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Kirstein B, Tomala J, Mayer J, Ulbrich S, Wagner M, Pu L, Piorkowski J, Hankel A, Huo Y, Gaspar T, Richter U, Hindricks G, Piorkowski C. Effect of concomitant Renal DeNervation and cardiac ablation on Atrial Fibrillation recurrence - RDN+AF study. J Cardiovasc Electrophysiol 2023; 34:44-53. [PMID: 36259713 DOI: 10.1111/jce.15714] [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: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Renal denervation (RDN) can reduce cardiac sympathetic activity maintained by arterial hypertension (aHT). Its potential antiarrhythmic effect on rhythm outcome in patients with multi-drug resistant aHT undergoing catheter ablation for atrial fibrillation (AF) is unclear. METHODS The RDN+AF study was a prospective, randomized, two-center trial. Patients with paroxysmal or persistent AF and uncontrolled aHT (mean systolic 24-h ambulatory BP > 135 mmHg) despite taking at least three antihypertensive drugs were enrolled. Patients were 1:2 randomized to either RDN+AF ablation or AF-only ablation. Primary endpoint was freedom from any AF episode > 2 min at 12 months assessed by implantable loop recorder (ILR) or 7d-holter electrocardiogram. Secondary endpoints included rhythm outcome at 24 months, blood pressure control, periprocedural complications, and renovascular safety. RESULTS The study randomized 61 patients (mean age 65 ± 9 years, 53% men). At 12 months, RDN+AF patients tended to have a greater decrease in ambulatory BPs but did not reach statistical significance. No differences in rhythm outcome were observed. Freedom from AF recurrence in the RDN+AF and AF-only group measured 61% versus 53% p = .622 at 12 months and 39% versus 47% p = .927 at 24 months, respectively. Periprocedural complications occurred in 9/61 patients (15%). No patient died. CONCLUSION Among patients with multidrug-resistant aHT and paroxysmal or persistent AF, concomitant RDN+AF ablation was not associated with better blood pressure control or rhythm outcome in comparison to AF-only ablation and medical therapy.
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Affiliation(s)
- Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Jakub Tomala
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Michael Wagner
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Liying Pu
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Judith Piorkowski
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany.,Steinbeis Research Center, "Rhythm & Heart", Dresden, Germany
| | | | - Yan Huo
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, Leipzig University, Leipzig, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center Dresden, TU Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany.,Steinbeis Research Center, "Rhythm & Heart", Dresden, Germany
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Huo Y, Gaspar T, Schönbauer R, Wójcik M, Fiedler L, Roithinger FX, Martinek M, Pürerfellner H, Kirstein B, Richter U, Ulbrich S, Mayer J, Krahnefeld O, Agdirlioglu T, Zedda A, Piorkowski J, Piorkowski C. Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation. NEJM Evid 2022; 1:EVIDoa2200141. [PMID: 38319851 DOI: 10.1056/evidoa2200141] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Low-Voltage Myocardium Ablation Trial of Persistent AFWe investigated ablation approaches in 324 patients with persistent AF by comparing ablation with PVI alone and PVI plus individualized SM. Patients had electrocardiogram recordings over 12 months of observation. Recurrent AF was documented in 50% of PVI only and 35% of PVI+SM patients. AEs occurred in six PVI+SM versus three PVI-alone patients.
