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Sazgary L, Samara ET, Stüssi A, Saltybaeva N, Guckenberger M, Ruschitzka F, Wolber T, Molitor N, Hofer D, Guan F, Suna G, Hermes-Laufer J, Breitenstein A, Brunckhorst CB, Duru F, Saguner AM. The Impact of Clinical Radiation Audits on Patient Radiation Exposure in Cardiac Implantable Electronic Device Procedures. Heart Rhythm 2024:S1547-5271(24)02387-7. [PMID: 38636928 DOI: 10.1016/j.hrthm.2024.04.060] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Lorraine Sazgary
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anja Stüssi
- Radiation Protection Unit, University Hospital Zurich, Zurich, Switzerland
| | - Natalia Saltybaeva
- Radiation Protection Unit, University Hospital Zurich, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fu Guan
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Gonca Suna
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Firat Duru
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Zurich, Switzerland.
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Hofer D, Perucchini F, Blessberger H, Steinwender C, Zehetleitner S, Molitor N, Saguner AM, El-Chami MF, Black G, Schiavone M, Forleo G, Gasperetti A, Steffel J, Noti F, Haeberlin A, Breitenstein A. Electrocardiographic predictors of atrial mechanical sensing in leadless pacemakers. Heart Rhythm 2024:S1547-5271(24)00233-9. [PMID: 38432424 DOI: 10.1016/j.hrthm.2024.02.061] [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: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Leadless pacemakers (LPs) capable of VDD pacing allow for atrioventricular synchrony through mechanical sensing of atrial contraction. However, mechanical sensing is less reliable and less predictable than electrical sensing. OBJECTIVE The purpose of this study was to evaluate P-wave amplitude during sinus rhythm from preoperative 12-lead electrocardiograms (ECGs) as a predictor for atrial mechanical sensing in patients undergoing VDD LP implantation. METHODS Consecutive patients undergoing VDD LP implantation were included in this 2-center prospective cohort study. ECG parameters were evaluated separately and in combination for association with the signal amplitude of atrial mechanical contraction (A4). RESULTS Eighty patients (median age 82 years; female 55%; mean body mass index [BMI] 25.8 kg/m2) were included in the study and 61 patients in the A4 signal analysis (19 patients in VVI mode during follow-up). Absolute (aVL, aVF, V1, V2) and BMI-adjusted (I, II, aVL, aVF, aVR, V1, V2) P-wave amplitudes from baseline ECGs demonstrated a statistically significant positive correlation with A4 signal amplitude (all P <.05). A combined P-wave signal amplitude of at least 0.2 mV in V1 and aVL was predictive, with specificity of 83% (95% confidence interval 67%-100%) for A4 signal ≥1 m/s2. We found a significant correlation of A4 signal amplitude and overall atrioventricular synchrony (P = .013). CONCLUSION P-wave amplitudes in ECG leads aVL and V1 can predict A4 signal amplitude in patients with VDD LP and therefore the probability of successful AV synchronous pacing.
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Affiliation(s)
- Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Fabrizio Perucchini
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Samantha Zehetleitner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Molitor
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - George Black
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post-Transcatheter Aortic Valve Replacement: A Retrospective Analysis. CJC Open 2024; 6:96-103. [PMID: 38585679 PMCID: PMC10994977 DOI: 10.1016/j.cjco.2023.10.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 04/09/2024] Open
Abstract
Background Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications. Methods Consecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected. Results A total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups. Conclusions LP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population.
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Affiliation(s)
- Julius Jelisejevas
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Ardan M. Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Bisignani G, Cheung JW, Rordorf R, Kutyifa V, Hofer D, Berti D, Di Biase L, Martens E, Russo V, Vitillo P, Zoutendijk M, Deneke T, Köhler I, Schrader J, Upadhyay G. Implantable cardiac monitors: artificial intelligence and signal processing reduce remote ECG review workload and preserve arrhythmia detection sensitivity. Front Cardiovasc Med 2024; 11:1343424. [PMID: 38322767 PMCID: PMC10844377 DOI: 10.3389/fcvm.2024.1343424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Implantable cardiac monitors (ICMs) provide long-term arrhythmia monitoring, but high rates of false detections increase the review burden. The new "SmartECG" algorithm filters false detections. Using large real-world data sets, we aimed to quantify the reduction in workload and any loss in sensitivity from this new algorithm. Methods Patients with a BioMonitor IIIm and any device indication were included from three clinical projects. All subcutaneous ECGs (sECGs) transmitted via remote monitoring were classified by the algorithm as "true" or "false." We quantified the relative reduction in workload assuming "false" sECGs were ignored. The remote monitoring workload from five hospitals with established remote monitoring routines was evaluated. Loss in sensitivity was estimated by testing a sample of 2000 sECGs against a clinical board of three physicians. Results Of our population of 368 patients, 42% had an indication for syncope or pre-syncope and 31% for cryptogenic stroke. Within 418.5 patient-years of follow-up, 143,096 remote monitoring transmissions contained 61,517 sECGs. SmartECG filtered 42.8% of all sECGs as "false," reducing the number per patient-year from 147 to 84. In five hospitals, nine trained reviewers inspected on average 105 sECGs per working hour. This results in an annual working time per patient of 83 min without SmartECG, and 48 min with SmartECG. The loss of sensitivity is estimated as 2.6%. In the majority of cases where true arrhythmias were rejected, SmartECG classified the same type of arrhythmia as "true" before or within 3 days of the falsely rejected sECG. Conclusion SmartECG increases efficiency in long-term arrhythmia monitoring using ICMs. The reduction of workload by SmartECG is meaningful and the risk of missing a relevant arrhythmia due to incorrect filtering by the algorithm is limited.
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Affiliation(s)
| | - Jim W. Cheung
- Division of Cardiology, Weill Cornell Medicine, New York, NY, United States
| | - Roberto Rordorf
- Department of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, United States
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Dana Berti
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Luigi Di Biase
- Arrhythmia Services, Albert Einstein College of Medicine at Montefiore Health System, New York, NY, United States
| | - Eimo Martens
- Department of Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincenzo Russo
- Department of Cardiology, University Vanvitelli, Monaldi Hospital, Napoli, Italy
| | - Paolo Vitillo
- Department of Cardiology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità San Giuseppe Moscati, Avellino, Italy
| | - Marlies Zoutendijk
- Department of Cardiology, Admiraal de Ruyter Ziekenhuis, Goes, Netherlands
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | | | | | - Gaurav Upadhyay
- Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, United States
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Tundo F, Breitenstein A, Montemerlo E, Monaco C, Gulletta S, Palmisano P, Hofer D, Rovaris G, Dello Russo A, Biffi M, Pisanò ECL, Della Bella P, Di Biase L, Chierchia GB, Saguner AM, Tondo C, Curnis A, Forleo GB. Sex differences in leadless pacemaker implantation: A propensity-matched analysis from the i-LEAPER registry. Heart Rhythm 2023; 20:1429-1435. [PMID: 37481220 DOI: 10.1016/j.hrthm.2023.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The impact of sex in clinical and procedural outcomes in leadless pacemaker (LPM) patients has not yet been investigated. OBJECTIVE The purpose of this study was to investigate sex-related differences in patients undergoing LPM implantation. METHODS Consecutive patients enrolled in the i-LEAPER registry were analyzed. Comparisons between sexes were performed within the overall cohort using an adjusted analysis with 1:1 propensity matching for age and comorbidities. The primary outcome was the comparison of major complication rates. Sex-related differences regarding electrical performance and all-cause mortality during follow-up were deemed secondary outcomes. RESULTS In the overall population (n = 1179 patients; median age 80 years), 64.3% were men. After propensity matching, 738 patients with no significant baseline differences among groups were identified. During median follow-up of 25 [interquartile range 24-39] months, female sex was not associated with LPM-related major complications (hazard ratio [HR] 2.03; 95% confidence interval [CI] 0.70-5.84; P = .190) or all-cause mortality (HR 0.98; 95% CI 0.40-2.42; P = .960). LPM electrical performance results were comparable between groups, except for a higher pacing impedance in women at implant and during follow-up (24 months: 670 [550-800] Ω vs 616 [530-770] Ω; P = .014) that remained within normal limits. CONCLUSION In a real-world setting, we found differences in sex-related referral patterns for LPM implantation with an underrepresentation of women, although major complication rate and LPM performance were comparable between sexes. Female patients showed higher impedance values, which had no impact on overall device performance. Electrical parameters remained within normal limits in both groups during the entire follow-up.
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Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica-Ospedale "V. Fazzi", Lecce, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, New York
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
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Frei C, Hofer D, Jan S, Grebmer C, Breitenstein A. Single center experience with the novel rotating dilator sheath TightRail TM Sub-C in transvenous lead extraction. J Cardiovasc Electrophysiol 2023; 34:1738-1743. [PMID: 37343057 DOI: 10.1111/jce.15970] [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: 07/14/2022] [Revised: 05/06/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) in transvenous lead extraction. METHODS For this retrospective single-center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at the University Heart Center Zurich. RESULTS A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45) occurred, but neither was directly related to the Sub-C. CONCLUSION This retrospective single-center analysis suggests that transvenous lead extraction with a routine use of the TightRailTM Sub-C extraction sheath is a safe strategy resulting in high success rates that may offer useful theoretical benefits. Future studies are needed to evaluate the incremental benefit of a routine use of short extraction sheaths including the Sub-C during TLE procedures.
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Affiliation(s)
- Celine Frei
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Steffel Jan
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Christian Grebmer
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
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Hofer D, Regoli F, Saguner AM, Conte G, Jelisejevas J, Luce Caputo M, Graup V, Grazioli Gauthier L, Gasperetti A, Steffel J, Auricchio A, Breitenstein A. Efficacy and Safety of Leadless Pacemaker Implantation in Octogenarians. Cardiology 2023; 148:441-447. [PMID: 37487479 DOI: 10.1159/000532075] [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: 04/23/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Long-term complication rates in standard transvenous pacemakers are reported around 4-12% with a higher incidence in the elderly population. We report our experience in octogenarians undergoing leadless pacemaker implantation in two large-volume centers in Switzerland. METHODS Consecutive patients undergoing leadless pacemaker implantation at two Swiss large volume centers (University Hospital Zurich, Zurich and Cardiocentro Ticino Institute, Lugano) between October 2015 and March 2020 were included in this retrospective analysis. Demographic information, clinical data, and procedural characteristics were recorded at the day of implantation and during follow-up. RESULTS Two hundred and twenty patients (mean age 80.6 ± 7.7 years, male 66%) were included. The main indication for pacemaker implantation was slow ventricular rate atrial fibrillation (111 of 220 patients, 50.4%). Out of the 220 patients, 124 (56.3%) were ≥80 years. Overall successful implantation rate was 98.6%. In the octogenarian population, the median procedure time (45 ± 20.2 min vs. 40 ± 19.6 min, p = 0.03) and radiation duration (6.1 ± 8.2 min vs. 5.0 ± 7.2 min, p = 0.03) were longer compared to patients <80 years. Major complications (2.7%, n = 6) and device measurements during follow-up were similar between patients ≥80 and <80 years. CONCLUSION Implantation of a leadless pacemaker device in octogenarians is safe and effective with a similarly low complication rate compared to non-octogenarians.
