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Gunawardene MA, Harloff T, Jularic M, Dickow J, Wahedi R, Anwar O, Wohlmuth P, Gessler N, Hartmann J, Willems S. Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping. Europace 2024; 26:euae072. [PMID: 38513110 PMCID: PMC11034699 DOI: 10.1093/europace/euae072] [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: 01/20/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT. METHODS AND RESULTS Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473]. CONCLUSION Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Peter Wohlmuth
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
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Wahedi R, Willems S, Feldhege J, Jularic M, Hartmann J, Anwar O, Dickow J, Harloff T, Gessler N, Gunawardene MA. Pulsed-field versus cryoballoon ablation for atrial fibrillation-Impact of energy source on sedation and analgesia requirement. J Cardiovasc Electrophysiol 2024; 35:162-170. [PMID: 38009545 DOI: 10.1111/jce.16141] [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: 07/27/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. METHODS Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB-PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation-associated complications. RESULTS A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p < .0001)]. Sedation-associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p > .99). Nonsedation-associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. CONCLUSIONS PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation.
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Affiliation(s)
- Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | | | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
- Asklepios Proresearch, Hamburg, Germany
| | - Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
- Semmelweis University, Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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Gunawardene MA, Frommeyer G, Ellermann C, Jularic M, Leitz P, Hartmann J, Lange PS, Anwar O, Rath B, Wahedi R, Eckardt L, Willems S. Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation. J Clin Med 2023; 12:6304. [PMID: 37834948 PMCID: PMC10573684 DOI: 10.3390/jcm12196304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. OBJECTIVE This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. METHODS Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. RESULTS In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62-95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. CONCLUSION LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option.
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Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 10178 Berlin, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Christian Ellermann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Patrick Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Philipp Sebastian Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 10178 Berlin, Germany
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Maurer T, Flindt M, Jularic M, Lemes C, Akbulak-Stegli RÖ, Gunawardene MA, Hartmann J, Eickholt C, Willems S, Schäffer B. A novel wide-band dielectric imaging system to guide radiofrequency ablation for pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:2467-2472. [PMID: 36217995 DOI: 10.1111/jce.15705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Recently, the wide-band dielectric mapping system Kodex-EPD was introduced. This study reports the first clinical experience using a novel system to guide pulmonary vein isolation (PVI) with radiofrequency (RF) ablation. METHODS AND RESULTS: The study included 20 consecutive patients undergoing de-novo PVI for symptomatic paroxysmal or persistent atrial fibrillation guided by Kodex-EPD. The primary efficacy endpoint was successful PVI. Secondary endpoints included procedural parameters and complications. In all 20 patients (mean age 68 ± 8 years, 12 male patients, paroxysmal fibrillation in 14/20 [70%] patients), PVI was successfully completed. One patient underwent additional cavo-tricuspid isthmus ablation for concomitant typical atrial flutter and one patient required additional ablation of a focal atrial tachycardia. A conventional three-dimensional image of the left atrium as well as the innovative endocardial panoramic view were used to guide catheter manipulation and ablation. Median procedure time was 115 [1st; 3rd quartile 93,75; 140] min and median total fluoroscopy time was 9.9 [9.7; 11.2] min, of which a median of 0.8 [0.6; 0.9] min was required to create left atrial maps. Complete left atrial imaging using Kodex-EPD was achieved within a median of 7.1 [5.7; 8.3] min. Median RF ablation time was 45.1 [34.6; 58.7] min. No major complications were observed. CONCLUSION RF ablation PVI guided by Kodex-EPD seems safe and feasible. The system provides effective three-dimensional guidance for PVI.
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Affiliation(s)
- Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Max Flindt
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | - Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Benjamin Schäffer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Akbulak RÖ, Hedenus K, Wahedi R, Anwar O, Gessler N, Hartmann J, Willems S. Pulsed field ablation in patients with complex consecutive atrial tachycardia in conjunction with ultra-high density mapping: Proof of concept. J Cardiovasc Electrophysiol 2022; 33:2431-2443. [PMID: 36259717 DOI: 10.1111/jce.15713] [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: 06/27/2022] [Revised: 08/19/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Catheter-ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel nonthermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT. This study sought to investigate PFA of consecutive LAT following prior CA of AF. METHODS Consecutive patients with LAT underwent ultrahigh-density (UHDx) mapping. Subsequent to identification of the AT mechanism, PFA was performed at the assumed critical sites for LAT maintenance. Continuous ablation lines were performed if required and evaluated with pre- and post-PFA HDx-mapping. RESULTS Fifteen patients (age 70 ± 10, male 73%) who underwent 3.6 ± 2 prior AF-CA procedures were included. The total mean procedure and fluoroscopy times were 141 ± 43 and 18 ± 10 min, respectively. All 19 of 19 (100%) LAT were successfully ablated with PFA. Two AT located at the right atria required RF-ablation. LAT were identified as localized reentry (n = 1) and macro-reentry LAT (n = 18) and targeted with PFA. All LAT terminated with PFA either to sinus rhythm (9/15) or a secondary AT (6/15 and subsequently to SR); 63% (12/19) terminated with the first PFA-application. All lines (13 roof, 11 anterior, 1 mitral) were blocked. LA-posterior-wall isolation (LAPWI) was successfully achieved when performed (10/10). AF/AT free survival was 80% (12/15) after 153 [88-207] days of follow-up. No procedure-related complications occurred. CONCLUSION PFA of consecutive LAT is feasible and safe. Successful creation of ablation lines and LAPWI can be achieved in a short time. PFA may offer the opportunity for effective ablation of atrial arrhythmias beyond AF.
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Affiliation(s)
- Melanie A Gunawardene
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Katja Hedenus
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Rahin Wahedi
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
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Wahedi R, Willems S, Jularic M, Hartmann J, Schaeffer B, Akbulak-Stegli Ö, Eickholt C, Anwar O, Maurer T, Hedenus K, Gunawardene M. Safety and efficacy of catheter ablation for atrial fibrillation in the very elderly. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.459] [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: 11/12/2022] Open
Abstract
Abstract
Background
The incidence and prevalence of atrial fibrillation (AF) increases with age. With an ageing general population, a 2.3-fold rise in AF prevalence is expected. Catheter ablation has emerged as an effective treatment option for rhythm control therapy. However, very elderly patients (≥80 years old) have been excluded in landmark clinical trials. Current data regarding the safety and efficacy of catheter ablation in the very elderly is therefore sparse.
Purpose
Due to the growing demand to manage AF in an increasingly ageing population, we investigated the safety and efficacy of catheter ablation in this particular patient population.
