliation(s)
- Susanne Löbe
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Pierre Stellmach
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Angeliki Darma
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
- Helios Health Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
- Helios Health Institute, Leipzig, Germany
| | - Simon Kircher
- Department of Electrophysiology, HELIOS Heart Center Leipzig—University of Leipzig, Struempellstr. 39, Leipzig 04289, Germany
| |
Collapse
|
7
|
König S, Wohlrab L, Leiner J, Pellissier V, Nitsche A, Darma A, Hilbert S, Nedios S, Seewöster T, Dinov B, Hindricks G, Bollmann A. Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: results from a patient survey as part of the monocentric FAST AFA trial. Europace 2023; 25:euad262. [PMID: 37656979 PMCID: PMC10492224 DOI: 10.1093/europace/euad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS Same-day discharge (SDD) following catheter ablation (CA) of atrial fibrillation (AF) was already introduced in selected facilities in Europe, but a widespread implementation has not yet succeeded. Data on patients' perspectives are lacking. Therefore, we conducted a survey to address patients' beliefs towards SDD and identify variables that are associated with their evaluation. METHODS AND RESULTS As part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing left atrial CA for AF were asked to participate in the survey consisting of a study-specific questionnaire, the AF knowledge scale, and pre-defined patient-reported outcome measures. The study cohort was stratified based on SDD willingness, and a logistic regression analysis was used to identify predictors for patients' valuation. Between 26 July 2021 and 01 July 2022, 256 of 376 screened patients consented to study participation of whom 248 (mean age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%), and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, expressed concerns included uncertainties with occurring complaints (50.6%), the insufficient recognition (47.8%), and treatment (48.9%) of complications. European Heart Rhythm Association class at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not. CONCLUSION We provide a detailed survey expressing patients' beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.
Collapse
Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Lisa Wohlrab
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Anne Nitsche
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
- Real World Evidence & Health Technology Assessment, Helios Health Institute, Berlin, Germany
| |
Collapse
|
8
|
Dilk P, Darma A, Hindricks G, Dinov B. Ultra-low-temperature cryoablation for ventricular tachycardia in nonischemic cardiomyopathy-A case report. HeartRhythm Case Rep 2023; 9:469-472. [PMID: 37492043 PMCID: PMC10363468 DOI: 10.1016/j.hrcr.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Patrick Dilk
- Address reprint requests and correspondence: Dr Patrick Dilk, Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
| | | | | | | |
Collapse
|
9
|
Matusik PS, Popiela TJ, Darma A, Gul EE, Matusik PT. Multiparametric Cardiac Magnetic Resonance and Arrhythmias in Myocarditis. J Clin Med 2023; 12:3754. [PMID: 37297951 PMCID: PMC10253391 DOI: 10.3390/jcm12113754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Myocarditis is an inflammatory disease of the myocardium with a wide range of potential etiological factors, including a variety of infectious agents (mainly viral), systemic diseases, drugs, and toxins.
Collapse
Affiliation(s)
- Patrycja S. Matusik
- Department of Diagnostic Imaging, University Hospital, 30-688 Kraków, Poland
| | - Tadeusz J. Popiela
- Chair of Radiology, Jagiellonian University Medical College, 31-501 Kraków, Poland
| | - Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, 04289 Leipzig, Germany
| | - Enes E. Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
| | - Paweł T. Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 31-202 Kraków, Poland
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland
| |
Collapse
|
10
|
Darma A, Dinov B, Bertagnolli L, Torri F, Lurz JA, Dagres N, Bollmann A, Hindricks G, Arya A. Cardiac tamponade complicating ventricular arrhythmia ablation: Real life data on incidence, management, and outcome. J Cardiovasc Electrophysiol 2023; 34:403-411. [PMID: 36434796 DOI: 10.1111/jce.15760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Cardiac tamponade during ablation procedures is a life-threatening complication. While the incidence and management of tamponade in atrial fibrillation ablation have been extensively described, the data on tamponade during ventricular ablations are very limited. The purpose of this study is to shed light on the incidence, typical perforation sites, and optimal management as observed through real-life data in a tertiary referral center for ventricular ablation. METHODS AND RESULTS Consecutive patients with structural heart disease undergoing ventricular tachycardia ablation from 2008-2020 were analyzed. Of the 1078 patients undergoing 1287 ventricular ablation procedures, 20 procedures (1.5%) were complicated by cardiac tamponade. In all but one patient, the tamponade was treated with emergent pericardial drainage, while nine patients eventually underwent surgical repair. The perforation occurred during transseptal or subxiphoid puncture in six patients, during ventricle mapping in two patients, and during ablation in five patients (predominantly basal left ventricle). Steam pop as definite perforation cause could only be established in two patients. Regardless of the management of the complication, all patients survived to discharge. CONCLUSION Cardiac tamponade during ventricular ablation occurred in 1.5% of the procedures. In nine patients cardiac repair was necessary. Perforation was mostly associated with subxiphoid puncture or ablation of the basal left ventricle.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiology and Electrophysiology, San Maurizio Hospital, Bolzano, Italy
| | - Federica Torri
- Department of Cardiology and Electrophysiology, San Maurizio Hospital, Bolzano, Italy
| | - Julia Anna Lurz
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Halle University, Halle, Germany
| |
Collapse
|
11
|
Dinov B, Darma A, Nedios S, Hindricks G. Management of patients with electrical storm: an educational review. Eur Heart J Acute Cardiovasc Care 2023; 12:69-73. [PMID: 36574428 DOI: 10.1093/ehjacc/zuac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Electrical storm (ES) is a medical emergency that is defined as ≥ 3 separate ventricular tachycardia (VT) episodes causing ICD therapy within 24 h. Patients with ES have high risk for hospitalization, heart failure (HF) decompensation, in-hospital death. Furthermore, it is associated with significant anxiety and distress for the patients. Frequent triggers of ES are myocardial ischaemia, acute decompensation of HF, metabolic and electrolyte disorders, drug side-effects, increased sympathetic tone. Acute management of ES requires sedation, antiarrhythmic drugs and correction of the precipitating factors; although, in severe refractory cases, intubation, mechanical ventilation, and circulatory support might be necessary. Radiofrequency catheter ablation is superior than antiarrhythmic drugs to suppress the ES and is also frequently required to terminate the ES, as well as to achieve acute and long-term freedom of VT. Optimization of the ICD programming is crucial to reduce the burden of further appropriate and inappropriate shocks. Use of appropriate discrimination criteria and algorithms, ATPs and extending the detection times are important measures to reduce the burden of ES. In patients with end-stage HF, ES can be a sign of failing heart and can be refractory of treatment. In such cases, deactivation of the ICD therapy should be considered and discussed with patients and their care givers.