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Affiliation(s)
- Daniel Hofer
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - François Regoli
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Cardiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ardan M Saguner
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Julius Jelisejevas
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vera Graup
- Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alessio Gasperetti
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Steffel
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Kanthasamy V, Breitenstein A, Schilling R, Hofer D, Tiongco B, Ang R, Hunter R, Earley M, Ahsan S, Mangiafico V, Honarbakhsh S, Ahluwalia N, Maclean E, Creta A, Finlay M. Catheter ablation of atrial fibrillation with a multi-electrode radiofrequency balloon; first and early two centre experience in Europe. J Cardiovasc Electrophysiol 2023; 34:1350-1359. [PMID: 36598422 DOI: 10.1111/jce.15799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/10/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The Heliostar™ ablation system is a novel RF balloon ablation technology with an integrated three-dimensional mapping system. Here, we describe our early experience and procedural outcomes using this technology for atrial fibrillation catheter ablation. METHODS We sought to comprehensively assess the first 60 consecutive patients undergoing pulmonary vein isolation using the novel HELISOTAR™ RF balloon technology including procedural outcomes. A comparison of the workflow between two different anaesthetic modalities (conscious sedation [CS] vs. general anaesthesia [GA]) was made. Procedural data were collected prospectively from two high-volume centers (Barts Heart Centre, UK and University Hospital of Zurich, Zurich). A standardized approach for catheter ablation was employed. RESULTS A total of 35 patients had the procedure under CS and the remaining under GA. Mean procedural and fluoroscopy times were 84 ± 33 min and 1.1 min. The median duration of RF energy application was 7 (5-9.8) mins per patient. All veins were successfully isolated, and the median isolation time was 10 (7-15) seconds. Our cohort's rate of procedural complications was low, with no mortality within 30 days postprocedure. CONCLUSION Our early experience shows that catheter ablation using the Heliostar™ technology can be performed efficiently and safely; however, long-term data is yet to be established. Low fluoroscopy requirements, short learning curves and use of this technology with CS is possible, including the use of an oesophageal temperature probe.
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Affiliation(s)
- Vijayabharathy Kanthasamy
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Richard Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Daniel Hofer
- Klinik für Kardiologie Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | - Benny Tiongco
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Richard Ang
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Ross Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Mark Earley
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Syed Ahsan
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Valentina Mangiafico
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Edd Maclean
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Antonio Creta
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Krizanovic-Grgic I, Anwer S, Steffel J, Hofer D, Saguner AM, Spengler CM, Breitenstein A, Tanner FC. 3D Atrial Strain for Predicting Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation. J Clin Med 2023; 12:jcm12113696. [PMID: 37297892 DOI: 10.3390/jcm12113696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
AIMS Association of two-(2D) and three-dimensional (3D) left atrial strain (LAS) and low-voltage area (LVA) with recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) was assessed. METHODS AND RESULTS 3D LAS, 2D LAS, and LVA were obtained in 93 consecutive patients undergoing PVI and recurrence of AF was analyzed prospectively. AF recurred in 12 patients (13%). The 3D left atrial reservoir strain (LARS) and pump strain (LAPS) were lower in patients with recurrent AF than without (p = 0.008 and p = 0.009, respectively). In univariable Cox regression, 3D LARS or LAPS were associated with recurrent AF (LARS: HR = 0.89 (0.81-0.99), p = 0.025; LAPS: HR = 1.40 (1.02-1.92), p = 0.040), while other values were not. Association of 3D LARS or LAPS with recurrent AF was independent of age, body mass index, arterial hypertension, left ventricular ejection fraction, and end-diastolic volume index and left atrial volume index in multivariable models. Kaplan-Meier curves revealed that patients with 3D LAPS < -5.9% did not exhibit recurrent AF, while those >-5.9% had a significant risk of recurrent AF. CONCLUSIONS 3D LARS and LAPS were associated with recurrent AF after PVI. Association of 3D LAS was independent of relevant clinical and echocardiographic parameters and improved their predictive value. Hence, they may be applied for outcome prediction in patients undergoing PVI.
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Affiliation(s)
- Iva Krizanovic-Grgic
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Exercise Physiology Laboratory, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology in Zurich (ETH Zürich), 8092 Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christina M Spengler
- Exercise Physiology Laboratory, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology in Zurich (ETH Zürich), 8092 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8006 Zurich, Switzerland
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10
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Molitor N, Hofer D, Çimen T, Gasperetti A, Akdis D, Costa S, Jenni R, Breitenstein A, Wolber T, Winnik S, Fokstuen S, Fu G, Medeiros-Domingo A, Ruschitzka F, Brunckhorst C, Duru F, Saguner AM. Evolution and triggers of defibrillator shocks in patients with arrhythmogenic right ventricular cardiomyopathy. Heart 2023:heartjnl-2022-321739. [PMID: 36889907 DOI: 10.1136/heartjnl-2022-321739] [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: 08/13/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease. METHODS This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings. RESULTS Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia. CONCLUSION The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
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Affiliation(s)
- Nadine Molitor
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tolga Çimen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, US
| | - Deniz Akdis
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology, GZO - Regional Health Center, Wetzikon, Switzerland
| | - Sarah Costa
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Jenni
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Stephan Winnik
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Siv Fokstuen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Genetic Medicine division, Diagnostic Department, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Guan Fu
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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11
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Hofer D, Kuster N, Bebié MC, Sasse T, Steffel J, Breitenstein A. Success and Complication Rates of Transvenous Lead Extraction in a Developing High-Volume Extraction Center: The Zurich Experience. J Clin Med 2023; 12:jcm12062260. [PMID: 36983262 PMCID: PMC10051593 DOI: 10.3390/jcm12062260] [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: 02/12/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Transvenous lead extractions are increasingly performed for malfunction or infection of cardiac implantable electronic devices, but they harvest a potential for complications and suboptimal success. Apart from multicenter registries and reports from highly experienced single centers, the outcome in individual newly developing high-volume centers starting a lead extraction program is less well established. We aimed to evaluate the clinical and radiological success and complication rate at our center, having started a lead extraction program less than a decade ago. Methods: We retrospectively analyzed patients who underwent transvenous lead extraction at the University Hospital Zurich from 2013 to 2021 regarding success as well as complications and compared our results to previously reported outcome rates. Results: A total of 346 patients underwent 350 transvenous lead extractions from January 2013 to December 2021. Combined radiological success was achieved in 97.7% and clinical success in 96.0% of interventions. Procedure-related major complications occurred in 13 patients (3.7%). Death within 30 days after transvenous lead extractions occurred in 13 patients (3.7%), with a procedure-related mortality of 1.4% (five patients). Summary: Transvenous lead extractions in newly developing high-volume centers can be performed with high clinical and radiological success rates, but procedure-related major complications may affect a relevant number of patients. Compared to large single or multicenter registries of experienced centers, the success rate may be lower and the complication rate higher in centers newly starting with lead extraction, which may have important implications for patient selection, procedural planning, proctoring, and safety measures.
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12
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Mitacchione G, Schiavone M, Gasperetti A, Arabia G, Breitenstein A, Cerini M, Palmisano P, Montemerlo E, Ziacchi M, Gulletta S, Salghetti F, Russo G, Monaco C, Mazzone P, Hofer D, Tundo F, Rovaris G, Russo AD, Biffi M, Pisanò ECL, Chierchia GB, Della Bella P, de Asmundis C, Saguner AM, Tondo C, Forleo GB, Curnis A. Outcomes of leadless pacemaker implantation following transvenous lead extraction in high-volume referral centers: Real-world data from a large international registry. Heart Rhythm 2023; 20:395-404. [PMID: 36496135 DOI: 10.1016/j.hrthm.2022.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data on the real-world safety and efficacy of leadless pacemakers (LPMs) post-transvenous lead extraction (TLE) are available. OBJECTIVE The purpose of this study was to assess the long-term safety and effectiveness of LPMs following TLE in comparison with LPMs de novo implantation. METHODS Consecutive patients who underwent LPM implantation in 12 European centers joining the International LEAdless PacemakEr Registry were enrolled. The primary end point was the comparison of LPM-related complication rate at implantation and during follow-up (FU) between groups. Differences in electrical performance were deemed secondary outcomes. RESULTS Of the 1179 patients enrolled, 15.6% underwent a previous TLE. During a median FU of 33 (interquartile range 24-47) months, LPM-related major complications and all-cause mortality did not differ between groups (TLE group: 1.6% and 5.4% vs de novo group: 2.2% and 7.8%; P = .785 and P = .288, respectively). Pacing threshold (PT) was higher in the TLE group at implantation and during FU, with very high PT (>2 V@0.24 ms) patients being more represented than in the de novo implantation group (5.4% vs 1.6 %; P = .004). When the LPM was deployed at a different right ventricular (RV) location than the one where the previous transvenous RV lead was extracted, a lower proportion of high PT (>1-2 V@0.24 ms) patients at implantation, 1-month FU, and 12-month FU (5.9% vs 18.2%, P = .012; 3.4% vs 12.9%, P = .026; and 4.3% vs 14.5%, P = .037, respectively) was found. CONCLUSION LPMs showed a satisfactory safety and efficacy profile after TLE. Better electrical parameters were obtained when LPMs were implanted at a different RV location than the one where the previous transvenous RV lead was extracted.
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Affiliation(s)
- Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy.
| | - Marco Schiavone
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Manuel Cerini
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | | | - Matteo Ziacchi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Francesca Salghetti
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Tundo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy
| | - Mauro Biffi
- Department of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi," Lecce, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ardan M Saguner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio Tondo
- Heart Rhythm Center, IRCCS Centro Cardiologico Monzino, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
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13
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Lau DH, Pierre B, Cabanas P, Martens E, Bisignani G, Hofer D, Berruezo A, Eschalier R, Mansourati J, Gaspar T, Sanfins VM, Erglis A, Hain A, Papaioannou G, Cuneo A, Tscholl V, Schrader J, Deneke T. Diagnostic yield of an insertable cardiac monitor in a large patient population. Heart Rhythm O2 2023; 4:97-102. [PMID: 36873314 PMCID: PMC9975005 DOI: 10.1016/j.hroo.2022.11.005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy. Objective The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications. Methods Patients from 2 prospective clinical studies were included to determine the diagnostic yield of the ICM. The primary endpoint was time to clinical diagnosis per implant indication or to the first change in atrial fibrillation (AF) therapy. Results A total of 632 patients were included with a mean follow-up of 233 ± 168 days. Of 384 patients with (pre)syncope, 34.2% had a diagnosis at 1 year. The most frequent therapy was permanent pacemaker implantation. Of 133 patients with cryptogenic stroke, 16.6% had an AF diagnosis at 1 year, resulting in oral anticoagulation. Of 49 patients with an indication for AF monitoring, 41.0% had a relevant change in AF therapy based on ICM data at 1 year. Of 66 patients with other indications, 35.4% received a rhythm diagnosis at 1 year. Moreover, 6.5% of the cohort had additional diagnoses: 26 of 384 patients with syncope, 8 of 133 patients with cryptogenic stroke, and 7 of 49 patients with AF monitoring. Conclusion In a large unselected patient population with heterogeneous ICM indications, the primary endpoint of rhythm diagnosis was achieved in ∼1 in 4, and additional clinically relevant findings was achieved in 6.5% of patients at short-term follow-up.