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Affiliation(s)
- Yan Huo
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Robert Schönbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna
| | - Maciej Wójcik
- Department of Cardiology, Medical University in Lublin, Lublin, Poland
| | - Lukas Fiedler
- Department of Internal Medicine II, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
- University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Franz Xaver Roithinger
- Department of Internal Medicine II, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Martin Martinek
- Department of Internal Medicine 2, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Helmut Pürerfellner
- Department of Internal Medicine 2, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Bettina Kirstein
- Heart Center, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
| | - Olaf Krahnefeld
- Department of Electrophysiology, Sana Kliniken Lübeck, Lübeck, Germany
| | - Tolga Agdirlioglu
- Department of Electrophysiology, Sana Kliniken Lübeck, Lübeck, Germany
| | - Angela Zedda
- Department of Electrophysiology, Heart Center, Dresden University of Technology, Dresden, Germany
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Zedda A, Huo Y, Kronborg M, Ulbrich S, Mayer J, Pu L, Richter U, Gaspar T, Piorkowski J, Piorkowski C. Left Atrial Isolation and Appendage Occlusion in Patients With Atrial Fibrillation at End-Stage Left Atrial Fibrotic Disease. Circ Arrhythm Electrophysiol 2021; 14:e010011. [PMID: 34270906 DOI: 10.1161/circep.121.010011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Angela Zedda
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Yan Huo
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Mads Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (M.K.)
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Julia Mayer
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Liying Pu
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Utz Richter
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
| | | | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany (Y.H., A.Z., S.U., J.M., L.P., U.R., T.G., J.P., C.P.)
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4
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Schönbauer R, Tomala J, Kirstein B, Huo Y, Gaspar T, Richter U, Piorkowski J, Schönbauer MS, Fiedler L, Roithinger FX, Hengstenberg C, Mascherbauer J, Ulbrich S, Piorkowski C. Left atrial phasic transport function closely correlates with fibrotic and arrhythmogenic atrial tissue degeneration in atrial fibrillation patients: cardiac magnetic resonance feature tracking and voltage mapping. Europace 2021; 23:1400-1408. [PMID: 33693595 DOI: 10.1093/europace/euab052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS To characterize the association of phasic left atrial (LA) transport function and LA fibrosis guided by multimodality imaging containing cardiac magnetic resonance imaging (CMR) feature tracking and bipolar voltage mapping. METHODS AND RESULTS Consecutive patients presenting for first-time ablation of atrial fibrillation (AF) were prospectively enrolled. Each patient underwent CMR prior to the ablation procedure. LA phasic indexed volumes (LA-Vi) and emptying fractions (LA-EF) were calculated and CMR feature tracking guided LA wall motion analysis was performed. LA bipolar voltage mapping was carried out in sinus rhythm to find areas of low voltage as a surrogate for fibrosis and arrhythmogenesis. One hundred and sixty-eight patients were enrolled. Low-voltage areas (LVAs) were present in 70 patients (42%). Contrary to LA volume, CMR based LA-EF [odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80-0.96, P = 0.005] and LA booster pump strain rate (SR) (OR 0.98, 95% CI 0.97-0.99, P = 0.001) significantly predicted presence and extent of LVA in multivariate logistic regression analysis for patients scanned in SR. In receiver operating characteristic analysis, LA-EF <40% carried a sensitivity of 83% and specificity of 76% (area under the curve 0.8; 95% CI 0.71-0.89) to predict presence of LVA. For patients scanned in AF only minimal LA-Vi on CMR (OR: 1.06; 95% CI: 1.02-1.10; P = 0.002) predicted presence of LVA. CONCLUSION For patients scanned in SR LA-EF and LA booster pump SR are closely linked to the presence and extent of LA LVA.
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Affiliation(s)
- Robert Schönbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jakub Tomala
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Bettina Kirstein
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Yan Huo
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Thomas Gaspar
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Utz Richter
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Judith Piorkowski
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany.,Steinbeis Research Institute-Rhythm and Heart, Dresden, Germany
| | | | - Lukas Fiedler
- Department of Cardiology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | | | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stefan Ulbrich
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany
| | - Christopher Piorkowski
- Department of Cardiac Electrophysiology, Heart Centre Dresden, Fetscherstraße 76, 01307 Dresden, Germany.,Abbott EP&HF Division, Minneapolis, MN, USA
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5
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Kirstein B, Neudeck S, Gaspar T, Piorkowski J, Wechselberger S, Kronborg MB, Zedda A, Hankel A, El-Armouche A, Tomala J, Schmidt T, Mayer J, Wagner M, Ulbrich S, Pu L, Richter U, Huo Y, Piorkowski C. Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study. Europace 2020; 22:1812-1821. [DOI: 10.1093/europace/euaa179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/04/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation.