Collapse
Affiliation(s)
- Borislav Dinov
- Department for Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Angeliki Darma
- Department for Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Sotirios Nedios
- Department for Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department for Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| |
Collapse
|
12
|
König S, Schröter T, Borger MA, Bertagnolli L, Nedios S, Darma A, Hindricks G, Arya A, Dinov B. Outcomes following cardiac sympathetic denervation in patients with structural heart disease and refractory ventricular arrhythmia. Europace 2022; 24:1800-1808. [DOI: 10.1093/europace/euac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Cardiac sympathetic denervation (CSD) has been introduced as a bailout therapy in patients with structural heart disease and refractory ventricular arrhythmias (VAs), but available data are scarce. Purpose of this study was to estimate immediate results, complications, and mid-term outcomes of CSD following recurrent VA after catheter ablation.
Methods and results
Adult patients who underwent CSD in the Heart Center Leipzig from March 2017 to February 2021 were retrospectively analysed. Follow-up (FU) was executed via implantable cardioverter defibrillator (ICD) interrogation, telephone interviews, and reviewing medical records. Twenty-one patients (age 63.7 ± 14.4 years, all men, 71.4% non-ischaemic cardiomyopathy, left ventricular ejection fraction 31.6 ± 12.6%) received CSD via video-assisted thoracoscopic surgery (90.5% bilateral, 9.5% left-sided only). Indication for CSD was monomorphic ventricular tachycardia in 76.2% and ventricular fibrillation in 23.8 with 71.4% of patients presenting with electrical storm before index hospitalization. Procedure-related major complications occurred in 9.5% of patients. In-hospital adverse events not related to surgery were common (28.6%) and two patients died during the index hospital stay. During FU (mean duration 9.1 ± 6.5 months), five more patients died. Of the remaining patients, 38.5 and 76.9% were free from any VA or ICD shocks, respectively.
Conclusions
The CSD showed additional moderate efficacy to suppress VAs, when performed as a bailout therapy after previously unsuccessful catheter ablation. At 9 months, it was associated with freedom of ICD shocks in two-thirds of patients. In a population with many comorbidities, the rate of CSD-related complications was acceptable, although there was an overall high risk of procedure unrelated adverse events and death.
Collapse
Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
- Leipzig Heart Institute , Leipzig , Germany
| | - Thomas Schröter
- Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery , Leipzig , Germany
| | - Michael A Borger
- Heart Center Leipzig at University of Leipzig, Department of Cardiac Surgery , Leipzig , Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
- Leipzig Heart Institute , Leipzig , Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Strümpellstraße 39, Leipzig 04289 , Germany
| |
Collapse
|
13
|
Nedios S, Seewoester T, Darma A, Dinov B, Hildert S, Lucas J, Doering M, Dagres N, Arya A, Hindricks G, Bollmann A, Richter S. Pacing electrodes to ablate, not to pace: what settings to use to create lesions even deep in the septum. Europace 2022. [DOI: 10.1093/europace/euac053.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Intramural septal ventricular arrhythmia remains challenging, requiring emergent technologies and experimental approaches. Although conduction system pacing (CSP) has allowed us to reach deep in the septum, ablation though pacing electrodes has not been examined yet.
Purpose
To evaluate lesion creation by radiofrequency ablation (RFA) through pacing electrodes.
Methods
A custom ex vivo swine model in a saline bath with an indifferent electrode was used to apply RFA with an 8 mm non-irrigated catheter (SJM, MN, USA) on the proximal end of pacing (CapSureFix 5086) or CSP-electrodes (SelectSecure 3830, Medtronic, MN, USA), screwed in perpendicularly to the slab. A generator (Ampere, SJM, MN, USA) applied RFA at varying settings (1-10 W, 1-20 sec). Lesion depth (D), width (W) and volume (V=3,14*W2*D/4) were assessed and analyzed (SPSS 23).
Results
A total of 80 lesions were used for analysis. Median RFA with 3 W over 6 sec resulted in an impedance drop from 200 to 140 Ω and a lesion of 2x3 mm or 9.4 mm3 (Figure 1). Higher energy settings caused impedance rise with abort (n=3, 4%) or charring (n=3, 4%). Compared to conventional electrodes, lesions with CSP-electrodes had similar volume (9.3±7 vs. 10.8±9 mm3, p=0.45) and width (2±0.8 vs. 2±0.7, p=0.58), but more depth (2.6±0.5 vs. 3±0.6, p=0.0.01). Regression analysis showed final-impedance (FI), power and duration (WS=W*Sec) as independent predictors of lesion volume (V=4.7WS-4.1WS2+4.5FI-4, p<0.001).
Conclusions
Effective ablation through pacing electrodes is possible, but lesion size is limited and low-power settings are necessary. Using CSP-electrodes for effective intramural lesions is possibly a new tool for septal arrhythmias. Further in vivo studies are warranted and bailout use should be considered.