Methods
Patients with symptomatic paroxysmal, persistent and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency, cryoballoon and pulsed field ablation as energy sources. Re-ablation procedures included re-PVI and consecutive atrial tachycardia ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Endpoints included acute procedural success (complete isolation of pulmonary veins and/or non-inducibility in the case of atrial tachycardia), major complications and early arrhythmia-recurrence.
Results
A total of eighty-eight patients (mean age 83.1±1.9 years, mean CHA2DS2-VASc-Score 4.4±1, mean left ventricular ejection fraction 56.7±7%, direct oral anticoagulation 92.1%, vitamin-K antagonists 7.9%) were included from January 2021 to October 2021. Fifty cases (56.8%) involved PVI as an index procedure (radiofrequency 58%, n=29/50, cryoballoon 36%, n=18/50, pulsed field ablation 6%, n=3/50). Thirty-eight procedures (43.2%) involved re-ablation procedures (Re-PVI 60.5%, n=23/38, linear lesions 65.8%, n=25/38, atrial tachycardia ablation 26.3%, n=10/38 and ablation of CFAE 15.8%, n=6/38). Acute procedural success was achieved in 87/88 patients (98.9%). Major complications included stroke (n=1/88, 1.1%), pericardial tamponade (n=1/88, 1.1%) and bradycardia with subsequent pacemaker implantation (n=3/88, 3.4%). No further major complications were documented. In 13/88 patients (14.8%) early arrhythmia-recurrence occurred (38.5%, n=5/13 after the index procedure and 61.5%, n=8/13 after re-ablation) during the 90-day blanking period.
Conclusions
Catheter ablation for atrial fibrillation in the very elderly shows favourable acute success and low complication rates. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Wahedi
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - S Willems
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - M Jularic
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - J Hartmann
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - B Schaeffer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | | | - C Eickholt
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - O Anwar
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - T Maurer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - K Hedenus
- Asklepios St. Georg Clinic , Hamburg , Germany
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Maurer T, Akbulak RÖ, Flindt M, Anwar O, Pape UF, Maasberg S, Gessler N, Hartmann J, Willems S. Pulsed-field ablation combined with ultrahigh-density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations. J Cardiovasc Electrophysiol 2022; 33:345-356. [PMID: 34978360 DOI: 10.1111/jce.15349] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulsed-field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited. OBJECTIVE This study sought to investigate PFA lesion creation with ultrahigh-density (UHDx) mapping. METHODS Consecutive AF patients underwent PFA-based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA-lesions and decrease of LA-voltage were assessed with pre- and post PFA UHDx-mapping (Orion™ catheter and Rhythmia™ 3D-mapping system, Boston Scientific). RESULTS In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx-mapping subsequent to PVI revealed early PV-reconnection in five case (5/80, 6.25%). Gaps were located at the anterior-superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p < .0001) with almost no complex electrogram-fractionation at the lesion border zones. PFA-catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites. CONCLUSION For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tilman Maurer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Max Flindt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ulrich F Pape
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Sebastian Maasberg
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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8
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Maurer T, Akbulak RÖ, Flindt M, Anwar O, Hartmann J, Willems S. Coronary Spasm During Pulsed Field Ablation of the Mitral Isthmus Line. JACC Clin Electrophysiol 2021; 7:1618-1620. [PMID: 34600850 DOI: 10.1016/j.jacep.2021.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022]
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9
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Hartmann J, Gunawardene M, Jularic M, Eickholt C, Willems S. Management des Vorhofflimmerns: Prognoseverbesserung nach Pulmonalvenenisolation? Aktuelle Kardiologie 2021. [DOI: 10.1055/a-1479-2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungVorhofflimmern ist die weltweit häufigste, anhaltende Herzrhythmusstörung. Trotz des
Fortschritts und der Innovationen im Management der betroffenen Patienten bleibt
Vorhofflimmern mit einer signifikanten Morbidität und Mortalität, bedingt durch das Auftreten
von unter anderem thrombembolischen Ereignissen, Herzinsuffizienz, kardiovaskulären
Ereignissen und plötzlichem Herztod, vergesellschaftet. Es konnte kürzlich gezeigt werden,
dass eine frühzeitige rhythmuserhaltende Therapie das Risiko für einen Tod durch
kardiovaskuläre Ursache, Schlaganfälle und Hospitalisierungen aufgrund von Herzinsuffizienz
reduzieren kann. Die Katheterablation von Vorhofflimmern ist zwar effektiver in der
Wiederherstellung und Erhaltung von Sinusrhythmus als eine medikamentöse Therapie, aber
lediglich in spezifischen Patientengruppen, die von Herzinsuffizienz und Vorhofflimmern
betroffen sind, konnte die Ablationsbehandlung mit einer Reduktion der Gesamtmortalität und von
Hospitalisierungen assoziiert werden.