Methods and results
In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P < 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P < 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P < 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P < 0.001).
Conclusion
Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.
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Affiliation(s)
- Bettina Kirstein
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Sebastian Neudeck
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Judith Piorkowski
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Simon Wechselberger
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Angela Zedda
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Anastasia Hankel
- Steinbeis Research Institute ‘Rhythm and Heart’, Pfotenhauer Straße 76, 01307 Dresden, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Jakub Tomala
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Thomas Schmidt
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Michael Wagner
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Liying Pu
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Yan Huo
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center, TU Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
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6
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Kirstein B, Neudeck S, Kronborg MB, El-Armouche A, Gaspar T, Piorkowski J, Wechselberger S, Zedda A, Tomala J, Mayer J, Wagner M, Ulbrich S, Richter U, Huo Y, Piorkowski C. P457Incidence of LA fibrosis and substrate-based AF ablation success rates in HF patients. Europace 2020. [DOI: 10.1093/europace/euaa162.036] [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
The author(s) received no specific funding for this work.
Background
In heart failure (HF) patients, sinus rhythm maintenance after catheter ablation for atrial fibrillation (AF) is mandatory to achieve better long-term outcome. Presence of left atrial (LA) fibrosis significantly attenuates ablation success rates. Incidence of LA fibrosis and the effect of an individualized substrate-based ablation concept on rhythm outcome in HF patients with AF is unclear.
Methods
This study investigated 103 patients (64 years, 69% men) with persistent AF (79%) and left ventricular (LV) dysfunction (EF 33% IQR [25; 38]) undergoing first time AF ablation. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. All patients received pulmonary vein isolation (PVI). LA fibrosis ablation was individualized by (i) homogenization of small areas, (ii) linear lesions connecting fibrosis and anatomical obstacles and (iii) linear lesions isolating large fibrotic areas. Rhythm outcome was measured by continuous device monitoring (AF detection ≥ 6 min) or Holter-ECG. A total post-procedural AF burden < 0.1% was defined as successful rhythm control.
Results
LA fibrosis in the overall cohort, in paroxysmal and persistent AF patients was detected in 39/103 (38%), 6/22 (27%) and 33/81 (41%), respectively. After 11 ± 5 months and 1.2 procedures/patient, freedom from AF recurrence was similar between patients with and without LA fibrosis (33/39 (84%) vs. 54/64 (84%); p = 0.485). With continuous monitoring, 73/87 (84%) patients recorded a total AF burden < 0.1%. There was no significant difference in AF burden outcome between patients with and without LA fibrosis (3.1% SD ±17.4 vs. 2.2% SD ±8.1; p = 0.4). No correlation between presence or extent of LA fibrosis and AF burden was found; p = 0.299.
Conclusion
A substantial number of HF patients with AF have no evidence of LA fibrosis. Among HF patients with LA fibrosis, individualized substrate-based AF ablation beyond PVI was able to achieve similar ablation success.