Collapse
Affiliation(s)
- S Nedios
- Heart Center of Leipzig, Leipzig, Germany
| | | | - A Darma
- Heart Center of Leipzig, Leipzig, Germany
| | - B Dinov
- Heart Center of Leipzig, Leipzig, Germany
| | - S Hildert
- Heart Center of Leipzig, Leipzig, Germany
| | - J Lucas
- Heart Center of Leipzig, Leipzig, Germany
| | - M Doering
- Heart Center of Leipzig, Leipzig, Germany
| | - N Dagres
- Heart Center of Leipzig, Leipzig, Germany
| | - A Arya
- Heart Center of Leipzig, Leipzig, Germany
| | | | - A Bollmann
- Heart Center of Leipzig, Leipzig, Germany
| | - S Richter
- Heart Center of Leipzig, Leipzig, Germany
| |
Collapse
|
14
|
Bacevicius J, Abramikas Z, Dvinelis E, Audzijoniene D, Petrylaite M, Marinskiene J, Staigyte J, Karuzas A, Juknevicius V, Jakaite R, Basyte-Bacevice V, Bileisiene N, Solosenko A, Sokas D, Petrenas A, Butkuviene M, Paliakaite B, Daukantas S, Rapalis A, Marinskis G, Jasiunas E, Darma A, Marozas V, Aidietis A. High Specificity Wearable Device With Photoplethysmography and Six-Lead Electrocardiography for Atrial Fibrillation Detection Challenged by Frequent Premature Contractions: DoubleCheck-AF. Front Cardiovasc Med 2022; 9:869730. [PMID: 35463751 PMCID: PMC9019128 DOI: 10.3389/fcvm.2022.869730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 01/25/2023] Open
Abstract
Background Consumer smartwatches have gained attention as mobile health (mHealth) tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement artifacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead signal and is limited in asymptomatic cases. Objective DoubleCheck-AF is a validation study of a wrist-worn device dedicated to providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with particular emphasis on the challenge of frequent premature beats. Methods and Results We performed a prospective, non-randomized study of 344 participants including 121 patients in AF. To challenge the specificity of the device two control groups were selected: 95 patients in stable SR and 128 patients in SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG tracings were labeled by two independent diagnosis-blinded cardiologists as “AF,” “SR” or “Cannot be concluded.” In case of disagreement, a third cardiologist was consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACs per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the wearable and combination of both yielded sensitivity and specificity of 94.2 and 96.9%; 99.2 and 99.1%; 94.2 and 99.6%, respectively. All seven false-positive PPG-based cases were from the frequent PVCs/PACs group compared to none from the stable SR group (P < 0.001). In the majority of these cases (6/7) cardiologists were able to correct the diagnosis to SR with the help of the ECG of the device (P = 0.012). Conclusions This is the first wearable combining PPG-based AF detection algorithm for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm confirmation. The system maintained high specificity despite a remarkable amount of frequent single or multiple premature contractions.
Collapse
Affiliation(s)
- Justinas Bacevicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Zygimantas Abramikas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ernestas Dvinelis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Deimile Audzijoniene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marija Petrylaite
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Julija Marinskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Justina Staigyte
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Albinas Karuzas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vytautas Juknevicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rusne Jakaite
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Neringa Bileisiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Andrius Solosenko
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Daivaras Sokas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Andrius Petrenas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Monika Butkuviene
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Birute Paliakaite
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Saulius Daukantas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Germanas Marinskis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Eugenijus Jasiunas
- Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Angeliki Darma
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.,Department of Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
| | - Audrius Aidietis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
15
|
Darma A, Bertagnolli L, Weber A, Dinov B, Torri F, Lurz JA, Shamloo AS, Dagres N, Bollmann A, Hindricks G, Arya A. Epicardial ablation of ventricular tachycardia in patients with structural heart disease: a single-centre experience over 12 years. Europace 2021; 23:1980-1988. [PMID: 34405874 DOI: 10.1093/europace/euab194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Epicardial ablation has risen to an essential part of the treatment of ventricular tachycardias (VTs). In this study, we report the efficacy, risks, and current trends of epicardial ablation in structural heart disease as reported in a tertiary single centre over a 12-year period. METHODS AND RESULTS Two hundred and thirty-six patients referred for VT ablation underwent a successful epicardial access and were included in the analysis (89% non-ischaemic cardiomyopathy, 90% males, mean age 60 years, mean left ventricular ejection fraction 38.4%). After performing epicardial ablation the clinical VTs were eliminated in 87% of the patients and 71% of the cohort achieved freedom from VT during 22-month follow-up. Twelve patients (5%) suffered major procedure-related complications. Until the end of follow-up 47 (20%) patients died, 9 (4%) underwent a left ventricular assist device implantation and 10 (4%) patients received a heart transplantation. Antiarrhythmic drugs at baseline and during follow-up were independent predictors of VT recurrence. Atrial fibrillation, renal dysfunction, worse New York Heart Association class, and antiarrhythmic drugs at follow-up were associated with worse survival in our cohort. CONCLUSION In this large tertiary single-centre experience, percutaneous epicardial access was feasible in the large majority of the cohort with acceptably low complications rates. A combined endo-/epicardial approach resulted in 87% acute and 71% long-term success. Further studies are needed to clarify the role of routine combined endo-/epicardial ablation in these complex cardiomyopathies.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Alexander Weber
- Department for Cardiology, KMG Güstrow Hospital, Güstrow, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Federica Torri
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Julia Anna Lurz
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Alireza Sepehri Shamloo
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Center University Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| |
Collapse
|
16
|
Darma A, Bertagnolli L, Torri F, Paetsch I, Jahnke C, Dinov B, Hindricks G, Arya A. LV Pseudoaneurysm With Concomitant Mitral Valve Defect After LV Summit Ablation: A Rare Late Complication. JACC Case Rep 2021; 3:1756-1759. [PMID: 34825204 PMCID: PMC8603023 DOI: 10.1016/j.jaccas.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022]
Abstract
A 25-year-old male patient with highly symptomatic, monomorphic, premature ventricular contractions presented for repeat ablation after failed endocardial ablation. Three weeks after excessive endocardial and epicardial ablation on the left ventricular summit, the patient was admitted again with tamponade following a pseudoaneurysm on the ablation site. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Federica Torri
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Ingo Paetsch
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| |
Collapse
|
17
|
Sepehri Shamloo A, Arya A, Darma A, Nedios S, Döring M, Bollmann A, Dagres N, Hindricks G. Atrial fibrillation: is there a role for cardiac troponin? Diagnosis (Berl) 2021; 8:295-303. [PMID: 31913848 DOI: 10.1515/dx-2019-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence rate is expected to be doubled over the next decades. Despite the wide use of biomarkers in the management of different cardiac diseases such as myocardial infarction and heart failure, utilization of biomarkers in AF management is not routinely recommended by current guidelines. There is also growing evidence that higher levels of cardiac-specific troponin, as an intracellular protein involved in cardiomyocyte contraction, may be associated with the risk of incident and recurrent AF and its complications. In the present paper, we review the association between troponin and AF and propose clinical suggestions for use of troponin in the management of AF patients.