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Affiliation(s)
- Jens Hartmann
- Asklepios Klinik St. Georg, Kardiologie und internistische Intensivmedizin, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Partnereinrichtungen Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
- ASKLEPIOS proresearch - Klinische Forschung und Entwicklung, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
| | - Melanie Gunawardene
- Asklepios Klinik St. Georg, Kardiologie und internistische Intensivmedizin, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Partnereinrichtungen Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
- ASKLEPIOS proresearch - Klinische Forschung und Entwicklung, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
| | - Mario Jularic
- Asklepios Klinik St. Georg, Kardiologie und internistische Intensivmedizin, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Partnereinrichtungen Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
- ASKLEPIOS proresearch - Klinische Forschung und Entwicklung, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
| | - Christian Eickholt
- Asklepios Klinik St. Georg, Kardiologie und internistische Intensivmedizin, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Partnereinrichtungen Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
- ASKLEPIOS proresearch - Klinische Forschung und Entwicklung, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
| | - Stephan Willems
- Asklepios Klinik St. Georg, Kardiologie und internistische Intensivmedizin, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Partnereinrichtungen Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
- ASKLEPIOS proresearch - Klinische Forschung und Entwicklung, Asklepios Kliniken Hamburg GmbH, Hamburg, Germany
- Semmelweis Universität, Budapest, Hungary
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10
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Gunawardene M, Münkler P, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Dinshaw L, Jungen C, Moser JM, Merbold L, Willems S, Meyer C. A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements. Europace 2020; 21:i34-i42. [PMID: 30801126 DOI: 10.1093/europace/euy273] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/10/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS A novel measure of local impedance (LI) has been found to predict lesion formation during radiofrequency current (RFC) catheter ablation. The aim of this study was to investigate the utility of this novel approach, while comparing LI to the well-established generator impedance (GI). METHODS AND RESULTS In 25 consecutive patients with a history of atrial fibrillation, catheter ablation was guided by a 3D-mapping system measuring LI in addition to GI via an ablation catheter tip with three incorporated mini-electrodes. Local impedance and GI before and during RFC applications were studied. In total, 381 RFC applications were analysed. The baseline LI was higher in high-voltage areas (>0.5 mV; LI: 110.5 ± 13.7 Ω) when compared with intermediate-voltage sites (0.1-0.5 mV; 90.9 ± 10.1 Ω, P < 0.001), low-voltage areas (<0.1 mV; 91.9 ± 16.4 Ω, P < 0.001), and blood pool LI (91.9 ± 9.9 Ω, P < 0.001). During ablation, mean LI drop (△LI; 13.1 ± 9.1 Ω) was 2.15 times higher as mean GI drop (△GI) (6.1 ± 4.2 Ω, P < 0.001). Baseline LI correlated with △LI: a mean LI of 99.9 Ω predicted a △LI of 12.9 Ω [95% confidence interval (12.1-13.6), R2 0.41; P < 0.001]. This relationship was weak for baseline GI predicting △GI (R2 0.06, P < 0.001). Catheter movements were represented by rapid LI changes. The duration of an RFC application was not predictive for catheter-tissue coupling with no further change of △LI (P = 0.247) nor △GI (P = 0.376) during prolonged ablation. CONCLUSION Local impedance can be monitored during ablation. Compared with the sole use of GI, baseline LI is a better predictor of impedance drops during ablation and may provide useful insights regarding lesion formation. However, further studies are needed to investigate if this novel approach is useful to guide catheter ablation.
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Affiliation(s)
- Melanie Gunawardene
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Julia M Moser
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | | | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
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11
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Jungen C, Akbulak R, Kahle A, Eickholt C, Schaeffer B, Dinshaw L, Schleberger R, Nies M, Gunawardene M, Muenkler P, Klatt N, Hartmann J, Jularic M, Willems S, Meyer C. Outcome after practical isthmus ablation of scar-related atrial tachycardia guided by high-density mapping. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0427] [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: 11/12/2022] Open
Abstract
Abstract
Background
High-density mapping (HDM) has been found to precisely identify the practical isthmus of scar-related atrial tachycardia (AT) circuits. Since practical isthmuses have been found to be shorter than the usual anatomical isthmuses targeted ablation has been proposed. However, outcome data are sparse. Here we describe HDM-guided catheter ablation by targeting the practical isthmus in patients with scar-related ATs.
Methods and results
In 250 consecutive patients with scar-related ATs HDM-guided catheter ablation with the support of a 64-electrode mini-basket catheter has been performed. Most patients underwent a prior catheter ablation (98%) while 13% had a prior cardiac valve surgery and 6% an underlying congenital heart disease. A total of 355 ATs occurred in the index procedure, of which 64% had a macro-, 26% a micro-reentry and 10% a focal mechanism. The ATs had a mean cycle length of 304±4.3 ms and in 237 patients (95%) an acute termination into sinus rhythm was achieved. They were mainly located in the left atrium (72%) but also in the right atrium (25%), bi-atrially (5%) or in the CS (3%) (see figure). Targeting the practical isthmus revealed arrhythmia freedom in 53% of patients after a single procedure during a mid-term follow-up (median 489 days, range 95–1407 days). Freedom from any arrhythmia could be achieved in 74% of patients after multiple procedures and in 93% of patients after multiple procedures and optimal clinical therapy, including pharmaceutical or electrical cardioversion.
Conclusions
HDM-guided catheter ablation of the practical isthmus in patients with scar-related ATs leads to a high acute success rate. Nevertheless, multiple procedures are necessary in a relevant number of patients resulting in a low recurrence rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Akbulak
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Kahle
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - C Eickholt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - L Dinshaw
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Schleberger
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Nies
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Gunawardene
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - J Hartmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - M Jularic
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
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12
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Jungen C, Akbulak R, Kahle AK, Eickholt C, Schaeffer B, Scherschel K, Dinshaw L, Muenkler P, Schleberger R, Nies M, Gunawardene MA, Klatt N, Hartmann J, Merbold L, Jularic M, Willems S, Meyer C. Outcome after tailored catheter ablation of atrial tachycardia using ultra-high-density mapping. J Cardiovasc Electrophysiol 2020; 31:2645-2652. [PMID: 32748442 DOI: 10.1111/jce.14703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/06/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Tailored catheter ablation of atrial tachycardias (ATs) is increasingly recommended as a potentially easy treatment strategy in the era of high-density mapping (HDM). As follow-up data are sparse, we here report outcomes after HDM-guided ablation of ATs in patients with prior catheter ablation or cardiac surgery. METHODS AND RESULTS In 250 consecutive patients (age 66.5 ± 0.7 years, 58% male) with ATs (98% prior catheter ablation, 13% prior cardiac surgery) an HDM-guided catheter ablation was performed with the support of a 64-electrode mini-basket catheter. A total of 354 ATs (1.4 ± 0.1 ATs per patient; mean cycle length 304 ± 4.3 ms; 64% macroreentry, 27% localized reentry, and 9% focal) with acute termination of 95% were targeted in the index procedure. A similar AT as in the index procedure recurred in five patients (2%) after a median follow-up time of 535 days (interquartile range (IQR) 25th-75th percentile: 217-841). Tailored ablation of reentry ATs with freedom from any arrhythmia was obtained in 53% after a single procedure and in 73% after 1.4 ± 0.4 ablation procedures (range: 1-4). A total of 228 patients (91%) were free from any arrhythmia recurrence after 210 days (IQR: 152-494) when including optimal usual care. CONCLUSIONS Tailored catheter ablation of ATs guided by HDM has a high acute success rate. The recurrence rate of the index AT is low. In patients with extensive atrial scaring further ablation procedures need to be considered to achieve freedom from any arrhythmia.