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Affiliation(s)
- B Kirstein
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - S Neudeck
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - M B Kronborg
- Aarhus University Hospital, Cardiology, Aarhus, Denmark
| | - A El-Armouche
- University Hospital Dresden, Pharmacology, Dresden, Germany
| | - T Gaspar
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - J Piorkowski
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - S Wechselberger
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - A Zedda
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - J Tomala
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - J Mayer
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - M Wagner
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - S Ulbrich
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - U Richter
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - Y Huo
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - C Piorkowski
- Heart Center - University Hospital Dresden, Dresden, Germany
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Huo Y, Kronborg MB, Richter U, Guo J, Ulbrich S, Zedda AM, Kirstein B, Mayer J, Pu L, Piorkowski J, Wagner M, Gaspar T, Piorkowski C. Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information. J Cardiovasc Electrophysiol 2020; 31:885-894. [PMID: 32037614 DOI: 10.1111/jce.14387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial substrate modification targeting low voltage zones (LVZ) is an ablation strategy that-in addition to pulmonary vein (PV) isolation-tries to eliminate arrhythmogenic mechanisms harbored in such tissue. Electrophysiological findings at reablation include (a) PV reconnection, (b) reconnection over previous substrate ablation, and (c) de-novo LVZ. OBJECTIVE To study, prevalence and contribution of these arrhythmogenic electrophysiological entities in patients with atrial fibrillation (AF) recurrences. METHODS Consecutive patients with highly symptomatic AF undergoing index and reablation were included (n = 113). In all patients' PV reconnection, reconnection over previous substrate ablation and spontaneous de-novo LVZ were quantitatively assessed and integrated into an individual reablation strategy. Follow-up was based on continuous device monitoring. RESULTS At re-do procedure, 45 out of 113 (39.8%) patients showed PV reconnection as the only electrophysiological abnormality. Reconduction over previous lines was the only electrophysiological abnormality in 8 out of 113 (7.1%) patients. Spontaneous de-novo LVZ was the only electrophysiological abnormality in 12 out of 113 (10.6%) patients. Combined findings of PV reconnection, line reconduction, and/or spontaneous de-novo LVZ were seen in 40 out of 113 (35.4%) patients. No detectable electrophysiological abnormality was observed in 8 out of 113 (7.1%) patients. In univariate analysis, none of the tested electrophysiological characteristics independently predicted the outcome after re-do. CONCLUSIONS In patients undergoing reablation, we could show that reconduction over previous substrate ablation as well as the development of new low voltage areas are frequent findings besides classical PV reconnection-without a clear leading cause for recurrences. These findings impact reablation strategies as well as the strategic focus during index procedures.
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Affiliation(s)
- Yan Huo
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | | | - Utz Richter
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Jianping Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Stefan Ulbrich
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Angela M Zedda
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Bettina Kirstein
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Liying Pu
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Judith Piorkowski
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Michael Wagner
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Dresden Heart Center, Dresden University of Technology, Dresden, Germany
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8
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Ulbrich S, Schoenbauer RS, Kirstein B, Tomala J, Huo Y, Mayer J, Richter U, Piorkowski J, Gaspar T, Mascherbauer J, Piorkowski C. P613Cardiac magnetic resonance imaging derived left ventricular mechanical function in patients with atrial fibrillation and left atrial low voltage zones. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0222] [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: 11/14/2022] Open
Abstract
Abstract
Background
The relation of left atrial low voltage zones (LVZ) to left ventricular function in patients undergoing pulmonary vein isolation (PVI) is not known.
Objective
To explore the relationship of left atrial low voltage zones (LVZ) on left ventricular function in patients with atrial fibrillation.
Methods
From June to Nov. 2018, 107 (mean age 67y, 70 men, 73 persistent AF) consecutive patients with symptomatic AF underwent a PVI with LVZ mapping. Before PVI the left ventricular ejection fraction (EF) and stroke volume (SV) were measured by cardiac magnetic resonance imaging (CMR). From feature-tracking of CMR-cine images left ventricular global, systolic and diastolic longitudinal strains (GLS), circumferential strains (GCS) and radial strains (GRS) were calculated.
Results
Of 59 patients CMR scanning in sinus rhythm was performed, LVZ were present in 24 patients.
LVEF was significantly lower in patients with left atrial LVZ (62±9% vs. 55±15%) (p=0,03). Left ventricular stroke volume was significantly decreased by the extent of LVZ (94±23 vs. 72±21ml), (p=0,03).