Collapse
Affiliation(s)
- Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Döring
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| |
Collapse
|
18
|
Darma A, Bertagnolli L, Torri F, Lurz JA, König S, Ueberham L, Bollmann A, Dagres N, Hindricks G, Dinov B, Arya A. Gender differences in patients with structural heart disease undergoing VT ablation. J Cardiovasc Electrophysiol 2021; 32:2675-2683. [PMID: 34411387 DOI: 10.1111/jce.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study sought to examine gender differences in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). BACKGROUND Female patients are often underrepresented in large studies. Significant differences in the clinical presentation, treatment, and prognosis of female patients have been described in previous studies. METHODS AND RESULTS We investigated 88 female patients with SHD undergoing VT ablation (mean age 59 years, 56% nonischemic cardiomyopathy, mean left ventricular ejection fraction 35%, 82% in electrical storm). A case-control study with 88 male patients was performed and the results regarding clinical and procedural characteristics, acute and long-term results of the two groups were compared. The female patients had more arrhythmogenic substrate, as they more commonly presented with electrical storm (p = .016) and had a higher number of inducible VT morphologies during the procedure (p = .018). Moreover, the female patients were less likely to have an optimized heart failure medical treatment at baseline (p = .030) and required more time from the first manifestation of the VT to ablation referral (p = .034). Although fewer epicardial ablations were performed in female patients (p = .019), the two groups showed similar results regarding VT noninducibility as ablation endpoint (p = .844), major procedure-related complications (p = .719) and freedom from VT during follow-up (p = .268). Moreover, the overall mortality in the two groups was similar (p = .176). Advanced NYHA class was associated with worse transplant and assist-device-free survival in the female group. CONCLUSION Female patients presenting for VT ablation had more arrhythmogenic substrate and were less likely to have an optimized heart failure medical treatment. Nevertheless, the procedural acute and long-term outcomes between the two genders were similar.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Federica Torri
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Julia A Lurz
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Sebastian König
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Laura Ueberham
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| |
Collapse
|
19
|
Darma A, Bertagnolli L, Dinov B, Shamloo AS, Torri F, Efimova E, Dagres N, Husser-Bollmann D, Bollmann A, Hindricks G, Arya A. Role of assist device implantation and heart transplantation in the long-term outcome of patients with structural heart disease after catheter ablation of ventricular tachycardia. Herzschrittmacherther Elektrophysiol 2021; 32:353-358. [PMID: 34269843 PMCID: PMC8413170 DOI: 10.1007/s00399-021-00787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Introduction Ablation of ventricular tachycardias (VTs) in patients with structural heart disease (SHD) has been associated with advanced heart failure and poor survival. Methods and results This matched case-control study sought to assess the difference in survival after left ventricular assist device (LVAD) implantation and/or heart transplantation (HTX) in SHD patients undergoing VT ablation. From the initial cohort of 309 SHD patients undergoing VT ablation (187 ischemic cardiomyopathy, mean age 64 ± 12 years, ejection fraction of 34 ± 13%), 15 patients received an LVAD and nine patients HTX after VT ablation during a follow-up period of 44 ± 33 months. Long-term survival after LVAD did not differ from the matched control group (p = 0.761), although the cause of lethal events was different. All post-HTX patients survived during follow-up. Conclusion In this matched case-control study on patients with SHD undergoing VT ablation, patients that received LVAD implantation had similar survival compared to the control group after 4‑year follow-up, while the patients with HTX had a significantly better outcome.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany.
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Federica Torri
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Elena Efimova
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Daniela Husser-Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| |
Collapse
|
20
|
Hindricks G, Darma A. Katheterablation bei asymptomatischem Vorhofflimmern – Wer profitiert? Aktuelle Kardiologie 2021. [DOI: 10.1055/a-1471-2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie Katheterablation von paroxysmalem oder persistierendem Vorhofflimmern hat sich in den
letzten Jahren als überlegene Therapiebehandlung zur Rhythmusstabilisierung gegenüber
Antiarrhythmika etabliert. Allerdings wird diese Behandlung nach den aktuellen Leitlinien nur
bei symptomatischen Patienten empfohlen. Ein großer Teil der Vorhofflimmerpatienten bleibt
jedoch asymptomatisch. Ältere Studien konnten keinen Vorteil bezüglich der Letalitäts- oder
Apoplexreduktion durch Rhythmusstabilisierung nachweisen. Eine aktuelle randomisierte Studie
zeigt erstmalig eine Reduktion der kardiovaskulären Ereignisse, aber nicht der
Gesamtletalität. Ist nach aktueller Datenlage eine Katheterablation im Falle von
asymptomatischen Patienten berechtigt und wer könnte davon profitieren?