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Affiliation(s)
- Christiane Jungen
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ruken Akbulak
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Benjamin Schaeffer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Katharina Scherschel
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Leon Dinshaw
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Paula Muenkler
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Ruben Schleberger
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Moritz Nies
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | | | - Niklas Klatt
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Willems
- German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian Meyer
- Clinic for Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Division of Cardiology, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany.,Institute of Neuronal and Sensory Physiology, Cardiac Neuro- and Electrophysiology Research Consortium, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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13
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Schleberger R, Jularic M, Salzbrunn T, Hacke C, Schwarzl JM, Hoffmann BA, Steven D, Willems S, Lemoine MD, Meyer C. Outcome of catheter ablation of non-reentrant ventricular arrhythmias in patients with and without structural heart disease. Eur J Med Res 2020; 25:4. [PMID: 32183887 PMCID: PMC7076989 DOI: 10.1186/s40001-020-0400-y] [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: 11/10/2019] [Accepted: 01/13/2020] [Indexed: 12/24/2022] Open
Abstract
Background Catheter ablation of non-reentrant, commonly termed “idiopathic” ventricular arrhythmias (VA) is highly effective in patients without structural heart disease (SHD). Meanwhile, the outcome of catheter ablation of these arrhythmias in patients with SHD remains unclear. This study sought to characterize the outcome of patients with and without SHD undergoing catheter ablation of non-reentrant VA. Methods In this single-centre study the acute and long-term outcome of 266 consecutive patients undergoing catheter ablation of non-reentrant VA was investigated. In 41.0% of patients a SHD was present (n = 109, 80.7% male, age 59.1 ± 14.7 years), 59.0% had no SHD (n = 157; 44.0% male, age 49.9 ± 16.5 years). Results Acute procedural success (absence of spontaneous or provoked VA at the end of procedure and within 48 h after the procedure) was achieved in 89.9% of patients with SHD vs. 94.3% without SHD (p = 0.238). During a mean follow-up of 34.7 ± 15.1 months a repeat catheter ablation was performed in 19.6% of patients with SHD vs. 13.0% without SHD (p = 0.179). Patients with dilated cardiomyopathy (DCM) were the most likely to require a repeat ablation procedure (32.0% of patients with DCM vs. 13.0% without SHD; p = 0.022). Periprocedural complications occurred in 5.5% of patients with SHD vs. 5.7% without SHD (p > 0.999). All complications were managed without sequelae. Conclusions The outcome of catheter ablation of non-reentrant VA in patients with SHD appears good and is comparable to patients without SHD. A slightly higher rate of repeat ablations was observed in patients with DCM.
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Affiliation(s)
- Ruben Schleberger
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Tim Salzbrunn
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claudia Hacke
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jana M Schwarzl
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Boris A Hoffmann
- Department of Electrophysiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Daniel Steven
- Department of Electrophysiology, University Heart Center Cologne, University Hospital Cologne, Kerpener Str. 52, 50937, Cologne, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Marc D Lemoine
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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14
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Gunawardene MA, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Schlüter M, Meyer C, Willems S, Schaeffer B. Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current. J Cardiovasc Electrophysiol 2020; 31:1051-1061. [DOI: 10.1111/jce.14413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/06/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Ruken Ö. Akbulak
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | | | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LübeckBerlin Germany
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Benjamin Schaeffer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
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15
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Jungen C, Alken FA, Eickholt C, Scherschel K, Kuklik P, Klatt N, Schwarzl J, Moser J, Jularic M, Akbulak RO, Schaeffer B, Willems S, Meyer C. Respiratory sinus arrhythmia is reduced after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Arch Med Sci 2020; 16:1022-1030. [PMID: 32863990 PMCID: PMC7444695 DOI: 10.5114/aoms.2019.83883] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/11/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Respiratory sinus arrhythmia (RSA) describes heart rate (HR) changes in synchrony with respiration. It is relevant for exercise capacity and mechanistically linked with the cardiac autonomic nervous system. After pulmonary vein isolation (PVI), the current therapy of choice for patients with paroxysmal atrial fibrillation (AF), the cardiac vagal tone is often diminished. We hypothesized that RSA is modulated by PVI in patients with paroxysmal AF. MATERIAL AND METHODS Respiratory sinus arrhythmia, measured by using a deep breathing test and heart rate variability parameters, was studied in 10 patients (64 ±3 years) with paroxysmal AF presenting in stable sinus rhythm for their first catheter-based PVI. Additionally, heart rate dynamics before and after PVI were studied during sympathetic/parasympathetic coactivation by using a cold-face test. All tests were performed within 24 h before and 48 h after PVI. RESULTS After PVI RSA (E/I difference: 7.9 ±1.0 vs. 3.5 ±0.6 bpm, p = 0.006; E/I ratio: 1.14 ±0.02 vs. 1.05 ±0.01, p = 0.003), heart rate variability (SDNN: 31 ±3 vs. 14 ±3 ms, p = 0.006; RMSSD: 17 ±2 vs. 8 ±2 ms, p = 0.002) and the HR response to sympathetic/parasympathetic coactivation (10.2 ±0.7% vs. 5.7 ±1.1%, p = 0.014) were diminished. The PVI-related changes in RSA correlated with the heart rate change during sympathetic/parasympathetic coactivation before vs. after PVI (E/I difference: r = 0.849, p = 0.002; E/I ratio: r = 0.786, p = 0.007). One patient with vagal driven arrhythmia experienced AF recurrence during follow-up (mean: 6.5 ±0.6 months). CONCLUSIONS Respiratory sinus arrhythmia is reduced after PVI in patients with paroxysmal AF. Our findings suggest that this is related to a decrease in cardiac vagal tone. Whether and how this affects the clinical outcome including exercise capacity need to be determined.
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Affiliation(s)
- Christiane Jungen
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fares-Alexander Alken
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Schwarzl
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Schaeffer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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16
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Münkler P, Gunawardene MA, Jungen C, Klatt N, Schwarzl JM, Akbulak RÖ, Dinshaw L, Hartmann J, Jularic M, Kahle AK, Riedel R, Merbold L, Eickholt C, Willems S, Meyer C. Local impedance guides catheter ablation in patients with ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 31:61-69. [PMID: 31701589 DOI: 10.1111/jce.14269] [Citation(s) in RCA: 20] [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: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
AIMS Catheter contact and local tissue characteristics are relevant information for successful radiofrequency current (RFC)-ablation. Local impedance (LI) has been shown to reflect tissue characteristics and lesion formation during RFC-ablation. Using a novel ablation catheter incorporating three mini-electrodes, we investigated LI in relation to generator impedance (GI) in patients with ventricular tachycardia (VT) and its applicability as an indicator of effective RFC-ablation. METHODS AND RESULTS Baseline impedance, Δimpedance during ablation and drop rate (Δimpedance/time) were analyzed for 625 RFC-applications in 28 patients with recurrent VT undergoing RFC-ablation. LI was lower in scarred (87.0 Ω [79.0-95.0]) compared to healthy myocardium (97.5 Ω ([82.75-111.50]; P = .03) while GI did not differ between scarred and healthy myocardium. ΔLI was higher (18 Ω [9.4-26.0]) for VT-terminating as compared to non-terminating RFC-ablation (ΔLI 13 Ω [8.85-18.0]; P = .03), but did not differ for ΔGI between terminating vs nonterminating RFC-ablation. Correspondingly, LI drop rate was higher for RFC-ablation terminating the VT compared with RFC-ablation not terminating the VT (0.63 Ω/s [0.52-0.76] vs 0.32 Ω [0.20-0.58]; P = .008) while there was no difference for GI drop rate. ΔLI was higher in patients with nonischemic cardiomyopathy vs patients with ischemic cardiomyopathy (16 Ω [11.0-20.0] vs 11.0 Ω [7.85-17.00]; P = .003). CONCLUSION Our findings suggest that LI is a sensitive parameter to guide RFC-ablation in patients with VT. LI indicates differences in tissue characteristics and generally is higher in patients with nonischemic cardiomyopathy. Hence, the etiology of the underlying cardiomyopathy needs to be considered when adopting LI for monitoring catheter ablation of VT.