The left ventricular diastolic strains during ventricular filling (caused by atrial contraction) of GLS (r=−0,52), GCS (r=−0,65) and GRS (r=−0,65) were highly signifcantly correlated to the occurence and extent of LVZ (each p<0,001 respectively).
The only systolic ventricular strain was GLS, which decreased (r=−0,3, p=0,03) by the occurance of atrial low voltage.
Conclusion
The active, atrial part of diastolic left ventricular filling properties is impaired by the occurrence and extent of left atrial LVZ. In patients with left atrial LVZ the left ventricular stroke volume and ejection fraction is decreased already in sinus rhythm. It seems possible that atrial mechanical dysfunction and presence of atrial low voltage maybe predicted by LV diastolic strain analysis.
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Affiliation(s)
- S Ulbrich
- Dresden University of Technology, Heart Center, Dresden, Germany
| | | | - B Kirstein
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - J Tomala
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - Y Huo
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - J Mayer
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - U Richter
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - J Piorkowski
- Dresden University of Technology, Heart Center, Dresden, Germany
| | - T Gaspar
- Dresden University of Technology, Heart Center, Dresden, Germany
| | | | - C Piorkowski
- Dresden University of Technology, Heart Center, Dresden, Germany
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9
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Schoenbauer R, Tomala J, Kirstein B, Huo Y, Gaspar T, Richter U, Piorkowski J, Schoenbauer MS, Fiedler L, Roithinger FX, Hengstenberg C, Mascherbauer J, Ulbrich S, Piorkowski C. P605Correlation of left atrial phasic transport function and arrhythmogenic substrate in patients with atrial fibrillation: cardiac magnetic resonance feature tracking and bipolar voltage mapping. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0214] [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: 11/14/2022] Open
Abstract
Abstract
Background
Bipolar voltage mapping is a widely accepted approach to identify areas of arrhythmogenic substrate in patients presenting for atrial fibrillation (AF) ablation.
However, until now little is known about the correlation of left atrial (LA) bipolar voltage distribution and LA transport function.
Purpose
To study the impact of LA low voltage zones (LVZ) on LA transport function.
Methods
107 consecutive patients presenting for ablation of symptomatic AF (34 paroxysmal AF, 73 persistent AF) were prospectively enrolled. Each patient underwent cardiac magnetic resonance imaging (CMR) within 24 hours prior to the ablation procedure. 59 patients were in sinus rhythm (SR) and 48 in AF. LA phasic indexed volumes (LAVi) and ejection fractions were calculated using biplane area length formula. In addition LA phasic strains and strain rates were analyzed using dedicated software (Figure 1A & B).
LA bipolar voltage mapping was performed prior to beginning of ablation in sinus rhythm using a 3-dimensional mapping system and LVZ were defined as areas of bipolar voltage <0.5mV.
Results
LVZ were present in 47 patients (23 in SR). The area of LVZ was 14.6cm2 (5.3–34.0). For patients in AF at the time of CMR only elevated minimal and maximal LAVi (p=0.001 and p=0.002 respectively) but no LA functional parameter was predictive for the occurrence of LVZ. In contrast for patients in SR all LA phasic volumes (endsystolic, pre atrial contraction and enddiastolic LAVi) and LA function parameters (passive, active and total ejection fraction (EF), reservoir, conduit and booster pump strains and strain rates) were predictive for the occurrence of LVZ. After clustered and pooled multivariate logistic regression only impaired booster pump strain rate was still predictive for occurrence of LVZ (OR 0.974, 95% CI 0.950–0.998, p=0.036).
In addition Pearson correlation analysis revealed a strong link between LA booster pump functional parameters and cm2 expansion of LVZ areas: LA active EF, LA booster pump strain and SR (r=−0.42, p=0.044; r=−0.47, p=0.024; r=−0.65, p=0.001 [Figure 1C] respectively).