Collapse
Affiliation(s)
- Gerhard Hindricks
- Abteilung für Rhythmologie, Herzzentrum Leipzig GmbH Universitatsklinik, Leipzig, Deutschland
| | - Angeliki Darma
- Abteilung für Rhythmologie, Herzzentrum Leipzig GmbH Universitatsklinik, Leipzig, Deutschland
| |
Collapse
|
21
|
Nedios S, Lindemann F, Darma A, Seewoester T, Bertganolli L, Dinov B, Hilbert S, Susanne L, Richter S, Arash A, Hindricks G, Bollmann A. CONTACT FORCE BY DEFORMATION OF ABLATION CATHETERS: CAN WE PREDICT BY BENDING? J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Darma A, Bertagnolli L, Dinov B, Torri F, Dagres N, Bollmann A, Hindricks G, Arya A. VT ablation in geriatric patients with structural heart disease: Should there still be an age limit? J Cardiovasc Electrophysiol 2021; 32:766-771. [PMID: 33428325 DOI: 10.1111/jce.14873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study sought to examine the feasibility and outcome of ablation of ventricular tachycardias (VTs) in a contemporary cohort of geriatric patients with structural heart disease (SHD). BACKGROUND Geriatric patients are often underrepresented in large studies. As frailty is becoming an increasing problem, we need to examine the best course of action for this population. METHODS AND RESULTS We investigated 68 SHD-patients ≥ 75 years old undergoing VT-ablation (men 88%, ischemic cardiomyopathy 77%, electrical storm 72%, mean left ventricular ejection fraction 31%) and divided the cohort into two groups: 75-79 years old (n = 51) and ≥80 years old (n = 17). The two groups showed similar results regarding noninducibility as ablation endpoint (p = .693), major procedure-related complications (p = .488), and VT-recurrence (p = .882) during the 39-month follow-up. At the end of the follow-up, 10 patients in the octogenarian group (59%) versus 16 patients of the other group (31%) died. CONCLUSION Geriatric patients with SHD including octogenarians showed similar results regarding procedural endpoints, freedom of VT, and major procedure-associated complications after VT-ablation. When ablation is indicated, age alone should not be an inhibiting factor to treat these patients.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Federica Torri
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
23
|
Darma A, Arya A, Dagres N, Kühl M, Hindricks G, Eifert S, Saeed D, Borger M, Martins RP, Leclercq C, Galand V. Validation of the VT-LVAD score for prediction of late VAs in LVAD recipients. J Cardiovasc Electrophysiol 2020; 32:515-522. [PMID: 33270307 DOI: 10.1111/jce.14827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to validate the performance of the VT-LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation. BACKGROUND The need for implantable cardioverter-defibrillator (ICD)-implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD-implantation or replacement. METHODS The study evaluated the performance of the VT-LVAD prognostic score (VAs prior LVAD, no ACE-inhibitor in medication, heart failure duration > 12 months, early VAs post-LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig. RESULTS From the initial 460 patients, 357 (age: 58 ± 10 years; left ventricular ejection fraction: 20 ± 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT-LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT-LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness-of-tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low- and intermediate-risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively). CONCLUSIONS The VT-LVAD score predicted accurately the occurrence of late VAs in high-risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Michael Kühl
- Department of Cardiology, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Leipzig, Germany
| | - Sandra Eifert
- Department of Cardiac Surgery, Heart Centre of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Centre of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Centre of Leipzig, Leipzig, Germany
| | - Raphaël P Martins
- Department of Cardiology and Electrophysiology, Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France.,Department of Cardiologie, Université de Rennes 1, Rennes, France.,Research Department, U1099, INSERM, Rennes, France
| | - Christophe Leclercq
- Department of Cardiology and Electrophysiology, Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France.,Department of Cardiologie, Université de Rennes 1, Rennes, France.,Research Department, U1099, INSERM, Rennes, France
| | - Vincent Galand
- Department of Cardiology and Electrophysiology, Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France.,Department of Cardiologie, Université de Rennes 1, Rennes, France.,Research Department, U1099, INSERM, Rennes, France
| |
Collapse
|
24
|
Nedios S, Doering M, Darma A, Lucas J, Dinov B, Arya A, Dagres N, Hindricks G, Bollmann A, Richter S, Bode K. Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead? Clin Cardiol 2020; 44:210-217. [PMID: 33295029 PMCID: PMC7852157 DOI: 10.1002/clc.23527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is widely used in atrial fibrillation (AF) patients and could impact rhythm stability. HYPOTHESIS We aimed to identify predictors of sinus rhythm (SR) stability or AF progression in a real-word cohort of CRT-AF patients. METHODS From 330 consecutive implantable cardioverter-defibrillator implantations due to ischemic or dilated cardiomyopathy, 65 (20%) patients with AF history (paroxysmal, n = 32) underwent a CRT implantation with an atrial electrode and were regularly followed every 4-6 months. Rhythm restoration was attempted for most AF patients based on symptoms, biventricular pacing (BP), and lack of thrombi. RESULTS After 33 months, 18 (28%) patients progressed to permanent mode switch (MS≥99%) and 20 (31%) patients had stable SR (MS < 1%). Logistic regression showed that history of persistent AF (OR: 8.01, 95%CI: 2.0-31.7, p = .003) is associated with higher risk of permanent MS. In persistent AF patients, a bigger left atrium (OR: 1.2 per mm, 95%CI: 1.03-1.4, p = .025) and older age (OR: 1.15 per life-year, 95%CI: 1.01-1.3, p = .032) were predictors of future permanent MS. Paroxysmal AF at implantation (OR: 5.96, 95%CI: 1.6-21.9, p = .007) and increased BP (OR: 1.4 per 1%, 95%CI: 1.05-1.89, p = .02) were associated with stable SR. In persistent AF patients, stable SR correlated with higher BP (98 ± 2 vs. 92 ± 8%, p < .001). CONCLUSION In patients with AF undergoing CRT implantation, persistent AF, LA dilatation and advanced age relate to future permanent MS (AF), whereas high BP promotes SR stability. These findings could facilitate the management of CRT-AF patients and guide therapy in order to maximize its effect on rhythm.