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Affiliation(s)
- Paula Münkler
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Melanie A Gunawardene
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Niklas Klatt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - René Riedel
- Max Planck Institute for Evolutionary Biology, Plön, Germany
| | | | - Christian Eickholt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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17
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Alken FA, Klatt N, Muenkler P, Scherschel K, Jungen C, Akbulak RO, Kahle AK, Gunawardene M, Jularic M, Dinshaw L, Hartmann J, Eickholt C, Willems S, Stute F, Mueller G, Blankenberg S, Rickers C, Sinning C, Zengin-Sahm E, Meyer C. Advanced mapping strategies for ablation therapy in adults with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S247-S263. [PMID: 31737533 DOI: 10.21037/cdt.2019.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Ultra-high density mapping (HDM) is a promising tool in the treatment of patients with complex arrhythmias. In adults with congenital heart disease (CHD), rhythm disorders are among the most common complications but catheter ablation can be challenging due to heterogenous anatomy and complex arrhythmogenic substrates. Here, we describe our initial experience using HDM in conjunction with novel automated annotation algorithms in patients with moderate to great CHD complexity. Methods We studied a series of consecutive adult patients with moderate to great CHD complexity and an indication for catheter ablation due to symptomatic arrhythmia. HDM was conducted using the Rhythmia™ mapping system and a 64-electrode mini-basket catheter for identification of anatomy, voltage, activation pattern and critical areas of arrhythmia for ablation guidance. To investigate novel advanced mapping strategies, postprocedural signal processing using the Lumipoint™ software was applied. Results In 19 patients (53±3 years; 53% male), 21 consecutive ablation procedures were conducted. Procedures included ablation of atrial fibrillation (n=7; 33%), atrial tachycardia (n=11; 52%), atrioventricular accessory pathway (n=1; 5%), the atrioventricular node (n=1; 5%) and ventricular arrhythmias (n=4; 19%). A total of 23 supraventricular and 8 ventricular arrhythmias were studied with the generation of 56 complete high density maps (atrial n=43; ventricular n=11, coronary sinus n=2) and an average of 12,043±1,679 mapping points. Multiple arrhythmias were observed in n=7 procedures (33% of procedures; range of arrhythmias detected 2-4). A total range of 1-4 critical areas were defined per procedure and treated within a radiofrequency application time of 16 (interquartile range 12-45) minutes. Postprocedural signal processing using Lumipoint™ allowed rapid annotation of fractionated signals within specific windows of interest. This supported identification of a practical critical isthmus in 20 out of 27 completed atrial and ventricular tachycardia activation maps. Conclusions Our findings suggest that HDM in conjunction with novel automated annotation algorithms provides detailed insights into arrhythmia mechanisms and might facilitate tailored catheter ablation in patients with moderate to great CHD complexity.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Paula Muenkler
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Melanie Gunawardene
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Fridrike Stute
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Goetz Mueller
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Carsten Rickers
- Department of Pediatric Cardiology/Pediatric Cardiac Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,Adults with Congenital Heart Disease Section, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Elvin Zengin-Sahm
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cNEP, Cardiac Neuro- and Electrophysiology Research Group, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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18
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Dinshaw L, Lemoine M, Hartmann J, Schaeffer B, Klatt N, Jularic M, Gunarwadene M, Muenkler P, Tam A, Eickholt C, Willems S, Patten M, Meyer C. P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0627] [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 common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain.
Purpose
The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems.
Methods
A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices.
Results
Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003).
Conclusion
Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.
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Affiliation(s)
- L Dinshaw
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Lemoine
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Gunarwadene
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - A Tam
- University Heart Center Hamburg, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Patten
- University Heart Center Hamburg, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
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19
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Schaeffer B, Akbulak RÖ, Jularic M, Moser J, Eickholt C, Schwarzl JM, Klatt N, Kuklik P, Meyer C, Willems S. High-Density Mapping and Ablation of Primary Nonfocal Left Atrial Tachycardia. JACC Clin Electrophysiol 2019; 5:417-426. [DOI: 10.1016/j.jacep.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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20
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Dinshaw L, Schäffer B, Akbulak Ö, Jularic M, Hartmann J, Klatt N, Dickow J, Gunawardene M, Münkler P, Hakmi S, Pecha S, Sultan A, Lüker J, Pinnschmidt H, Hoffmann B, Gosau N, Eickholt C, Willems S, Steven D, Meyer C. Long-term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads. J Cardiovasc Electrophysiol 2019; 30:679-687. [PMID: 30821012 DOI: 10.1111/jce.13890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Long-term efficacy and safety are uncertain in patients with cardiac implantable electronic devices (CIED) and transvenous leads (TVL) undergoing radiofrequency catheter ablation of atrial fibrillation (AF). Thus, we assessed the outcome of AF ablation in those patients during long-term follow-up using continuous atrial rhythm monitoring (CARM). METHODS AND RESULTS A total of 190 patients (71.3 ± 10.7 years; 108 (56.8% men) were included in this study. At index procedure 81 (42.6%) patients presented with paroxysmal AF and 109 (57.4%) with persistent AF. The ablation strategy included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines, if appropriate. AF recurrences were assessed by CARM- and CIED-related complications by device follow-up. After a mean follow-up of 55.4 ± 38.1 months, freedom of AF was found in 86 (61.4%) and clinical success defined as an AF burden less than or equal to 1% in 101 (72.1%) patients. Freedom of AF was reported in 74.6% and 51.9% (P = 0.006) and clinical success in 89.8% and 59.3% (P < 0.001) of patients with paroxysmal and persistent AF, respectively. In 3 of 408 (0.7%) ablation procedures, a TVL malfunction occurred within 90 days after catheter ablation. During long-term follow-up 9 (4.7%) patients showed lead dislodgement, 2 (1.1%) lead fracture, and 2 (1.1%) lead insulation defect not related to the ablation procedure. CONCLUSION Our findings using CARM demonstrate long-term efficacy and safety of radiofrequency catheter ablation of AF in patients with CIED and TVL.