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Affiliation(s)
- Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, Australia
| | - Bertrand Pierre
- Department of Cardiology, Tours University Hospital, Chambray-lès-Tours, France
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Antonio Berruezo
- Department of Cardiology, Teknon Heart Institute, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Alessandro Cuneo
- Department of Cardiology, Krankenhaus Maria-Hilf Stadtlohn, Stadtlohn, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité Universitaetsmedizin, Campus Mitte, Berlin, Germany
| | - Jürgen Schrader
- Department of Cardiology, Biotronik SE & Co.KG, Berlin, Germany
| | - Thomas Deneke
- Department of Cardiology, Rhön Clinic Campus Bad Neustadt, Saale, Germany
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14
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Gulletta S, Schiavone M, Gasperetti A, Breitenstein A, Palmisano P, Mitacchione G, Chierchia GB, Montemerlo E, Statuto G, Russo G, Casella M, Vitali F, Mazzone P, Hofer D, Arabia G, Moltrasio M, Lipartiti F, Fierro N, Bertini M, Dello Russo A, Pisanò ECL, Biffi M, Rovaris G, de Asmundis C, Tondo C, Curnis A, Della Bella P, Saguner AM, Forleo GB. Peri-procedural and mid-term follow-up age-related differences in leadless pacemaker implantation: Insights from a multicenter European registry. Int J Cardiol 2023; 371:197-203. [PMID: 36115442 DOI: 10.1016/j.ijcard.2022.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Age-related differences on leadless pacemaker (LP) are poorly described. Aim of this study was to compare clinical indications, periprocedural and mid-term device-associated outcomes in a large real-world cohort of LP patients, stratified by age at implantation. METHODS Two cohorts of younger and older patients (≤50 and > 50 years old) were retrieved from the iLEAPER registry. The primary outcome was to compare the underlying indication why a LP was preferred over a transvenous PM across the two cohorts. Rates of peri-procedural and mid-term follow-up major complications as well as LP electrical performance were deemed secondary outcomes. RESULTS 1154 patients were enrolled, with younger patients representing 6.2% of the entire cohort. Infective and vascular concerns were the most frequent characteristics that led to a LP implantation in the older cohort (45.8% vs 67.7%, p < 0.001; 4.2% vs 16.4%, p = 0.006), while patient preference was the leading cause to choose a LP in the younger (47.2% vs 5.6%, p < 0.001). Median overall procedural (52 [40-70] vs 50 [40-65] mins) and fluoroscopy time were similar in both groups. 4.3% of patients experienced periprocedural complications, without differences among groups. Threshold values were higher in the younger, both at discharge and at last follow-up (0.63 [0.5-0.9] vs 0.5 [0.38-0-7] V, p = 0.004). CONCLUSION When considering LP indications, patient preference was more common in younger, while infective and vascular concerns were more frequent in the older cohort. Rates of device-related complications did not differ significantly. Younger patients tended to have a slightly higher pacing threshold at mid-term follow-up.
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Affiliation(s)
- Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, IT, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, IT, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy.
| | | | | | - Gianfranco Mitacchione
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | | | - Giovanni Statuto
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giulia Russo
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Daniel Hofer
- University Hospital Zurich, Zurich, CH, Switzerland
| | - Gianmarco Arabia
- Department of Cardiology, Spedali Civili Hospital, University of Brescia, Brescia, IT, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy
| | - Felicia Lipartiti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Nicolai Fierro
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Ferrara, IT, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, IT, Italy
| | - Ennio C L Pisanò
- U.O.S.V.D. Elettrofisiologia Cardiologica - Ospedale "V. Fazzi", Lecce, IT, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, IT, Italy
| | - Giovanni Rovaris
- Department of Cardiology, ASST Monza, San Gerardo Hospital, Monza, IT, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, BE, Belgium
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, IT, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, IT, Italy
| | | | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, IT, Italy
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15
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Hofer D, Anwer S, Tanner FC, Auf der Maur C, Steffel J, Richter S, Breitenstein A. Improved symptoms, exercise capacity, and homogeneity of cardiac deformation through conduction system pacing in a patient with symptomatic left bundle branch block. HeartRhythm Case Rep 2023; 9:43-47. [PMID: 36685687 PMCID: PMC9845555 DOI: 10.1016/j.hrcr.2022.10.013] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sergio Richter
- Division of Electrophysiology, Department of Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
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16
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Bisignani G, De Bonis S, Pierre B, Lau DH, Hofer D, Sanfins VM, Hain A, Cabanas P, Martens E, Berruezo A, Eschalier R, Milliez P, Lüsebrink U, Mansourati J, Papaioannou G, Giacopelli D, Gargaro A, Ploux S. Insertable cardiac monitor with a long sensing vector: Impact of obesity on sensing quality and safety. Front Cardiovasc Med 2023; 10:1148052. [PMID: 37025684 PMCID: PMC10071510 DOI: 10.3389/fcvm.2023.1148052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background Fat layers in obese patients can impair R-wave detection and diagnostic performance of a subcutaneous insertable cardiac monitor (ICM). We compared safety and ICM sensing quality between obese patients [body mass index (BMI) ≥ 30 kg/m2] and normal-weight controls (BMI <30 kg/m2) in terms of R-wave amplitude and time in noise mode (noise burden) detected by a long-sensing-vector ICM. Materials and methods Patients from two multicentre, non-randomized clinical registries are included in the present analysis on January 31, 2022 (data freeze), if the follow-up period was at least 90 days after ICM insertion, including daily remote monitoring. The R-wave amplitudes and daily noise burden averaged intraindividually for days 61-90 and days 1-90, respectively, were compared between obese patients (n = 104) and unmatched (n = 268) and a nearest-neighbour propensity score (PS) matched (n = 69) normal-weight controls. Results The average R-wave amplitude was significantly lower in obese (median 0.46 mV) than in normal-weight unmatched (0.70 mV, P < 0.0001) or PS-matched (0.60 mV, P = 0.003) patients. The median noise burden was 1.0% in obese patients, which was not significantly higher than in unmatched (0.7%; P = 0.056) or PS-matched (0.8%; P = 0.133) controls. The rate of adverse device effects during the first 90 days did not differ significantly between groups. Conclusion Although increased BMI was associated with reduced signal amplitude, also in obese patients the median R-wave amplitude was >0.3 mV, a value which is generally accepted as the minimum level for adequate R-wave detection. The noise burden and adverse event rates did not differ significantly between obese and normal-weight patients.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04075084 and NCT04198220.
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Affiliation(s)
- Giovanni Bisignani
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
- Correspondence: Giovanni Bisignani
| | - Silvana De Bonis
- Department of Cardiology, Ospedale Civile Ferrari, Castrovillari, Italy
| | | | - Dennis H. Lau
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Daniel Hofer
- Department of Cardiology, UniversitätsspitalZürich, Zurich, Switzerland
| | - Victor Manuel Sanfins
- Department of Cardiology, Hospital Senhora da Oliveira—Guimarães, Guimarães, Portugal
| | - Andreas Hain
- Department of Cardiology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Pilar Cabanas
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Eimo Martens
- Department of Cardiology, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Antonio Berruezo
- Department of Cardiology, Centro Médico Teknon, Barcelona, Spain
| | - Romain Eschalier
- Department of Cardiology, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Paul Milliez
- Department of Cardiology, Le Centre Hospitalier Universitaire de Caen CHRU Caen, Caen, France
| | - Ulrich Lüsebrink
- Department of Cardiology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany
| | | | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Milano, Italy
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padova, Italy
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Hofer D, Steffel J, Duru F, Graup V, Sasse T, Saguner A, Breitenstein A. Feasibility, Efficiency, and Safety of Zero-Fluoroscopy Catheter Interventions for Right-Sided Cardiac Arrhythmias Using Only Electroanatomic Mapping. Cardiology 2022; 147:547-556. [PMID: 35977529 PMCID: PMC9808658 DOI: 10.1159/000526564] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Fluoroscopy is traditionally used for catheter interventions in electrophysiology but carries a long-term health risk. Besides additional invasive procedures to achieve zero-fluoroscopy (ZF) interventions, electroanatomic mapping may be an alternative to fluoroscopy without the need of additional procedures. We aimed to investigate the feasibility, safety, and efficiency of a ZF approach using only electroanatomic mapping (ZF) compared to a conventional fluoroscopic (CF) approach for patients with right sided cardiac arrhythmias. METHODS We performed a single centre retrospective cohort study of consecutive patients undergoing catheter interventions for electrophysiologic procedures from January 2019 to December 2020. Patients with left-sided arrhythmias, focal cryoablation, implanted endocardial devices, or additional interventions requiring fluoroscopy were excluded. RESULTS 202 patients underwent a ZF and 126 patients underwent a CF approach for right-sided cardiac arrhythmias. Apart from atrial fibrillation (ZF 16% vs. CF 9%, p = 0.044), baseline demographics were similar in both groups. Acute success rate was 100% in the ZF group and 97.9% in the CF group. Mean procedure time was lower in the ZF group (70 ± 36 vs. 87 ± 44 min, p = 0.0001), while ablation time (356 ± 324 vs. 320 ± 294 s, p = 0.157) was similar. Total complication rate was low in general (1.0 % major, 2% minor complications) and without a difference between both groups. CONCLUSION A ZF approach using only electroanatomic mapping without additional invasive procedures to diagnose and treat right-sided cardiac arrhythmias is feasible, efficient, and safe.
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Affiliation(s)
- Daniel Hofer
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland,*Daniel Hofer,
| | - Jan Steffel
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Vera Graup
- Division of General Internal Medicine, Triemli Hospital, Zurich, Switzerland
| | - Tom Sasse
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan Saguner
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Division of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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18
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Krizanovic-Grgic I, Anwer S, Steffel J, Hofer D, Saguner AM, Spengler CM, Breitenstein A, Tanner FC. 3D atrial strain for prediction of atrial fibrillation recurrence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) is one of the most common supraventricular arrhythmias. Treatment options apart from medication include interventional catheter-guided pulmonary vein isolation (PVI). However, there is limited knowledge about factors predicting arrhythmia recurrence after PVI.