Conclusion
For patients in SR LA transport function is closely linked to the occurrence of LA LVZ and outperforms LA volumetric measurements for the prediction of LA LVZ.
Furthermore LA booster pump function parameters show robust correlation to the extension of LA LVZ.
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Affiliation(s)
- R Schoenbauer
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - J Tomala
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - B Kirstein
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - Y Huo
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - T Gaspar
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - U Richter
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - J Piorkowski
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | | | - L Fiedler
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - F X Roithinger
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Ulbrich
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
| | - C Piorkowski
- Dresden University of Technology, Department of Cardiology, Division of Cardiac Electrophysiology, Dresden, Germany
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10
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Wechselberger S, Kronborg M, Huo Y, Piorkowski J, Neudeck S, Päßler E, El-Armouche A, Richter U, Mayer J, Ulbrich S, Pu L, Kirstein B, Gaspar T, Piorkowski C. Continuous monitoring after atrial fibrillation ablation: the LINQ AF study. Europace 2019; 20:f312-f320. [PMID: 29688326 PMCID: PMC6277150 DOI: 10.1093/europace/euy038] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 10/13/2017] [Accepted: 02/19/2018] [Indexed: 01/27/2023] Open
Abstract
Aims To study device performance, arrhythmia recurrence characteristics, and methods of outcome assessment using a novel implantable cardiac monitor (ICM) in patients undergoing ablation for atrial fibrillation (AF). Methods and results In 419 consecutive patients undergoing first-time catheter ablation for symptomatic paroxysmal (n = 224) or persistent (n = 195) AF an ICM was injected at the end of the procedure. Telemedicine staff ensured full episode transmission coverage and manually evaluated all automatic arrhythmia episodes. Device detection metrics were calculated for ≥2, ≥6, and ≥10 min AF detection durations. Four methods of outcome assessment were studied: continuous recurrence analysis, discontinuous recurrence analysis, AF-burden analysis, and analysis of individual rhythm profiles. A total of 43 673 automatic AF episodes were transmitted over a follow-up of 15 ± 6 months. Episode-based positive predictive values changed significantly with longer AF detection durations (70.5% for ≥2 min, 81.8% for ≥6 min, and 85.9% for ≥10 min). Patients with exclusive short episode recurrences (≥2 to <6 min) were rare and their arrhythmia detection was clinically irrelevant. Different methods of outcome assessment showed a large variation (46–79%) in ablation success. Individual rhythm characteristics and subclinical AF added to this inconsistency. Analysis of AF-burden and individual rhythm profiles were least influenced and showed successful treatment in 60–70% of the patients. Conclusion We suggest AF detection duration >6 min and AF burden >0.1% as a standardized outcome definition for AF studies to come in the future.
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Affiliation(s)
- Simon Wechselberger
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Mads Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yan Huo
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Judith Piorkowski
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Sebastian Neudeck
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Ellen Päßler
- Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, University of Technology Dresden, Dresden, Germany
| | - Utz Richter
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Stefan Ulbrich
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Liying Pu
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Bettina Kirstein
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, Heart Center, University of Technology Dresden, Fetscherstrasse 76, Dresden, Germany
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11
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Schoenbauer R, Tomala J, Kirstein B, Huo Y, Gaspar T, Richter U, Piorkowski J, Schoenbauer MS, Fiedler L, Roithinger FX, Hengstenberg C, Mascherbauer J, Ulbrich S, Piorkowski C. 227Correlation of left atrial transport function and bipolar voltage maps in patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez113] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Schoenbauer
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - J Tomala
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - B Kirstein
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - Y Huo
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - T Gaspar
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - U Richter
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - J Piorkowski
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | | | - L Fiedler
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - F X Roithinger
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - S Ulbrich
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
| | - C Piorkowski
- University of Technology, Heart Center, Cardiac Electrophysiology, Dresden, Germany
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12