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Affiliation(s)
| | - Benjamin Schäffer
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Özge Akbulak
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Jannis Dickow
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Melanie Gunawardene
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiovascular Surgery, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Arian Sultan
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Jakob Lüker
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Hans Pinnschmidt
- Department of Medical Biometry, Institute of Medical Biometry and Epidemiology, University Hospital Hamburg, Hamburg, Germany
| | - Boris Hoffmann
- Department of Cardiology-Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Nils Gosau
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Daniel Steven
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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21
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Jularic M, Akbulak RÖ, Schäffer B, Moser J, Nuehrich J, Meyer C, Eickholt C, Willems S, Hoffmann BA. Image integration into 3-dimensional-electro-anatomical mapping system facilitates safe ablation of ventricular arrhythmias originating from the aortic root and its vicinity. Europace 2018; 20:520-527. [PMID: 28340078 DOI: 10.1093/europace/euw399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/17/2016] [Indexed: 11/12/2022] Open
Abstract
Aims During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV). Methods and results Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases. Conclusion Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map.
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Affiliation(s)
- Mario Jularic
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Ruken Özge Akbulak
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Benjamin Schäffer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Julia Moser
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jana Nuehrich
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Gunawardene MA, Hoffmann BA, Schaeffer B, Chung DU, Moser J, Akbulak RO, Jularic M, Eickholt C, Nuehrich J, Meyer C, Willems S. Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation. Europace 2018; 20:43-49. [PMID: 27742775 DOI: 10.1093/europace/euw307] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 07/19/2016] [Accepted: 08/30/2016] [Indexed: 01/02/2023] Open
Abstract
Introduction Comparative data of early recurrence rates of atrial fibrillation (ERAF) following second-generation cryoballoon (CB-G2) and radiofrequency current (RFC) ablation for pulmonary vein isolation (PVI) in paroxysmal AF (PAF) are rare. We randomized PAF patients into either PVI with CB-G2 (group 1) or PVI with a combined RFC-approach applying contact force (CF) with the endpoint of unexcitability (group 2) to investigate ERAF. Methods and results In group 1 (n = 30), CB-G2-PVI was performed. After CF-PVI in group 2 (n = 30), bipolar pacing on the ablation line and additional ablation until unexcitability was conducted. Follow-up included 48 h of in-hospital monitoring followed by 5-day Holter ECGs 1, 2, 3, 6, 12 months postablation to evaluate ERAF. Acute PVI was reached in 100% of group 2 and in 99% of group 1. Shorter procedure durations (98.0 ± 21.9 vs. 114.3 ± 18.7 min, P < 0.05) but extended fluoroscopy times (15.4 ± 3.9 vs. 10.0 ± 4.3 min, P < 0.05) were found in the CB-G2 group. Ten non-severe complications occurred (6 vs. 4 in group 1 and 2, P = 0.73). In group 2, five patients suffered from ERAF vs. seven patients in group 1 (P = 0.67). The time until the occurrence of ERAF was shorter in group 2 (1 day (q1-q3: 1-4.5)) when compared with group 1 (22 (q1-q3: 6-54) days, P = 0.025). Conclusion ERAF rates were equal among groups; however, they occurred earlier in the initial phase after RFC ablation when compared with CB-G2. PVI utilizing cryoablation is associated with shorter procedure durations but extended fluoroscopy time while being similarly secure.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Benjamin Schaeffer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julia Moser
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ruken Oezge Akbulak
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana Nuehrich
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Jungen C, Kuklik P, Eickholt C, Akbulak R, Klatt N, Hartmann J, Gunawardene M, Geisler A, Jularic M, Klene C, Klutmann S, Willems S, Mester J, Meyer C. 3012Ventricular arrhythmia ablation in areas of mismatch between sympathetic innervation and electroanatomical voltage. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - P Kuklik
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - R Akbulak
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Gunawardene
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - A Geisler
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Klene
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Klutmann
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Mester
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
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Dinshaw L, Akbulak Ö, Schaeffer B, Jularic M, Gunawardene M, Muench J, Klatt N, Hartmann J, Eickholt C, Gosau N, Patten M, Willems S, Meyer C. P844Long-term outcome of ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Dinshaw
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - Ö Akbulak
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Gunawardene
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Muench
- University Heart Center Hamburg, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - N Gosau
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Patten
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
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Schaeffer B, Rüden L, Salzbrunn T, Pinnschmidt HO, Akbulak RÖ, Moser JM, Jularic M, Meyer C, Eickholt C, Sultan A, Lüker J, Steven D, Willems S, Hoffmann BA. Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation. J Cardiovasc Electrophysiol 2018; 29:537-547. [DOI: 10.1111/jce.13447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/15/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Benjamin Schaeffer
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Lea Rüden
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Tim Salzbrunn
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Hans O. Pinnschmidt
- Department of Medical Biometry and Epidemiology; University Hospital Hamburg; Hamburg Germany
| | - Ruken Özge Akbulak
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Julia Magdalena Moser
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
| | - Arian Sultan
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
| | - Jakob Lüker
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
| | - Daniel Steven
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg Germany
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26
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Moser J, Schaeffer B, Akbulak R, Nuerich J, Eickholt C, Jularic M, Willems S, Hoffmann B. P804Sedation monitoring with processed electroencephalogram signals under propofol sedation: a potential benefit on mapping and catheter ablation of ventricular premature contractions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gunawardene MA, Dickow J, Schaeffer BN, Akbulak RÖ, Lemoine MD, Nührich JM, Jularic M, Sinning C, Eickholt C, Meyer C, Moser JM, Hoffmann BA, Willems S. Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography. J Cardiovasc Electrophysiol 2017. [DOI: 10.1111/jce.13279] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/27/2022]
Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Jannis Dickow
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Benjamin N. Schaeffer
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Ruken Ö. Akbulak
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Marc D. Lemoine
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Jana M. Nührich
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Christoph Sinning
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Julia M. Moser
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Boris A. Hoffmann
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Heart Center; University Hospital Hamburg Eppendorf; Hamburg Germany
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28