Aim
To study the association of 3-dimensional (3D) left atrial (LA) strain (LAS) and 3D electro-anatomical voltage mapping (EAVM) with early recurrence of AF after PVI.
Methods
In this prospective single center study, 93 patients undergoing PVI were enrolled between December 2018 and October 2021. All patients underwent an echocardiographic examination within two weeks before PVI using the Canon Aplio i900 system to analyse LAS from 3D LA volume. A 3D EAVM was obtained using high-density mapping catheters during PVI. The CARTO 3 system (Version V6-V7) was used for determining LA scar area by low voltage mapping (local amplitude <0.5 mV) indicated as percentage (EAVM-%). Follow-up time points were set at 2, 3, 6 and 12 months to investigate recurrence of AF, with exclusion of events occurring during the first two months (blanking phase).
Results
During follow-up, 12 out of 93 patients experienced recurrence of AF (12.9%; AF-Group). Baseline characteristics did not differ between AF-Group and Non-AF-Group. In contrast, LAS was significantly impaired in the AF-Group (median −4.6, IQR [−5.6 to −3.6]) when compared to the Non-AF-Group (−6.2 [−8.3 to −4.5]; p=0.009). The EAVM-% did not differ between the groups (AF-Group: 5.0 [1.5 to 21.5]; Non-AF-Group: 4.4 [1.5 to 15.9]; p=0.710). No significant correlations were found between LAS and EAVM-% (r=0.03, p=0.812). A cut-off value of −5.89% for LAS had a sensitivity of 100% and a specificity of 57% for AF recurrence (AUC=70%; p<0.001). Kaplan Meier curves for event-free survival were generated based on the LAS cut-off demonstrating excellent differentiation of those with and without AF recurrence (p<0.001; see figure). Furthermore, LAS was associated with an increased risk of early AF recurrence (HR 1.40, IQR [1.02–1.92], p=0.040), while EAVM-% was not (HR 0.99 [0.95–1.04], p=0.787).
Conclusion
3D LAS was associated with an increased risk of early AF recurrence after PVI, while EAVM-% was not. 3D LAS might be used for identifying patients who would benefit from PVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Anwer
- University Hospital Zurich , Zurich , Switzerland
| | - J Steffel
- University Hospital Zurich , Zurich , Switzerland
| | - D Hofer
- University Hospital Zurich , Zurich , Switzerland
| | - A M Saguner
- University Hospital Zurich , Zurich , Switzerland
| | - C M Spengler
- Swiss Federal Institute of Technology Zurich (ETH Zurich) , Zurich , Switzerland
| | | | - F C Tanner
- University Hospital Zurich , Zurich , Switzerland
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19
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Mohamed AKYS, Auer D, Hofer D, Küng J. A systematic literature review for authorization and access control: definitions, strategies and models. IJWIS 2022. [DOI: 10.1108/ijwis-04-2022-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Authorization and access control have been a topic of research for several decades. However, existing definitions are inconsistent and even contradicting each other. Furthermore, there are numerous access control models and even more have recently evolved to conform with the challenging requirements of resource protection. That makes it hard to classify the models and decide for an appropriate one satisfying security needs. Therefore, this study aims to guide through the plenty of access control models in the current state of the art besides this opaque accumulation of terms meaning and how they are related.
Design/methodology/approach
This study follows the systematic literature review approach to investigate current research regarding access control models and illustrate the findings of the conducted review. To provide a detailed understanding of the topic, this study identified the need for an additional study on the terms related to the domain of authorization and access control.
Findings
The authors’ research results in this paper are the distinction between authorization and access control with respect to definition, strategies, and models in addition to the classification schema. This study provides a comprehensive overview of existing models and an analysis according to the proposed five classes of access control models.
Originality/value
Based on the authors’ definitions of authorization and access control along with their related terms, i.e. authorization strategy, model and policy as well as access control model and mechanism, this study gives an overview of authorization strategies and propose a classification of access control models providing examples for each category. In contrast to other comparative studies, this study discusses more access control models, including the conventional state-of-the-art models and novel ones. This study also summarizes each of the literature works after selecting the relevant ones focusing on the database system domain or providing a survey, a classification or evaluation criteria of access control models. Additionally, the introduced categories of models are analyzed with respect to various criteria that are partly selected from the standard access control system evaluation metrics by the National Institute of Standards and Technology.
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20
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Hofer D, Bebié MC, Kuster N, Steffel J, Breitenstein A. Evolution of Procedure Indication and Cardiovascular Risk in Transvenous Lead Extraction. J Clin Med 2022; 11:jcm11133596. [PMID: 35806882 PMCID: PMC9267900 DOI: 10.3390/jcm11133596] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The use of cardiac implantable electronic devices (CIEDs) to treat tachy- and bradyarrhythmia has significantly increased over the past decades. Consequently, transvenous lead extractions (TLE) have been performed more frequently, particularly in the treatment of device infection or malfunction. We aimed to evaluate the development of procedure indications and cardiovascular risk factors of patients undergoing TLE over time. Materials and methods: 277 TLE cases from 2013 to 2020 performed at the University Hospital Zurich were included in this retrospective analysis. Patient charts and follow-up letters were screened for procedure indication and cardiovascular risk factors to evaluate trends over time. Results: 502 leads were extracted in 273 patients. The main indications for TLE remained lead dysfunction (48.7%) and infection (31.4%) throughout the investigated period; however, infections were less and device upgrade more frequently encountered indications for TLE over time. Mean patient age at the time of TLE (64.0 ± 0.9 in the entire sample) decreased over time, while the incidence of chronic kidney disease (33.6%), heart failure (48.6%), or diabetes mellitus (22%) demonstrated an increasing trend. Conclusions: The main indications for TLE remain device malfunction and infection, while device upgrade was increasingly encountered as an indication for TLE in recent years. Over time, patients undergoing TLE were increasingly younger and more often presented with cardiovascular risk factors.
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21
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Breitenstein A, Perucchini F, Gasperetti A, Hofer D, Schiavone M, Forleo GB, Algibbawi M, El-Chami MF, Steinwender C. Early experience with the second generation of leadless pacemakers and correlation with ecg parameters. Europace 2022. [DOI: 10.1093/europace/euac053.433] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Leadless pacing has evolved as a safe and effective treatment option in selected patients. With the updated generation that allows sensing of atrial contraction, atrioventricular synchronized pacing is now possible in a VDD mode. Previous retrospective analyses have demonstrated that echocardiographic parameters may be helpful in selecting patients with a higher chance of good atrioventricular synchronous pacing behaviour.
Purpose
Analysis of the early experience with the second generation of leadless pacemaker and the role of ECG parameters to predict a good atrial contraction signal (so-called A4 amplitude) in patients who underwent leadless pacemaker implantation in four tertiary centres.
Methods and Results
In this retrospective analysis, a total of 136 patients were included. Mean age was 78.0 (64.7 - 84.2 years) years with 48.9 % being male. Coronary artery disease was the leading underlying heart disease with 27.1 % affected patients. 61.7 % of the population suffered from sinus rhythm with complete or intermittent atrioventricular block. The majority of devices were implanted at the mid-septal (61.2 %) or high-septal (25.6 %) right ventricle, respectively. Electrical parameters were optimal at implant (Table 1) and remained stable over time (Table 1). In addition, A4 signal amplitude remained stable too during follow-up compared to the value early after implantation (Table 1). From this entire cohort, patients with an ECG available at implant and those in which the device was working predominantly in the VDD mode were selected for further analyses (62 patients). PR interval measured from the ECG prior to implantation did not correlate with the A4 signal amplitude (Figure 1A; P = NS). Next, P wave amplitudes were measured in all 12 ECG leads. There was a correlation between P wave amplitude from lead V2 with the A4 amplitude (Figure 1B; P = 0.034, R2 = 0.09), whereas the other right-sided ECG leads (V1/aVR), either alone or in combination, did not correlate with the A4 signal amplitude (P = NS).
Conclusions
In our cohort of patients with the second generation of leadless pacemakers, offering VDD pacing, good electrical parameters can be achieved as it has been observed with the first generation. Also the A4 signal amplitude as a marker for atrial contraction remains stable over time. In regard to ECG parameters measured prior to device implantation, only the P wave amplitude in lead V2 correlated with a amplitude of the A4 signal.
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Affiliation(s)
| | | | | | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - M Schiavone
- Luigi Sacco University Hospital, Milano, Italy
| | - GB Forleo
- Luigi Sacco University Hospital, Milano, Italy
| | - M Algibbawi
- Emory University Hospital, Atlanta, United States of America
| | - MF El-Chami
- Emory University Hospital, Atlanta, United States of America
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22
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Breitenstein A, Hofer D, Starck CH, Steffel J. Systematic screening for right-to-left shunt prior to lead extraction. Europace 2022. [DOI: 10.1093/europace/euac053.530] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Transvenous lead extraction has become a relevant treatment option in patients with device-associated infection, but also in the context of device- and lead dysfunction. Lead extraction can be complicated by a stroke, which may result from paradoxical embolization of lead debrids during lead extraction in the presence of a patent foramen ovale (PFO) with a right-to-left shunt.
Purpose
Analysis of the presence of a PFO in patients undergoing transvenous lead extraction in a Swiss tertiary centre. Furthermore, different strategies to reduce the risk for stroke due to the presence of a PFO will be summarized.
Methods and Results
In this retrospective analysis from January 2017 until December 2021, a total of 304 patients who underwent lead extraction were included. In nearly half of the population, lead dysfunction was the leading cause for extraction, while device-associated infection was present in 31 % of the patients. In 14 patients (4.6 %), a right-to-left shunt was detected either during (via transesophageal echocardiography) or prior to the procedure. Prior to the systematic pre-procedural PFO screening, 9 patients with a right-to-left shunt were identified of which 2 patients suffered from a peri-interventional stroke (22 %) while in the population without a PFO no stroke occurred. The remaining 5 patients with a right-to-left shunt were identified prior to the lead extraction procedure (after setting up an institutional PFO screening programm) and were treated accordingly. Since then, no further neurological episodes occurred (Figure 1). If a PFO was identified, an interventional PFO occlusion was performed either prior to the lead extraction (2 of 5 patients) or together with the lead extraction as a single procedure (1 patient). In the 2 other patients, where a device infection was present together with a PFO, the PFO shunt was occluded transiently using a sizing balloon during the lead extraction procedure to avoid to implant a PFO occluder device in an infectious environment.
Conclusions
Presence of a right-to-left shunt in patients who need to undergo transvenous lead extraction is a known risk factor for embolic strokes. Identification and treatment of this condition prior or during lead extraction is associated with a reduction in stroke events.