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Piorkowski C, Kronborg M, Hourdain J, Piorkowski J, Kirstein B, Neudeck S, Wechselberger S, Päßler E, Löwen A, El-Armouche A, Mayer J, Ulbrich S, Pu L, Richter U, Gaspar T, Huo Y. Endo-/Epicardial Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e005748. [DOI: 10.1161/circep.117.005748] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Mads Kronborg
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Jerome Hourdain
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Judith Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Bettina Kirstein
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Sebastian Neudeck
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Simon Wechselberger
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ellen Päßler
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Anastasia Löwen
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ali El-Armouche
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Julia Mayer
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Stefan Ulbrich
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Liying Pu
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Utz Richter
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Thomas Gaspar
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Yan Huo
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
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13
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Persky V, Coover L, Hernandez E, Contreras A, Slezak J, Piorkowski J, Curtis L, Turyk M, Ramakrishnan V, Scheff P. Chicago community-based asthma intervention trial: feasibility of delivering peer education in an inner-city population. Chest 1999; 116:216S-223S. [PMID: 10532497 DOI: 10.1378/chest.116.suppl_2.216s] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The most effective means of educating children with asthma and their families has not been clearly demonstrated in previous studies. Peer education is uniquely suited to the complex problems encountered in underserved populations. The purpose of this study was to show the feasibility of delivering a peer education program for children with asthma and the effect of the program on indoor allergen levels in an inner-city population in Chicago. Overall, the program was well received. Baseline allergen levels were consistent with some previous studies in showing low levels of mite allergens and high levels of cockroach allergens, with 79.6% of samples having levels > 8 U/g. A total of 28.2% of samples had cat allergen levels > 2 microg/g, although only 9.7% of homes had cats, confirming previous reports that cat allergen is ubiquitous. Mold levels were seasonal, with the highest levels in the summer. Results from this study suggest that intervention programs should focus more on elimination of cockroaches than was previously appreciated, while minimizing the use of pesticides, and on identification of the sources of cat allergen. Structural and psychosocial issues in homes need to be addressed in future studies. This study has demonstrated the feasibility of delivering peer education in a inner-city population and highlighted the need for comprehensive intervention strategies addressing complex issues facing underserved neighborhoods.
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Affiliation(s)
- V Persky
- Epidemiology and Biostatistics Division of the School Public Health, University of Illinois at Chicago, 60612, USA
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14
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Persky VW, Slezak J, Contreras A, Becker L, Hernandez E, Ramakrishnan V, Piorkowski J. Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children. Ann Allergy Asthma Immunol 1998; 81:266-71. [PMID: 9759806 DOI: 10.1016/s1081-1206(10)62824-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Asthma mortality rates in Chicago are among the highest in the United States, with substantially greater rates in poor and minority populations. How much of the differential can be attributed to differences in prevalence versus severity or access to care has not been determined. OBJECTIVE To examine rates of asthma prevalence, severity, and symptoms and to explore the relationships of these rates to race and socioeconomic status in a random sample of Chicago school children. METHODS Self-administered survey. RESULTS Overall, rates of asthma were higher than previously reported, with 16% of students in the stratified cluster random sample of 3,670 children in the 7th and 8th grades having had asthma. Prevalence rates were significantly higher in schools with >98% African Americans than in other schools, with the highest prevalence rates seen in African American schools in low income neighborhoods. Rates were associated with the percent of African American children in the school and with median income of the school's census tract. Relationships were most consistent with indices of more severe disease. CONCLUSIONS Asthma prevalence is higher than previously noted, with rates greatest in minority and low income populations. Differences are more striking for measures of severity than for symptoms of wheezing, but are far less than previously reported differences in mortality, suggesting that additional factors, such as differential access to continuous health care, may be affecting high death rates from asthma in Chicago.
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Affiliation(s)
- V W Persky
- Epidemiology/Biostatistics Program, University of Illinois at Chicago, School of Public Health, Erie Family Health Center, 60612-7260 USA
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