Collapse
Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| |
Collapse
|
25
|
Darma A, Bertagnolli L, Dinov B, Torri F, Shamloo AS, Lurz JA, Dagres N, Husser-Bollmann D, Bollmann A, Hindricks G, Arya A. Predictors of long-term mortality after catheter ablation of ventricular tachycardia in a contemporary cohort of patients with structural heart disease. Europace 2020; 22:1672-1679. [DOI: 10.1093/europace/euaa189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Ablation of ventricular tachycardias (VTs) in patients with structural heart disease has been established in the past decades as an effective and safe treatment. However, the prognosis and long-term outcome remains poor.
Methods and results
We investigated 309 patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) (186 ICM, 123 NICM; 271 males; mean age 64.1 ± 12 years; ejection fraction 34 ± 13%) after ≥1 VT ablations over a mean follow-up period of 34 ± 28 months. Electrical storm was the indication for 224 patients (73%), whereas 86 patients (28%) underwent epicardial as well as endocardial ablation. During follow-up, 132 patients (43%) experienced VT recurrence and 97 (31%) died. Ischaemic cardiomyopathy and NICM patients showed comparable results, regarding procedural endpoints, complications, VT recurrence and survival. The Cox-regression analysis for all-cause mortality revealed that the presence of higher left ventricular end-diastolic volume (LVEDV; P < 0.001), male gender (P = 0.018), atrial fibrillation (AF; P < 0.001), chronic obstructive pulmonary disease (COPD; P = 0.001), antiarrhythmic drugs during the follow-up (P < 0.001), polymorphic VTs (P = 0.028), and periprocedural complications (P = 0.001) were independent predictors of mortality.
Conclusion
Ischaemic cardiomyopathy and NICM patients undergoing VT ablation had comparable results regarding procedural endpoints, complications, VT recurrence and 3-year mortality. Higher LVEDV, male gender, COPD, AF, polymorphic VTs, use of antiarrhythmics, and periprocedural complications are strong and independent predictors for increased mortality. The PAINESD score accurately predicted the long-term outcome in our cohort.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Livio Bertagnolli
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Federica Torri
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Alireza Sepehri Shamloo
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Julia Anna Lurz
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Daniela Husser-Bollmann
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Centre of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| |
Collapse
|
26
|
Darma A, Daneschnejad SS, Gaspar T, Huo Y, Wetzel U, Dagres N, Husser D, Sommer P, Piorkowski C, Bollmann A, Hindricks G, Arya A. Role of inducibility and its dynamic change in the outcome of catheter ablation of atrial fibrillation: a single center prospective study. J Cardiovasc Electrophysiol 2020; 31:705-711. [PMID: 31943494 DOI: 10.1111/jce.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF) has been a controversial subject in many studies. Our goal is to evaluate the significance of inducibility, the impact of multiple sites or protocols of stimulation or the change in inducibility status in a prospective study including patients with AF undergoing first catheter ablation. METHODS We studied 170 consecutive patients with AF (62.9% paroxysmal) undergoing catheter ablation. All patients underwent two separate stimulation protocols before and after the ablation from the coronary sinus ostium and the left atrial appendage: burst pacing at 300, 250, 200 milliseconds (or until refractoriness) for 10 seconds and ramp decrementing from 300 to 200 milliseconds in increments of 10 milliseconds every three beats for 10 seconds. Inducibility was defined as any sustained AF or organized atrial tachycardia (AT) lasting >30 seconds. RESULTS We had AF/AT inducibility in 55 patients at baseline compared to 36 following ablation. After a mean of 41, 3 months follow-up, 115 patients were free of AF. Inducibility before or after the ablation or change in inducibility status did not influence AF recurrence. There were no significant differences regarding paroxysmal or persistent patients with AF. CONCLUSIONS Non-inducibility of atrial arrhythmia or change in inducibility status following pulmonary vein (PV) isolation and substrate modification are not associated with long-term freedom from recurrent arrhythmia. Therefore, the use of induction of an endpoint in AF ablation is limited.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sait S Daneschnejad
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Yan Huo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ulrike Wetzel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| |
Collapse
|
27
|
Sepehri Shamloo A, Schoene K, Stauber A, Darma A, Dagres N, Dinov B, Bertagnolli L, Hilbert S, Müssigbrodt A, Husser D, Bollmann A, Hindricks G, Arya A. Epicardial adipose tissue thickness as an independent predictor of ventricular tachycardia recurrence following ablation. Heart Rhythm 2019; 16:1492-1498. [DOI: 10.1016/j.hrthm.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Indexed: 01/20/2023]
|
28
|
Hindricks G, Sepehri Shamloo A, Lenarczyk R, Kalarus Z, Arya A, Kircher S, Darma A, Dagres N. Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges. Kardiol Pol 2018; 76:1680-1686. [DOI: 10.5603/kp.a2018.0216] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
|
29
|
Athiyyah AF, Darma A, Ranuh R, Riawan W, Endaryanto A, Rantam FA, Surono IS, Sudarmo SM. Lactobacillus plantarum IS-10506 activates intestinal stem cells in a rodent model. Benef Microbes 2018; 9:755-760. [PMID: 29726283 DOI: 10.3920/bm2017.0118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study investigated the probiotic effect of Lactobacillus plantarum IS-10506 in activating and regenerating leucine-rich repeat-containing G-protein-coupled receptor (Lgr)5- and B lymphoma Moloney murine leukaemia virus insertion region (Bmi)1-expressing intestinal stem cells in rodents following Escherichia coli serotype 055:B5 lipopolysaccharide (LPS) exposure. Male Sprague-Dawley rats (n=64) were randomised into control (KN), LPS (KL), probiotic + LPS (KL-Pr), and sequential probiotic + LPS + probiotic (KPR-7L) groups. Microencapsulated L. plantarum IS-10506 (2.86×1010 cfu/day) was administered via a gastric tube once daily for up to 7 days, and LPS (250 ng/kg body weight) was administered via a gastric tube on the first day of the experiment to all but the KN group. On day 3, 4, 6, and 7, four rats per group were sacrificed, and Lgr5, Bmi1, extracellular signal-regulated kinase (ERK), and β-catenin expression in the ileum was assessed by immunohistochemistry. LPS treatment reduced Lgr5 (P≤0.05) and Bmi1 (P=0.000) levels in intestinal epithelial cells, whereas probiotic treatment increased levels of Lgr5 (KPR-7L, P=0.008) and Bmi1 (KL-Pr, P=0.008; and KPR-7L, P=0.000). Lgr5 expression was upregulated in the KL-Pr group on day 3, 4, 6, and 7 (P=0.056). Additionally, ERK levels were elevated in Bmi1- and Lgr5-expressing cells in rats treated with probiotics (KL-Pr and KPR-7L), whereas β-catenin levels were increased in Lgr5-expressing cells from KPR-7L rats and in Bmi1-expressing cells from KL-Pr and KPR-7L rats on day 3 and 4. These results demonstrated that the probiotic L. plantarum IS-10506 activated intestinal stem cells to counter inflammation and might be useful for maintaining intestinal health, especially when used as a prophylactic agent.