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Affiliation(s)
| | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - CH Starck
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - J Steffel
- University Heart Center, Zurich, Switzerland
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23
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Breitenstein A, Kanthasamy V, Hofer D, Hunter R, Butcher CH, Ahluwalia N, Schilling RJ, Finlay M. Early results of the novel radiofrequency balloon ablation catheter for pulmonary vein isolation. Europace 2022. [DOI: 10.1093/europace/euac053.263] [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
Pulmonary vein isolation (PVI) remains the cornerstone for treating of symptomatic atrial fibrillation (AF). Single-shot PVI technologies have evolved as a standard for first-time PVI. A novel radiofrequency balloon ablation catheter is now available to offer single-shot RF pulmonary vein isolation.
Purpose
To summarize the early experience using the novel RF balloon ablation catheter for patients undergoing PVI in two tertiary centres in Europe.
Methods
We prospectively assessed the first 38 consecutive patients undergoing PVI using RF balloon ablation catheter for paroxysmal or persistent AF in two high volume centres. Both centres used a standardised approach including ultrasound-guided vascular access, uninterrupted anticoagulation, transeptal puncture via the RF balloon sheath and a limited 3D mapping software-guided LA geometry created with a circular mapping catheter. Radiofrequency application for 60s to the anterior segments and 20s posteriorly was performed in all cases, phrenic pacing was employed for ablation of right PVs. BHS performed all procedures (except 2 cases due to high BMI and severe sleep apnea) under sedation, while all patients from UHZ underwent PVI procedures with general anaesthesia as per institutional protocol. All patients had an oesophageal temperature probe to assess oesophageal temperature during ablation (passed orally under sedation) and had uninterrupted oral anticoagulation throughout the periprocedural period.
Results
Overall, mean age was 64±8 years, 23 (61%) were male, 24 (63%) of patients had paroxysmal AF. The majority were de novo interventions (92%). There was no significant difference between the patients demographics in the two hospitals. All veins were isolated in both groups with a total of 144 applications (n = 73 in the sedation group, n = 71 in the GA population). Median fluoroscopy time was comparable (sedation group 1.1 minutes vs GA group 1.2 minutes; P = 0.58), but median procedure time was shorter in the sedation group (65 minute vs 106 minutes; P < 0.001). The median number of RF ablation per patient (sedation group 7 vs GA group 9; P = 0.32) and time to isolation of each vein (sedation group 11 seconds vs GA group 10 seconds; P = 0.9) were similar. Number of acute reconnections requiring further ablations were not significantly different between groups (sedation group 11 [15%] vs GA group 14 [20%]; P = 0.96). One patient sustained transient phrenic nerve injury in the sedation group.
Conclusion
Our early experience shows the novel HS balloon ablation can be performed effectively, efficiently and safely under either GA or conscious sedition. The RF balloon ablation catheter paradigm lends itself to refined workflows, with low fluoroscopy requirements and a short learning curve even in initial cohorts.
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Affiliation(s)
| | - V Kanthasamy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - R Hunter
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - CH Butcher
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Ahluwalia
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - RJ Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Finlay
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Jelisejevas J, Regoli F, Hofer D, Conte G, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless pacemaker implantation after transcatheter aortic valve replacement. Europace 2022. [DOI: 10.1093/europace/euac053.421] [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
Impairment of the conduction system may occur in 9-30 % of patients undergoing transcatheter aortic valve replacement (TAVR). Since this is typically an elderly and frail patient population, leadless pacing potentially offers benefits over conventional transvenous pacemaker devices. However, available efficacy and safety outcome data of leadless pacing in a population who underwent a TAVR procedure is still limited.
Purpose
Retrospective analysis of efficacy and safety outcome data in patients who underwent leadless pacemaker implantation after TAVR due to relevant bradycardias.
Methods and Results
In this retrospective analysis from two large Swiss implantation centres, 257 consecutive patients undergoing leadless pacemaker were included. Of the total cohort, 26 subjects had a previous TAVR complicated by early (within 30 days)- or late-onset (after 30 days) bradycardias (Table 1). The TAVR group did not differ compared to the non-TAVR with regard to age, gender and left-ventricular ejection fraction (LVEF). Median duration between valve intervention and leadless pacemaker implantation was 8 days (range 0 to 368 days). After a TAVR procedure, left femoral access was chosen in 30.8% (8 of 26 of cases) for the leadless pacemaker implantation as compared to 5.2% (12 of 231 of the cases) in the remaining population (P < 0.01). Mean implantation duration was 56 ± 22 min in the TAVR group compared to 48 ± 20 min (P = NS) and a successful implantation rate of 100.0 % in the TAVR group vs 98.7% in the remaining population (P = NS). There were no significant differences in pacing parameters (sensing, impedance and threshold, respectively) between the two groups. A total of eight major periprocedural complications (3.1%) were encountered in the entire cohort within 30 days, of which one (pericardial effusion) occurred in the TAVR population (P = 0.04), which was managed conservatively with pericardiocentesis.
Conclusions
Leadless pacemaker implantation appears to be safe and effective in patients after TAVR in need of antibradycardia pacing.
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Affiliation(s)
| | - F Regoli
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - G Conte
- Cardiocentro Ticino, Lugano, Switzerland
| | - AM Saguner
- University Heart Center, Zurich, Switzerland
| | - ML Caputo
- Cardiocentro Ticino, Lugano, Switzerland
| | - L Grazioli
- Cardiocentro Ticino, Lugano, Switzerland
| | - J Steffel
- University Heart Center, Zurich, Switzerland
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25
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Jelisejevas J, Regoli F, Hofer D, Conte G, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, Breitenstein A. Leadless pacemaker implantation in patients with a previous transvenous device. Europace 2022. [DOI: 10.1093/europace/euac053.413] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Leadless pacing has been established as an alternative approach to transvenous devices for selected patients suffering from bradycardias. While in the majority of cases leadless pacemaker implantation represents a de novo procedure, in an increasing number of patients such a device is used after a previously implanted transvenous pacemaker.
Purpose
Retrospective analysis of the efficacy and safety outcome in patients who underwent leadless pacemaker implantation in the context of a previously implanted conventional pacemaker.
Methods and Results
In this retrospective analysis from two large Swiss implantation centres, 257 consecutive patients undergoing leadless pacemaker implantation were included. Of the total cohort, 233 patients were diagnosed with new-onset bradycardias, while in 24 patients a prior transvenous device was present. Out of these 24 patients, 20 subjects required lead extraction of the previous system due to infection (70%, 14 patients), malfunction or other reasons (Table 1). In 3 patients with device-related infection, lead extraction and leadless pacemaker implantation were performed as a single procedure, while in the remaining 11 cases a time window between the two procedures was present (median of 11.5 days with a range of 2 to 186 days). In the population with a previous device, mean age at implantation was 81 ± 9 years which did not differ compared to the de novo cohort. Mean implantation duration was 57 ± 31 minutes in the cohort with a previous device versus 48 ± 191 minutes in the de novo population without a significant difference (P=NS) and with a successful implantation rate of 100% versus 98.7% in the de novo population (P=NS). Electrical device parameters (sensing, impedance, threshold) at implantation and during follow-up (mean 12.5 ± 9.3 months) were similar between the two groups. Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 femoral bleedings and 1 intra-abdominal bleeding) in the entire cohort within a 30 days period, of which the majority occurred in the de novo cohort (75 %, 6 of 8). A total of 4 pericardial effusions occurred, which could be managed without the need for cardiac surgery. The were no reinfections registered after leadless pacemaker implantation during follow-up.
Conclusions
Implantation of a leadless pacemaker in patients with a prior conventional system (with or without extraction of the previous device) was effective and safe in our population of patients.
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Affiliation(s)
| | - F Regoli
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - G Conte
- Cardiocentro Ticino, Lugano, Switzerland
| | - AM Saguner
- University Heart Center, Zurich, Switzerland
| | - ML Caputo
- Cardiocentro Ticino, Lugano, Switzerland
| | - L Grazioli
- Cardiocentro Ticino, Lugano, Switzerland
| | - J Steffel
- University Heart Center, Zurich, Switzerland
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Kanthasamy V, Breitenstein A, Hofer D, Honarbakhsh S, Creta A, mangiafico V, Hunter RJ, Ang R, Earley MJ, Schilling RJ, Finlay MC. PO-711-06 HELIOSTARTM RF BALLOON CATHETER ACHIEVES EXCELLENT ACUTE RESULTS INCLUDING CONSCIOUS SEDATION AND SAME-DAY DISCHARGE; EARLY MULTICENTRE EXPERIENCE IN EUROPE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1131] [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: 11/04/2022]
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27
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Rossi VA, Krizanovic-Grgic I, Steffel J, Hofer D, Wolber T, Brunckhorst CB, Ruschitzka F, Duru F, Breitenstein A, Saguner AM. Predictors of left atrial fibrosis in patients with atrial fibrillation referred for catheter ablation. Cardiol J 2022; 29:413-422. [PMID: 35285513 PMCID: PMC9170329 DOI: 10.5603/cj.a2022.0012] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Left atrial (LA) fibrosis in patients with atrial fibrillation (AF) is associated with an increased risk of AF recurrence after catheter ablation. Therefore, we searched for clinical risk factors that confer an increased risk of LA fibrosis, which can influence the treatment strategy. Methods We included 94 patients undergoing 3-dimensional electroanatomical voltage mapping-guided catheter ablation of AF. LA low-voltage areas during sinus rhythm as a surrogate parameter of fibrosis were measured with the CARTO3 mapping system and adjusted for LA volumes obtained by computed tomography. Blood tests including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and echocardiographic parameters of left ventricular function were also analyzed. Results Patients were 62.5 ± 11.4 years old, and 29% were female. LA fibrosis was present in 65%, with 50% having a fibrotic area > 5% (≥ Utah-Stage 1). Mean left ventricular ejection fraction (LVEF) was 53.9 ± 10.5%. Patients with LA fibrosis had higher NT-proBNP levels (869 ± 1056 vs. 552 ± 859 ng/L, p = 0.001) and larger LA volumes (body surface area-corrected 63.3 ± 19.3 vs. 80 ± 27.1 mL/m2, p = 0.003). In univariable analyses, LA fibrosis was significantly associated with female gender, older age, increased LA volumes, hypertension, statin therapy, higher NT-proBNP values, and echocardiographic E/e′. In bivariable analyses, higher NT-proBNP, echocardiographic parameters of diastolic dysfunction, female gender, older age, and higher DR-FLASH scores remained as independent predictors of LA fibrosis. Conclusions In this single-center longitudinal study, surrogate parameters of elevated left-sided cardiac filling pressures such as higher NT-proBNP levels and higher echocardiographic E/e′ values as well as female gender independently predicted the prevalence of LA fibrosis in patients referred for catheter ablation of AF.