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Nührich JM, Kaiser L, Akbulak RÖ, Schäffer BN, Eickholt C, Schwarzl M, Kuklik P, Moser J, Jularic M, Willems S, Meyer C. Substrate characterization and catheter ablation in patients with scar-related ventricular tachycardia using ultra high-density 3-D mapping. J Cardiovasc Electrophysiol 2017; 28:1058-1067. [DOI: 10.1111/jce.13270] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 02/10/2017] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jana M. Nührich
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Lukas Kaiser
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Ruken Özge Akbulak
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Benjamin N. Schäffer
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Christian Eickholt
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Michael Schwarzl
- Department of Interventional Cardiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
| | - Pawel Kuklik
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Julia Moser
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Mario Jularic
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
| | - Christian Meyer
- Department of Electrophysiology, University Heart Center; University Hospital Eppendorf; Hamburg Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Hamburg/Kiel/Lübeck; 13347 Berlin Germany
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29
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Kaiser L, Jularic M, Akbulak RÖ, Nührich J, Willems S, Meyer C. Catheter ablation of hemodynamically unstable ventricular tachycardia in ischemic cardiomyopathy using high-resolution mapping. Clin Case Rep 2017; 5:389-393. [PMID: 28396753 PMCID: PMC5378853 DOI: 10.1002/ccr3.833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/11/2016] [Revised: 12/11/2016] [Accepted: 12/21/2016] [Indexed: 01/08/2023] Open
Abstract
Catheter ablation is a recommended therapy option for ventricular tachycardia (VT). The antegrade transseptal approach for targeting VT with left ventricular origin is feasible with the high-resolution basket catheter. High-resolution mapping offers the potential to quickly acquire detailed voltage and activation maps. This may help to identify the crucial VT-substrate even in patients with huge scar areas and hemodynamically unstable VT.
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Affiliation(s)
- Lukas Kaiser
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany
| | - Mario Jularic
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany
| | - Ruken Özge Akbulak
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany
| | - Jana Nührich
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany
| | - Stephan Willems
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany; DZHK (German Center for Cardiovascular Research) Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - Christian Meyer
- Department of Cardiology and Electrophysiology University Heart Center Hamburg Hamburg Germany; DZHK (German Center for Cardiovascular Research) Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
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30
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Gunawardene M, Willems S, Schäffer B, Moser J, Akbulak RÖ, Jularic M, Eickholt C, Nührich J, Meyer C, Kuklik P, Sehner S, Czerner V, Hoffmann BA. Influence of periprocedural anticoagulation strategies on complication rate and hospital stay in patients undergoing catheter ablation for persistent atrial fibrillation. Clin Res Cardiol 2016; 106:38-48. [PMID: 27435077 DOI: 10.1007/s00392-016-1021-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/26/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The use of non-vitamin K antagonists (NOACs), uninterrupted (uVKA) and interrupted vitamin K antagonists (iVKA) are common periprocedural oral anticoagulation (OAC) strategies for atrial fibrillation (AF) ablation. Comparative data on complication rates resulting from OAC strategies for solely persistent AF (persAF) undergoing ablation are sparse. Thus, we sought to determine the impact of these OAC strategies on complication rates among patients with persAF undergoing catheter ablation. METHODS Consecutive patients undergoing persAF ablation were included. Depending on preprocedural OAC, three groups were defined: (1) NOACs (paused 48 h preablation), (2) uVKA, and (3) iVKA with heparin bridging. A combined complication endpoint (CCE) composed of bleeding and thromboembolic events was analyzed. RESULTS Between 2011 and 2014, 1440 persAF ablation procedures were performed in 1092 patients. NOACs were given in 441 procedures (31 %; rivaroxaban 57 %, dabigatran 33 %, and apixaban 10 %), uVKA in 488 (34 %), and iVKA in 511 (35 %). Adjusted CCE rates were 5.5 % [95 % confidence interval (CI) (3.1-7.8)] in group 1 (NOACs), 7.5 % [95 % CI (5.0-10.1)] in group 2 (uVKA), and 9.9 % [95 % CI (6.6-13.2)] in group 3. Compared to group 1, the combined complication risk was almost twice as high in group 3 [odd's ratio (OR) 1.9, 95 % CI (1.0-3.7), p = 0.049)]. The major complication rate was low (0.9 %). Bleeding complications, driven by minor groin complications, are more frequent than thromboembolic events (n = 112 vs. 1, p < 0.0001). CONCLUSIONS Patients undergoing persAF ablation with iVKA anticoagulation have an increased risk of complications compared to NOACs. Major complications, such as thromboembolic events, are generally rare and are exceeded by minor bleedings.
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Affiliation(s)
- Melanie Gunawardene
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - S Willems
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - B Schäffer
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - J Moser
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - R Ö Akbulak
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - M Jularic
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - C Eickholt
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - J Nührich
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - C Meyer
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - P Kuklik
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Sehner
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - V Czerner
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - B A Hoffmann
- Department of Cardiology-Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
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Schaeffer BN, Rybczynski M, Sheikhzadeh S, Akbulak RÖ, Moser J, Jularic M, Schreiber D, Daubmann A, Willems S, von Kodolitsch Y, Hoffmann BA. Heart rate turbulence and deceleration capacity for risk prediction of serious arrhythmic events in Marfan syndrome. Clin Res Cardiol 2015; 104:1054-63. [PMID: 26033711 DOI: 10.1007/s00392-015-0873-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 02/21/2015] [Accepted: 05/20/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Marfan syndrome (MFS) is associated with a substantial risk for ventricular arrhythmia and sudden cardiac death (SCD). We used heart rate turbulence (HRT) and deceleration capacity (DC), to evaluate the risk stratification for these patients. METHODS We enrolled 102 patients [45 male (44.1 %), age 40.5 ± 14.6 years] with MFS. Blood samples were obtained to determine N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Transthoracic echocardiography studies were conducted to evaluate heart function parameters and a 24-h holter ECG was performed. An analysis of two HRT parameters, turbulence onset (TO) and turbulence slope (TS), and DC was performed. Therefore, optimal cut-off values were calculated. Primary endpoint was the combination of SCD, ventricular arrhythmia and arrhythmogenic syncope. Secondary endpoint was total mortality. RESULTS During a follow-up of 1145 ± 491 days, 12 (11.7 %) patients reached the primary and 8 (7.8 %) patients the secondary endpoint. Patients reaching the primary were significantly older, had a higher burden of premature ventricular complexes and NT-proBNP levels and lower values of LVEF, DC and HRT TS. Multivariate analysis identified NT-proBNP (HR 1.25, 95 % CI 1.01-1.56, p = .04) and the abnormal HRT (abnormal TS and/or TO (HR 7.04, 95 % CI 1.07-46.27, p = .04) as independent risk predictor of arrhythmogenic events. CONCLUSION Patients with Marfan syndrome are at risk for severe ventricular arrhythmias and SCD. Abnormal HRT parameters and NT-proBNP values are independent risk factors for arrhythmogenic events and SCD. The assessment of these tools may help predicting SCD patients with MFS.