Collapse
Affiliation(s)
- A F Athiyyah
- 1 Department of Child Health Dr. Soetomo Hospital Faculty of Medicine Airlangga University, Jl. Prof. Dr. Moestopo No. 6-8, Surabaya, Indonesia
| | - A Darma
- 1 Department of Child Health Dr. Soetomo Hospital Faculty of Medicine Airlangga University, Jl. Prof. Dr. Moestopo No. 6-8, Surabaya, Indonesia
| | - R Ranuh
- 1 Department of Child Health Dr. Soetomo Hospital Faculty of Medicine Airlangga University, Jl. Prof. Dr. Moestopo No. 6-8, Surabaya, Indonesia
| | - W Riawan
- 2 Laboratory of Biochemistry and Biomolecular Brawijaya University, Jl. Veteran, Malang, Indonesia
| | - A Endaryanto
- 1 Department of Child Health Dr. Soetomo Hospital Faculty of Medicine Airlangga University, Jl. Prof. Dr. Moestopo No. 6-8, Surabaya, Indonesia
| | - F A Rantam
- 3 Stem Cell Laboratory Institute of Tropical Disease, Jl. Mulyorejo, Surabaya, Indonesia
| | - I S Surono
- 4 Food Technology Department, Faculty of Engineering, Bina Nusantara University, Jakarta 11480, Indonesia
| | - S M Sudarmo
- 1 Department of Child Health Dr. Soetomo Hospital Faculty of Medicine Airlangga University, Jl. Prof. Dr. Moestopo No. 6-8, Surabaya, Indonesia
| |
Collapse
|
30
|
Nedios S, Darma A, Richter S, Doering M, Muessigbrodt A, Arya A, Sommer P, Hindricks G, Bollmann A. P5463Cardiac resynchronization therapy in patients with Atrial Fibrillation. Predictors of sinUs rhythm REstoration (CRT-AF PURE). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Nedios S, Darma A, Richter S, Doering M, Muessigbrodt A, Arya A, Sommer P, Hindricks G, Bollmann A. P1449Cardiac Resynchronization Therapy in patients with Atrial Fibrillation. Predictors of sinUs rhythm REstoration (CRT-AF PURE). Europace 2017. [DOI: 10.1093/ehjci/eux158.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
32
|
Nedios S, Darma A, Stevanello C, Richter S, Doering M, Rolf S, Sommer P, Hindricks G, Bollmann A, Arya A. Electrical storm in patients with implantable cardioverter-defibrillator in the era of catheter ablation: Implications for better rhythm control. Heart Rhythm 2015; 12:2419-25. [DOI: 10.1016/j.hrthm.2015.07.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 11/16/2022]
|
33
|
Darma A, Nedios S, Kosiuk J, Richter S, Doering M, Arya A, Rolf S, Sommer P, Hindricks G, Bollmann A. Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies. Europace 2015; 18:405-12. [PMID: 26056190 DOI: 10.1093/europace/euv138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/24/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients with both ischaemic and non-ischaemic cardiomyopathy by terminating life-threatening arrhythmias. However, such arrhythmic events are unequally distributed among different patient subgroups. We aimed to evaluate predictors of appropriate ICD therapies as a step towards risk stratification in a real-world cohort. METHODS AND RESULTS The prevalence and predictors of appropriate ICD therapies were analysed in 330 consecutive patients (mean age 65 ± 11, 81% male) with implanted ICDs due to ischaemic (n = 204) or dilated (n = 126) cardiomyopathy. During a mean follow-up of 19 ± 9 months, 1545 appropriate ICD therapies (antitachycardia pacing and shocks) were detected in 94 patients (29%). In multivariate analysis applied on the whole cohort, the presence of atrial fibrillation [AF: odds ratio (OR) = 1.906, confidence interval (CI) = 1.143-3.177, P = 0.013] and secondary prevention indication (OR = 1.963, CI = 1.123-3.432, P = 0.018) was associated with ICD therapy. The presence of cardiac resynchronization therapy (CRT) had a protective value (OR = 0.563, CI = 0.327-0.968, P = 0.038). Moreover, the predictors were different depending on the aetiology of the cardiomyopathy: in the ischaemic group, only secondary prevention indication (OR = 2.0, CI = 1.029-3.891, P = 0.041) and the presence of a biventricular system (OR = 0.359, CI = 0.163-0.794, P = 0.011) remained significant, while in the non-ischaemic group, an association with AF was observed (OR = 4.281, CI = 1.632-11.231, P = 0.003). CONCLUSION The aetiology of cardiomyopathy should be taken into consideration for the therapy of ICD patients. The protective role of CRT devices should be pointed out in ischaemic cardiomyopathy (ICM) and a more rigorous antiarrhythmic treatment should be considered for ICM patients with secondary prevention or for dilated cardiomyopathy patients with AF.