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Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
| | - Iva Krizanovic-Grgic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas Wolber
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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Deneke T, Cabanas P, Hofer D, Gaspar T, Pierre B, Bisignani G, Pathak RK, Sanfins VM, Martens E, Mansourati J, Berruezo-Sanchez A, Wiemer M, Hain A, Pezawas T, Wenzel B, Lau D. New Generation Miniaturized Insertable Cardiac Monitor with a Long Sensing Vector: Insertion Procedure, Sensing Performance, and Home Monitoring Transmission Success in a Real-World Population. Heart Rhythm O2 2022; 3:152-159. [PMID: 35496450 PMCID: PMC9043386 DOI: 10.1016/j.hroo.2022.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Thomas Deneke
- Rhön Clinic Campus Bad Neustadt, Bad Neustadt a. d. Saale, Germany
- Address reprint requests and correspondence: Prof Dr Thomas Deneke, RHÖN-KLINIKUM Campus Bad Neustadt, Von-Guttenberg-Strasse 11, 97616 Bad Neustadt a.d. Saale, Germany.
| | | | | | - Thomas Gaspar
- Heart Center, University of Dresden, Dresden, Germany
| | | | | | | | | | - Eimo Martens
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | | | | | | | | | | | - Dennis Lau
- Royal Adelaide Hospital, Adelaide, Australia
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Guan F, Saguner AM, Hofer D, Wolber T, Breitenstein A, Krasniqi N, Eriksson U, Steffel J, Brunckhorst C, Duru F. Distinctive characteristics of his bundle potentials in patients with atrioventricular nodal reentrant tachycardia. Cardiol J 2021:VM/OJS/J/78782. [PMID: 34581428 DOI: 10.5603/cj.a2021.0107] [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] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND His bundle (HB) potentials vary in amplitude and duration in patients with and without slow pathways. The aim of this study was to determine the characteristics of HB potentials and to elucidate whether they can provide clues for identification of slow pathway (SP). METHODS The present research prospectively studied the electrophysiological findings of 162 patients with symptomatic atrioventricular nodal reentrant tachycardia (AVNRT) due to slow-fast or fast-slow type and atrioventricular reentrant tachycardia (AVRT). Maximal HB potential (HBmax, HB with the highest amplitude) among HB cloud was recorded in both groups. For AVNRT patients, the following were measured: (1) AH interval at the "jump" during programmed atrial stimulation (A2H2, taken as a reflection of SP conduction time); (2) Distance from HBmax to the successful SP ablation site (HBmax-ABL) and from HBmax to the ostium of coronary sinus (HBmax-CSO). RESULTS HBmax was 0.29 ± 0.10 mV in AVNRT patients, whereas it was 0.17 ± 0.05 mV in AVRT group (p < 0.0001). Likewise, the HBmax duration was 22 ± 5 ms in AVNRT group and 16 ± 3 ms in AVRT group (p < 0.0001). The area under the ROC curve of HBmax amplitude in AVNRT patients was 0.86 and the optimal HBmax cut-off to predict AVNRT was ≥ 0.22 mV with a sensitivity of 0.78 and specificity of 0.84. HBmax-CSO was positively correlated with HBmax-ABL, and HBmax-ABL was positively correlated with A2H2. CONCLUSIONS HBmax amplitudes were higher and durations longer in patients with AVNRT, as compared to those with AVRT. Moreover, the distance between HBmax and successful ablation site was positively correlated with the SP conduction time and with the distance from HBmax to the CS ostium.
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Affiliation(s)
- Fu Guan
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland. .,Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Ardan M Saguner
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Daniel Hofer
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas Wolber
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Alexander Breitenstein
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Nazmi Krasniqi
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Department of Cardiology, GZO Regional Health Centre Wetzikon, Switzerland
| | - Urs Eriksson
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jan Steffel
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Corinna Brunckhorst
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Firat Duru
- Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Abstract
Purpose
For aiding computer security experts in their study, log files are a crucial piece of information. Especially the time domain is very important for us because in most cases, timestamps are the only linking points between events caused by attackers, faulty systems or simple errors and their corresponding entries in log files. With the idea of storing and analyzing this log information in graph databases, we need a suitable model to store and connect timestamps and their events. This paper aims to find and evaluate different approaches how to store timestamps in graph databases and their individual benefits and drawbacks.
Design/methodology/approach
We analyse three different approaches, how timestamp information can be represented and stored in graph databases. For checking the models, we set up four typical questions that are important for log file analysis and tested them for each of the models. During the evaluation, we used the performance and other properties as metrics, how suitable each of the models is for representing the log files’ timestamp information. In the last part, we try to improve one promising looking model.
Findings
We come to the conclusion, that the simplest model with the least graph database-specific concepts in use is also the one yielding the simplest and fastest queries.
Research limitations/implications
Limitations to this research are that only one graph database was studied and also improvements to the query engine might change future results.
Originality/value
In the study, we addressed the issue of storing timestamps in graph databases in a meaningful, practical and efficient way. The results can be used as a pattern for similar scenarios and applications.
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Hermes-Laufer J, Hofer D, Flammer A, Ruschitzka F, Steffel J, Winnik S. Right ventricular only pacing for cardiac resynchronization therapy. Europace 2021; 24:70-71. [PMID: 34389862 PMCID: PMC8742625 DOI: 10.1093/europace/euab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Corresponding author. Tel: +41 44 255 47 82. E-mail address:
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Jelisejevas J, Breitenstein A, Hofer D, Winnik S, Steffel J, Saguner A. Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes. Europace 2021. [DOI: 10.1093/europace/euab116.377] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, Leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left sided femoral venous approach may benecessary. We hypothesized that a left sided femoral venous approach is as safe and effective as compared to a right sided approach.
Objective
We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach as compared to the conventional right sided approach.
Methods and Results: In this retrospective single-center analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases as compared to 8% in the remaining population (p = 0.003). Final leadless pacemaker position within the right ventricle was mid-septal in 82% (102/125) for right femoral access vs 72% (13/18) for left femoral access (p = 0.16). In the remaining cases (28 %, 5/18), the device was placed infero-septal following a left femoral venous access, as compared to 14% (18/125) for a right sided approach (p = 0.19). No repositioning was needed in 68% (85/125) using a right femoral access vs 72% (13/ 18) patients with a left femoral access (p = 0.84).
Conclusions
A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left- vs. right femoral venous access was a previous transfemoral TAVI procedure.
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Affiliation(s)
| | | | - D Hofer
- University Hospital Zurich, Zurich, Switzerland
| | - S Winnik
- University Hospital Zurich, Zurich, Switzerland
| | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - A Saguner
- University Hospital Zurich, Zurich, Switzerland
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Jelisejevas J, Breitenstein A, Hofer D, Winnik S, Steffel J, Saguner AM. Left femoral venous access for leadless pacemaker implantation: patient characteristics and outcomes. Europace 2021; 23:1456-1461. [PMID: 33822918 DOI: 10.1093/europace/euab083] [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: 12/18/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Leadless pacing has become an alternative approach for patients requiring a single-chamber pacemaker. Conventionally, leadless Micra Transcatheter Pacing System (TPS) pacemakers are implanted via a right femoral venous access. However, due to various reasons, a left-sided femoral venous approach may be necessary. We hypothesized that a left-sided femoral venous approach is as safe and effective when compared with a right-sided approach. We assessed indications, procedural characteristics, safety and mid-term outcomes of Micra TPS implantation via a left femoral venous approach when compared with the conventional right-sided approach. METHODS AND RESULTS In this retrospective single-centre analysis, 143 consecutive patients undergoing Micra TPS implantation were included. 87% (125/143) underwent Micra TPS implantation via a right, and 13% (18/143) via a left femoral venous access. The mean age at implantation was 79.8 ± 7.5 years. Acute procedural success, mean procedure and fluoroscopy times as well as device parameters at implantation and follow-up (mean 15 ± 11.5 months) were similar between the two groups. Five major complications (3.5%) were encountered, all using a right-sided approach. After a transfemoral TAVI procedure, left femoral venous access was used in 42% of cases when compared with 8% in the remaining population (P = 0.003). CONCLUSIONS A left femoral venous access for Micra TPS implantation is safe and effective with an excellent implantation success rate similar to a conventional right femoral venous access without longer implantation and fluoroscopy times. The most frequent reason for choosing left vs. right femoral venous access was a previous transfemoral TAVI procedure.
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Affiliation(s)
- Julius Jelisejevas
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Alexander Breitenstein
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Stephan Winnik
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jan Steffel
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ardan M Saguner
- Electrophysiology Division, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Stuetz M, Templin C, Templin-Ghadri JR, Ruschitzka F, Pohl H, Hofer D. Acute heart and brain failure: a case report. Eur Heart J Case Rep 2021; 4:1-8. [PMID: 33447724 PMCID: PMC7793236 DOI: 10.1093/ehjcr/ytaa352] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 08/30/2020] [Indexed: 11/14/2022]
Abstract
Background Takotsubo syndrome (TTS) is characterized by often reversible but acute heart failure occurring after an emotional or physical trigger event. The 'brain failure' counterpart is posterior reversible encephalopathy syndrome (PRES) characterized by often reversible but acute neurological symptoms. This case report elaborates on a complex clinical scenario with co-existence of coronary artery disease, TTS and PRES and discusses the pathophysiology, differential diagnosis, and management. Case summary An 82-year-old woman presented with acute heart failure and generalized tonic-clonic seizures following an acute exacerbation of her chronic back pain. Brain magnetic resonance imaging demonstrated vasogenic oedema consistent with the diagnosis of PRES. Focal wall motion abnormalities on echocardiography without causal coronary stenoses on angiography were consistent with the diagnosis of TTS. After an interdisciplinary approach to differential diagnosis and treatment, the patient was discharged to geriatric rehabilitation without heart failure or neurological defects 4 weeks later. Discussion TTS and PRES share significant similarities in proposed pathogenesis, epidemiology, management, and clinical outcome. This case report highlights the need for early recognition of this rare association and multidisciplinary approach to diagnosis and treatment as both heart and brain disease may require early intervention up to rapid intensive care support.