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Affiliation(s)
- Benjamin N Schaeffer
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
| | - Meike Rybczynski
- Department of Cardiology, University Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Sara Sheikhzadeh
- Department of Cardiology, University Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, University Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Doreen Schreiber
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of Cardiology, University Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg, Martinistr. 52, 20246, Hamburg, Germany
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Akbulak RÖ, Schäffer B, Jularic M, Moser J, Schreiber D, Salzbrunn T, Meyer C, Eickholt C, Kuklik P, Hoffmann BA, Willems S. Reduction of Radiation Exposure in Atrial Fibrillation Ablation Using a New Image Integration Module: A Prospective Randomized Trial in Patients Undergoing Pulmonary Vein Isolation. J Cardiovasc Electrophysiol 2015; 26:747-53. [PMID: 25807878 DOI: 10.1111/jce.12673] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 02/23/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, a new image integration module (IIM, CartoUnivu™ Module) has been introduced to combine and merge fluoroscopy images with 3-dimensional-(3D)-electroanatomical maps (Carto® 3 System) into an accurate 3D view. The aim of the study was to investigate the influence of IIM on the fluoroscopy exposure during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. METHODS AND RESULTS Between June and November 2014, a total of 60 patients with PAF (73.3% male, 64.0 ± 9.2 years), who underwent PVI with the endpoint of unexcitability of the ablation line, were randomized to either a conventional 3D mapping system (Carto® 3 System) or to an additional IIM on the basis of an assumed reduction of fluoroscopy exposure by the use of IIM. There were no significant differences in baseline characteristics. The median ablation procedure time was identical in both groups (140.7 ± 27.8 minutes vs. 140.8 ± 39.5 minutes; P = 0.851). A significant decrease of mean fluoroscopy time from 11.9 ± 2.1 to 7.4 ± 2.6 minutes (P < 0.0006) and median fluoroscopy dose from 882.9 to 476.5 cGycm(2) (P < 0.001) was achieved. The main reduction of radiation could be realized during creation of the 3D-map. No major complications occurred during the procedures. After a median follow-up of 125.7 ± 45.6 days 80% of the patients were free from any atrial arrhythmias. CONCLUSION CartoUnivu™ module easily integrates into the workflow of PVI with the endpoint of unexcitability of the ablation line without prolonging the procedure time. It is associated with a marked reduction in fluoroscopic dose when compared to a conventional 3D mapping system.
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Affiliation(s)
- Ruken Özge Akbulak
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Schäffer
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Doreen Schreiber
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Salzbrunn
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Schroeder K, Jularic M, Horsburgh SM, Hirschhausen N, Neumann C, Bertling A, Schulte A, Foster S, Kehrel BE, Peters G, Heilmann C. Molecular characterization of a novel Staphylococcus aureus surface protein (SasC) involved in cell aggregation and biofilm accumulation. PLoS One 2009; 4:e7567. [PMID: 19851500 PMCID: PMC2761602 DOI: 10.1371/journal.pone.0007567] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 09/01/2009] [Indexed: 01/30/2023] Open
Abstract
Background Staphylococci belong to the most important pathogens causing implant-associated infections. Colonization of the implanted medical devices by the formation of a three-dimensional structure made of bacteria and host material called biofilm is considered the most critical factor in these infections. To form a biofilm, bacteria first attach to the surface of the medical device, and then proliferate and accumulate into multilayered cell clusters. Biofilm accumulation may be mediated by polysaccharide and protein factors. Methology/Principal Findings The information on Staphylococcus aureus protein factors involved in biofilm accumulation is limited, therefore, we searched the S. aureus Col genome for LPXTG-motif containing potential surface proteins and chose the so far uncharacterized S. aureus surface protein C (SasC) for further investigation. The deduced SasC sequence consists of 2186 amino acids with a molecular mass of 238 kDa and has features typical of Gram-positive surface proteins, such as an N-terminal signal peptide, a C-terminal LPXTG cell wall anchorage motif, and a repeat region consisting of 17 repeats similar to the domain of unknown function 1542 (DUF1542). We heterologously expressed sasC in Staphylococcus carnosus, which led to the formation of huge cell aggregates indicative of intercellular adhesion and biofilm accumulation. To localize the domain conferring cell aggregation, we expressed two subclones of sasC encoding either the N-terminal domain including a motif that is found in various architectures (FIVAR) or 8 of the DUF1542 repeats. SasC or its N-terminal domain, but not the DUF1542 repeat region conferred production of huge cell aggregates, higher attachment to polystyrene, and enhanced biofilm formation to S. carnosus and S. aureus. SasC does not mediate binding to fibrinogen, thrombospondin-1, von Willebrand factor, or platelets as determined by flow cytometry. Conclusions/Significance Thus, SasC represents a novel S. aureus protein factor involved in cell aggregation and biofilm formation, which may play an important role in colonization during infection with this important pathogen.
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Affiliation(s)
- Katrin Schroeder
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
| | - Mario Jularic
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
| | - Samantha M. Horsburgh
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, United Kingdom
| | - Nina Hirschhausen
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
| | - Claudia Neumann
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
| | - Anne Bertling
- Department of Anaesthesiology and Intensive Care, Experimental and Clinical Haemostasis, University Hospital of Münster, Münster, Germany
| | - Anja Schulte
- Department of Anaesthesiology and Intensive Care, Experimental and Clinical Haemostasis, University Hospital of Münster, Münster, Germany
| | - Simon Foster
- Department of Molecular Biology and Biotechnology, University of Sheffield, Sheffield, United Kingdom
| | - Beate E. Kehrel
- Department of Anaesthesiology and Intensive Care, Experimental and Clinical Haemostasis, University Hospital of Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital of Münster, Münster, Germany
- * E-mail:
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