Collapse
Affiliation(s)
- Angeliki Darma
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| |
Collapse
|
34
|
Müssigbrodt A, Kosiuk J, Koutalas E, Pastromas S, Dagres N, Darma A, Lucas J, Breithardt OA, Sommer P, Dinov B, Eitel C, Rolf S, Döring M, Richter S, Arya A, Husser D, Bollmann A, Hindricks G. Results of catheter ablation of atrial fibrillation in hypertrophied hearts – Comparison between primary and secondary hypertrophy. J Cardiol 2015; 65:474-8. [DOI: 10.1016/j.jjcc.2014.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 11/17/2022]
|
35
|
Kosiuk J, Koutalas E, Doering M, Nedios S, Sommer P, Rolf S, Darma A, Breithardt OA, Dinov B, Hindricks G, Richter S, Bollmann A. Comparison of dabigatran and uninterrupted warfarin in patients with atrial fibrillation undergoing cardiac rhythm device implantations. Case-control study. Circ J 2014; 78:2402-2407. [PMID: 25253506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The incidence of postoperative complications following pacemaker or implantable cardioverter-defibrillator implantations in patients treated with new oral anticoagulation agents has not been studied. Here we present a first comparison of complications after cardiac rhythm device (CRD) implantations in patients with atrial fibrillation (AF) treated with dabigatran or uninterrupted warfarin. METHODS AND RESULTS Using a case-control study design, we compared complications within 30 days after 236 CRD procedures performed under uninterrupted warfarin (n=118) or interrupted dabigatran (n=118).There were no significant differences in the baseline characteristics of both groups. In the warfarin group, 9 (8%) pocket hematomas were observed vs. 3 (3%) in the dabigatran group (P=0.075). Two complications in the warfarin group necessitated surgical intervention as opposed to none in the dabigatran group (P=0.156). The postprocedural blood loss expressed as a drop in hemoglobin was significantly greater in the warfarin group (-0.9±0.7 vs. -0.5±0.4 mmol/L, P=0.023). In the dabigatran group, 1 case of transient ischemic attack occurred. The mean time to hospital discharge was shorter in patients treated with dabigatran (2.5±2.3 vs. 3.8±4.1 days, P=0.02). CONCLUSIONS The incidence and severity of bleeding complications may be lower in patients treated with periprocedurally discontinued dabigatran when compared with uninterrupted warfarin therapy. Further evaluation of peri-interventional complications and establishment of an optimal anticoagulation management protocol are needed.
Collapse
|
36
|
Kosiuk J, Koutalas E, Doering M, Nedios S, Sommer P, Rolf S, Darma A, Breithardt OA, Dinov B, Hindricks G, Richter S, Bollmann A. Comparison of Dabigatran and Uninterrupted Warfarin in Patients With Atrial Fibrillation Undergoing Cardiac Rhythm Device Implantations. Circ J 2014:DN/JST.JSTAGE/circj/CJ-14-0665. [PMID: 25152420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background:The incidence of postoperative complications following pacemaker or implantable cardioverter-defibrillator implantations in patients treated with new oral anticoagulation agents has not been studied. Here we present a first comparison of complications after cardiac rhythm device (CRD) implantations in patients with atrial fibrillation (AF) treated with dabigatran or uninterrupted warfarin.Methods and Results:Using a case-control study design, we compared complications within 30 days after 236 CRD procedures performed under uninterrupted warfarin (n=118) or interrupted dabigatran (n=118).There were no significant differences in the baseline characteristics of both groups. In the warfarin group, 9 (8%) pocket hematomas were observed vs. 3 (3%) in the dabigatran group (P=0.075). Two complications in the warfarin group necessitated surgical intervention as opposed to none in the dabigatran group (P=0.156). The postprocedural blood loss expressed as a drop in hemoglobin was significantly greater in the warfarin group (-0.9±0.7 vs. -0.5±0.4 mmol/L, P=0.023). In the dabigatran group, 1 case of transient ischemic attack occurred. The mean time to hospital discharge was shorter in patients treated with dabigatran (2.5±2.3 vs. 3.8±4.1 days, P=0.02).Conclusions:The incidence and severity of bleeding complications may be lower in patients treated with periprocedurally discontinued dabigatran when compared with uninterrupted warfarin therapy. Further evaluation of peri-interventional complications and establishment of an optimal anticoagulation management protocol are needed.
Collapse
|
37
|
Kosiuk J, Nedios S, Darma A, Rolf S, Richter S, Arya A, Piorkowski C, Gaspar T, Sommer P, Husser D, Hindricks G, Bollmann A. Impact of single atrial fibrillation catheter ablation on implantable cardioverter defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies. Europace 2014; 16:1322-6. [DOI: 10.1093/europace/euu018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
38
|
Kosiuk J, Koutalas E, Doering M, Nedios S, Sommer P, Rolf S, Darma A, Breithardt OA, Dinov B, Hindricks G, Richter S, Bollmann A. Comparison of Dabigatran and Uninterrupted Warfarin in Patients With Atrial Fibrillation Undergoing Cardiac Rhythm Device Implantations. Circ J 2014. [DOI: 10.1253/circj.cj-14-0665] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Sascha Rolf
- Department of Electrophysiology, Heart Center Leipzig
| | | | | | | | | | | | | |
Collapse
|
39
|
Kosiuk J, Nedios S, Koutalas E, Darma A, Sommer PH, Rolf S, Hindricks G, Bollmann A, Doering M, Richter S. Safety and efficacy of dabigatran compared with warfarin therapy in patients with atrial fibrillation undergoing cardiac rhythm device interventions. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|