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Affiliation(s)
- Magdalena Stuetz
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Jelena-Rima Templin-Ghadri
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
| | - Heiko Pohl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, 8006 Zurich, Switzerland
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Hofer D, Breitenstein A. Snare technique for coronary sinus cannulation in cardiac resynchronization therapy. Indian Pacing Electrophysiol J 2020; 20:293-295. [PMID: 33002591 PMCID: PMC7691783 DOI: 10.1016/j.ipej.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/04/2020] [Accepted: 09/26/2020] [Indexed: 11/02/2022] Open
Abstract
Purpose Methods and results Conclusion
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36
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Breitenstein A, Saguner AM, Gasperetti A, Hofer D, Koepfli P, Regoli F, Steffel J. Assessment of injury current during leadless pacemaker implantation. Int J Cardiol 2020; 323:113-117. [PMID: 32916226 DOI: 10.1016/j.ijcard.2020.08.098] [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: 08/11/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Leadless pacemakers are an established treatment option for bradyarrhythmias. Similar to conventional transvenous pacemakers, satisfying pacing values during implantation are targeted for optimal long-term device function. The objective is to investigate the role of a local injury current (IC) in leadless pacemaker implantations. METHOD The IC, sensing value, capture threshold and impedance were collected in 30 consecutive patients receiving a leadless pacemaker. RESULTS 39 EGMs were recorded from 30 patients (including 9 device repositions). An IC was detected in 15 cases (38%). At implantation, the presence of an IC was associated with a significantly lower sensing (7.1 ± 3.7 mV vs 12.0 ± 4.0 mV; P = 0.004) and a higher capture threshold (median threshold 1.13 V at 0.24 ms [0.50-2.00] vs 0.50 V at 0.24 ms [0.25-0.75]; P = 0.002) and with a 26 fold higher likelihood of device repositioning compared to the absence of an IC (OR 26.3 [2.79-248], P < 0.001). Patients with an IC in their final implant position had a lower sensing (9.3 ± 4.4 mV vs 13.6 ± 4.7 mV at implantation, P = 0.04), while the initially similar capture threshold was lower after 24 h in the IC group. After 2 weeks, all parameters were similar between the two groups. CONCLUSIONS Our study shows that an IC can readily be observed during leadless pacemaker implantation associated with a lower sensing and a higher capture threshold at implantation but with similar to even better values during follow-up.
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Affiliation(s)
- Alexander Breitenstein
- Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Ardan M Saguner
- Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jan Steffel
- Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Kahr PC, Trenson S, Schindler M, Kuster J, Kaufmann P, Tonko J, Hofer D, Inderbitzin DT, Breitenstein A, Saguner AM, Flammer AJ, Ruschitzka F, Steffel J, Winnik S. Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long-term retrospective cohort study. ESC Heart Fail 2020; 7:2773-2783. [PMID: 32652900 PMCID: PMC7524059 DOI: 10.1002/ehf2.12876] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) has become an important therapy in patients with heart failure with reduced left ventricular ejection fraction (LVEF). The effect of diabetes on long-term outcome in these patients is controversial. We assessed the effect of diabetes on long-term outcome in CRT patients and investigated the role of diabetes in ischaemic and non-ischaemic cardiomyopathy. METHODS AND RESULTS All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were enrolled. The study endpoints were (i) a composite of ventricular assist device (VAD) implantation, heart transplantation, or all-cause mortality; and (ii) reverse remodelling (improvement of LVEF ≥ 10% or reduction of left ventricular end-systolic volume ≥ 15%). Median follow-up of the 418 patients (age 64.6 ± 11.6 years, 22.5% female, 25.1% diabetes) was 4.8 years [inter-quartile range: 2.8;7.4]. Diabetic patients had an increased risk to reach the composite endpoint [adjusted hazard ratio (aHR) 1.48 [95% CI 1.12-2.16], P = 0.041]. Other factors associated with an increased risk to reach the composite endpoint were a lower body mass index or baseline LVEF (aHR 0.95 [0.91; 0.98] and 0.97 [0.95; 0.99], P < 0.01 each), and a higher New York Heart Association functional class or creatinine level (aHR 2.14 [1.38; 3.30] and 1.04 [1.01; 1.05], P < 0.05 each). Early response to CRT, defined as LVEF improvement ≥ 10%, was associated with a lower risk to reach the composite endpoint (aHR 0.60 [0.40; 0.89], P = 0.011). Reverse remodelling did not differ between diabetic and non-diabetic patients with respect to LVEF improvement ≥ 10% (aHR 0.60 [0.32; 1.14], P = 0.118). However, diabetes was associated with decreased reverse remodelling with respect to a reduction of left ventricular end-systolic volume ≥ 15% (aHR 0.45 [0.21; 0.97], P = 0.043). In patients with ischaemic cardiomyopathy, survival rates were not significantly different between diabetic and non-diabetic patients (HR 1.28 [0.83-1.97], P = 0.101), whereas in patients with non-ischaemic cardiomyopathy, diabetic patients had a higher risk of reaching the composite endpoint (HR 1.65 [1.06-2.58], P = 0.027). The latter effect was dependent on other risk factors (aHR 1.47 [0.83-2.61], P = 0.451). The risk of insulin-dependent patients was not significantly higher than in patients under oral antidiabetic drugs (HR 1.55 [95% CI 0.92-2.61], P = 0.102). CONCLUSIONS Long-term follow-up revealed diabetes mellitus as independent risk factor for all-cause mortality, heart transplantation, or VAD in heart failure patients undergoing CRT. The detrimental effect of diabetes appeared to weigh heavier in patients with non-ischaemic compared with ischaemic cardiomyopathy.
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Affiliation(s)
- Peter C Kahr
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Joël Kuster
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Philippe Kaufmann
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Department of Medicine, GZO Zurich Regional Health Center, Wetzikon, Switzerland
| | - Johanna Tonko
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Devdas T Inderbitzin
- Department of Cardiovascular Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
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Oechslin L, Hofer D, Hermann M. [CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome]. Praxis (Bern 1994) 2020; 109:1117-1118. [PMID: 33108996 DOI: 10.1024/1661-8157/a003544] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.
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Affiliation(s)
| | - Daniel Hofer
- Klinik für Kardiologie, Universitätsspital Zürich
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Oechslin L, Hofer D, Hermann M. [CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome]. Praxis (Bern 1994) 2020; 109:1017-1025. [PMID: 33050815 DOI: 10.1024/1661-8157/a003543] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.
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Affiliation(s)
| | - Daniel Hofer
- Klinik für Kardiologie, Universitätsspital Zürich
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Breitenstein A, Hofer D, Saguner AM, Steffel J. Extraction of a leadless pacemaker 23 months after implantation. Eur Heart J 2019; 41:2038. [DOI: 10.1093/eurheartj/ehz671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Breitenstein
- Electrophysiology Division, University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Daniel Hofer
- Electrophysiology Division, University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Ardan M Saguner
- Electrophysiology Division, University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Jan Steffel
- Electrophysiology Division, University Heart Centre, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Gartenmann SJ, Hofer D, Wiedemeier D, Sahrmann P, Attin T, Schmidlin PR. Comparative effectiveness of hand scaling by undergraduate dental students following a two-week pre-clinical training course. Eur J Dent Educ 2019; 23:1-7. [PMID: 29696742 DOI: 10.1111/eje.12361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Bologna reform resulted in a drastic restructuring of pre-clinical training courses at the University of Zurich. The aim of this study was to assess student pre-clinical scaling/root planning skills after just 8.5 hours of manual training. MATERIAL AND METHODS Three consecutive classes of dental students (n = 41; n = 34; n = 48) were tasked with removing lacquer concrement from the maxillary left canine on a typodont using Gracey and universal (Deppeler M23A) curettes. At baseline (prior to instruction), a timed five-minute session of scaling/root planning was undertaken. The second scaling/root planning session was held immediately following training. Eight experienced dental hygienists and eight lay people served as positive and negative controls, using the same instruments and time limit, respectively. Instrumented teeth were collected, scanned and planimetrically analysed for the percentage of tooth surface cleaned. Statistical analyses were performed to assess the dental students' improvement after the training (Wilcoxon signed-rank test) and to compare it to that of laypeople and dental hygienists (Kruskal-Wallis rank sum test followed by Conover's post hoc test). RESULTS At baseline, the dental students' mean scaling scores of the cleaned surfaces were not significantly different than those of laypeople (29.8%, 31.0%, 42% vs 27.9%). However, after 8.5 hours of manual training, the students' ability to clean the maxillary tooth improved significantly and they achieved mean removal values of 61.7%, 79.5% and 76% compared to the 67.4% (P < .001) of the experienced dental hygienists (Tables Tables and ). There were no statistically significant differences between the scores achieved by students after training and those achieved by experienced dental hygienists. CONCLUSION A shortened pre-clinical training time was sufficient for students to acquire the basic scaling/root planning skills needed in preparation for clinical training. Further research is needed to identify ways to help students consistently reach highest skill levels.
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Affiliation(s)
- S J Gartenmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - D Hofer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - D Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - T Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Hofer D, Saguner AM, Gass M, Brunckhorst C. [Not Available]. Praxis (Bern 1994) 2017; 106:1016-1020. [PMID: 28875757 DOI: 10.1024/1661-8157/a002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Daniel Hofer
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | | | - Corinna Brunckhorst
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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Hofer D, Saguner AM, Gass M, Brunckhorst C. [Not Available]. Praxis (Bern 1994) 2017; 106:919-920. [PMID: 28830323 DOI: 10.1024/1661-8157/a002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Daniel Hofer
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | | | - Corinna Brunckhorst
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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Ulbing M, Kirsch AH, Leber B, Lemesch S, Münzker J, Schweighofer N, Hofer D, Trummer O, Rosenkranz AR, Müller H, Eller K, Stadlbauer V, Obermayer-Pietsch B. MicroRNAs 223-3p and 93-5p in patients with chronic kidney disease before and after renal transplantation. Bone 2017; 95:115-123. [PMID: 27866993 PMCID: PMC6326349 DOI: 10.1016/j.bone.2016.11.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 01/18/2023]
Abstract
Chronic kidney disease (CKD) is associated with a multifactorial dysregulation of bone and vascular calcification and closely linked to increased cardiovascular mortality and concomitant bone disease. We aimed to investigate specific microRNA (miRNA) signatures in CKD patients to find indicators for vascular calcification and/or bone mineralization changes during CKD and after kidney transplantation (KT). A miRNA array was used to investigate serum miRNA profiles in CKD patients, then selected miRNAs were quantified in a validation cohort comprising 73 patients in CKD stages 3 to 5, 67 CKD patients after KT, and 36 healthy controls. A spectrum of biochemical parameters including markers for kidney function, inflammation, glucose, and mineral metabolism was determined. The relative expression of miR-223-3p and miR-93-5p was down-regulated in patients with CKD stage 4 and 5 compared to healthy controls. This down-regulation disappeared after kidney transplantation even when lower glomerular filtration rates (eGFR) persisted. MiR-223-3p and miR-93-5p were associated with interleukin-6 (IL-6) and eGFR levels, and by trend with interleukin-8 (IL-8), C-peptide, hematocrit, and parathyroid hormone (PTH). This study contributes new knowledge of serum miRNA expression profiles in CKD, potentially reflecting pathophysiological changes of bone and calcification pathways associated with inflammation, vascular calcification, mineral and glucose metabolism. Identified miRNA signatures can contribute to future risk markers or future therapeutic targets in bone and kidney disease.
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Affiliation(s)
- M Ulbing
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria.
| | - A H Kirsch
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - B Leber
- Dept. of Surgery, Clinical Division of Transplantation Surgery, Medical University of Graz, Austria
| | - S Lemesch
- Dept. of Internal Medicine, Clinical Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - J Münzker
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - N Schweighofer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - D Hofer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - O Trummer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - A R Rosenkranz
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - H Müller
- Dept. of Surgery, Clinical Division of Transplantation Surgery, Medical University of Graz, Austria
| | - K Eller
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - V Stadlbauer
- Dept. of Internal Medicine, Clinical Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
| | - B Obermayer-Pietsch
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
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Hofer D, Suter M, Haughey E, Finn JA, Hoekstra NJ, Buchmann N, Lüscher A. Yield of temperate forage grassland species is either largely resistant or resilient to experimental summer drought. J Appl Ecol 2016. [DOI: 10.1111/1365-2664.12694] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Hofer
- Agroscope, Institute for Sustainability Sciences ISS Reckenholzstrasse 191 CH‐8046 Zürich Switzerland
- Institute of Agricultural Sciences ETH Zürich Universitätstrasse 2 CH‐8092 Zürich Switzerland
| | - Matthias Suter
- Agroscope, Institute for Sustainability Sciences ISS Reckenholzstrasse 191 CH‐8046 Zürich Switzerland
| | - Eamon Haughey
- Environment Research Centre Teagasc Johnstown Castle Wexford Ireland
- School of Biology & Environmental Science University College Dublin Belfield, Dublin 4 Ireland
| | - John A. Finn
- Environment Research Centre Teagasc Johnstown Castle Wexford Ireland
| | - Nyncke J. Hoekstra
- Agroscope, Institute for Sustainability Sciences ISS Reckenholzstrasse 191 CH‐8046 Zürich Switzerland
| | - Nina Buchmann
- Institute of Agricultural Sciences ETH Zürich Universitätstrasse 2 CH‐8092 Zürich Switzerland
| | - Andreas Lüscher
- Agroscope, Institute for Sustainability Sciences ISS Reckenholzstrasse 191 CH‐8046 Zürich Switzerland
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Münzker J, Hofer D, Trummer C, Ulbing M, Harger A, Pieber T, Owen L, Keevil B, Brabant G, Lerchbaum E, Obermayer-Pietsch B. Testosterone to dihydrotestosterone ratio as a new biomarker for an adverse metabolic phenotype in the polycystic ovary syndrome. J Clin Endocrinol Metab 2015; 100:653-60. [PMID: 25387259 DOI: 10.1210/jc.2014-2523] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is a heterogeneous disease with many different aspects, including hyperandrogenism and metabolic disturbances. Clinical phenotypes show different patterns of steroid hormones that have been investigated to some extent. OBJECTIVE This study intended to determine the role of the testosterone (TT) to dihydrotestosterone (DHT) ratio (TT/DHT ratio) in PCOS patients and to further assess the correlation of this ratio with hormonal, anthropometric, and metabolic parameters. DESIGN AND SETTING Serum samples of 275 premenopausal PCOS patients fulfilling Rotterdam criteria and 35 BMI-matched, premenopausal, healthy controls were analyzed for testosterone, DHT, dehydroepiandrosterone (DHEA), and androstenedione using liquid chromatography/mass spectrometry. MAIN OUTCOME MEASURES We measured total levels of testosterone and DHT and calculated unbound hormone levels as well as the ratio of testosterone to DHT. Further, impaired glucose tolerance, basal and stimulated serum insulin levels, metabolic syndrome and insulin resistance according to the homeostatic model assessment (HOMA-IR) were assessed. RESULTS PCOS patients showed significantly higher levels of TT (P < .001), free testosterone (P < .001), and free DHT (P < .001) compared to healthy controls. The TT/DHT ratio was significantly higher in PCOS patients (P < .001). No difference was found for total DHT levels (P = .072). In PCOS patients alone, the TT/DHT ratio was significantly higher in obese patients (P < .001) and patients with metabolic syndrome (P < .001), impaired glucose tolerance (IGT) (P < .001) or insulin resistance (P < .001). Significant correlations of the TT/DHT ratio with various adverse anthropometric, hormonal, lipid and liver parameters and parameters of glucose metabolism were found. CONCLUSION Our data provide evidence for a strong link between a high TT/DHT ratio and an adverse metabolic phenotype in PCOS patients. This correlation was only found in PCOS patients, suggesting the TT/DHT ratio to be a new biomarker for an adverse metabolic phenotype in PCOS patients.
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Affiliation(s)
- J Münzker
- Division of Endocrinology and Metabolism, Department of Internal Medicine (J.M., D.H., C.T., M.U., A.H., T.P., E.L., B.O-P.), Medical University of Graz, 8036 Graz, Austria; Manchester Academic Health Science Centre, Department of Clinical Chemistry (L.O., B.K.), University Hospital S Manchester, Manchester M23 9LT, United Kingdom; Department of Endocrinology (G.B.), The Christie, University of Manchester, Manchester M20 4BX, United Kingdom; and Experimental and Clinical Endocrinology (G.B.), Med Clinic 1, University of Lübeck, 23538 Lübeck, Germany
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Hofer D, Meier A, Sener B, Guggenheim B, Attin T, Schmidlin PR. In vitro evaluation of a novel biofilm remover. Int J Dent Hyg 2014; 13:246-53. [PMID: 25421848 DOI: 10.1111/idh.12113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate a novel device for its efficacy in removing experimental biofilm from root surfaces and its potential for concomitantly removing/roughening the surface substance. METHODS AND MATERIALS A novel acrylic rotary device (biofilm remover, BR) was tested in vitro in three experiments: surface loss, surface roughness [positive controls: Perioset (PS) and Proxoshape (PR)] and biofilm removal [positive controls: ultrasonic (US) and PS]. Surface loss/surface roughness was evaluated for dentin samples instrumented for three 20 s periods. The calcium removed during instrumentation was analysed after each interval and cumulatively, using atomic absorption spectrophotometry (AAS). Surface roughness was measured using profilometric analysis. Biofilm removal was evaluated on dentin specimens coated with a 64.5 h 6-species in vitro formed biofilm, after one 20 s treatment. Surface loss was analysed using anova with Scheffé post hoc test, and surface roughness/biofilm removal was analysed using Mann-Whitney test (all P ≤ 0.05). RESULTS Significantly less substance loss [μg (± 1 SD)] was observed with the novel device at all time points, both interval and cumulative (1.0 (± 0.5) versus 9.3 (± 3.2) PS and 9.9 (± 1.9) PR at 60 s). Surface roughness [μm (95% CI)] was significantly lower for BR than for PS and PR [0.00 (-0.01, 0.08) 0.20 (0.16, 0.27) and 0.21 (0.19, 0.24) at 60 s]. Significantly less biofilm bacteria remained after treatment with both BR 4.5 (-0.1, 16.2) and US 1.9 (-0.2, 14.3), compared to PS 52 (27.9, 82.1). CONCLUSIONS The novel biofilm remover was less damaging to dentin surfaces, while removing biofilm at least as effectively as devices used in this study.
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Affiliation(s)
- D Hofer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - A Meier
- Institute of Oral Biology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - B Sener
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - B Guggenheim
- Institute of Oral Biology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - T Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Hofer D, Münzker J, Schwetz V, Ulbing M, Hutz K, Stiegler P, Zigeuner R, Pieber TR, Müller H, Obermayer-Pietsch B. Testicular synthesis and vitamin D action. J Clin Endocrinol Metab 2014; 99:3766-73. [PMID: 24937537 DOI: 10.1210/jc.2014-1690] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT The vitamin D system has pleiotropic effects not only in bone metabolism. Its role in testicular steroidogenesis is new and deserves intensive research. OBJECTIVE We hypothesize that vitamin D, especially 1,25 dihydroxyvitamin D3 [1,25(OH)2D3 (calcitriol)] induces male steroidogenesis and intend to identify its impact on genes and pathways in testicular androgen regulation. METHODS Human adult primary testicular cells were isolated, treated with 1,25(OH)2D3, and their gene expression levels profiled by microarray analysis. Highly regulated genes were confirmed by real-time quantitative PCR. In addition, the effects of 1,25(OH)2D3 in combination with LH and IGF-I on the gene expression level of androgens were assessed. T levels in the culture media were determined by a high-resolution ELISA. The expression of vitamin D receptor was confirmed at baseline and after 1,25(OH)2D3 stimulation using immunocytochemistry. RESULTS Microarrays depicted 63 genes significantly regulated by 1,25(OH)2D3, including genes related to male androgen and vitamin D metabolism, mainly triggered by the vitamin D receptor/retinoid X receptor activation. 1,25(OH)2D3 led to significant changes in the expression profiles of reproductive genes and significantly increased T synthesis in human testicular cell cultures. CONCLUSIONS Data from our human primary testicular cell culture model suggest that vitamin D plays a major role in male steroidogenesis in vitro.
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Affiliation(s)
- D Hofer
- Department of Internal Medicine, Division of Endocrinology and Metabolism (D.H., J.M., V.S., M.U., T.R.P., B.O.-P.), Department of Urology (K.H., R.Z.), and Department of Surgery, Division of Transplantation Surgery (P.S., H.M.), Medical University of Graz, 8036 Graz, Austria
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Münzker J, Hofer D, Ulbing M, Harger A, Pieber T, Keevil B, Brabant G, Lerchbaum E, Obermayer-Pietsch B. Testosterone/dihydrotestosterone ratio as a new biomarker for PCOS. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388570] [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: 10/24/2022] Open
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Volksen W, Yoon DY, Hedrick JL, Hofer D. Chemistry and Characterization Of Polyimides Derived from Poly(Amic Alkyl Esters). ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-227-23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTThe modification of the pendant acid groups along the poly(amic acid) backbone in the form of alkyl ester groups leads to greatly improved polyimide precursors. These poly(amic alkyl esters) are characterized by the absence of hydrolytic instability due to elimimation of the “monomer-polymer” equilibrium associated with poly(amic acids), a broad imidization temperature regime, improved solubility characteristics, and enhanced mechanical properties. In the absence of hydrolytic instability, it is now possible to use an aqueous work-up of the polyimide precursor. This presents an attractive synthetic pathway for the preparation of well-defined, amine-terminated oligomers. Such oligomers can then be utilized both in the preparation of low molecular weight, chain-extendable polyimide precursors as well as polyimide block copolymers. The higher imidization temperatures offered by the “amic ester” chemistry allows for more efficient chain extension prior to imidization. Alternatively, the lack of the “monomer-polymer” equilibrium and accompanying propensity for monomer randomization reactions presents a potential pathway for the preparation of polyimide blends.
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