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Goulouti E, Lam A, Nozica N, Elchinova E, Dernektsi C, Neugebauer F, Branca M, Servatius H, Noti F, Haeberlin A, Thalmann G, Kozhuharov NA, Madaffari A, Tanner H, Reichlin T, Roten L. Incidental Arrhythmias During Atrial Fibrillation Screening With Repeat 7-Day Holter ECGs in a Hospital-Based Patient Population. J Am Heart Assoc 2024; 13:e032223. [PMID: 38348803 PMCID: PMC11010089 DOI: 10.1161/jaha.123.032223] [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: 08/16/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Screening for atrial fibrillation (AF) may reveal incidental arrhythmias of relevance. The aim of this study was to describe incidental arrhythmias detected during screening for AF in the STAR-FIB (Predicting SilenT AtRial FIBrillation in Patients at High Thrombembolic Risk) cohort study. METHODS AND RESULTS In the STAR-FIB cohort study, we screened hospitalized patients for AF with 3 repeat 7-day Holter ECGs. We analyzed all Holter ECGs for the presence of the following incidental arrhythmias: (1) sinus node dysfunction, defined as sinus pause of ≥3 seconds' duration; (2) second-degree (including Wenckebach) or higher-degree atrioventricular block (AVB); (3) sustained supraventricular tachycardia of ≥30 seconds' duration; and (4) sustained ventricular tachycardia of ≥30 seconds' duration. We furthermore report treatment decisions because of incidental arrhythmias. A total of 2077 Holter ECGs were performed in 794 patients (mean age, 74.7 years; 49% women), resulting in a mean cumulative duration of analyzable ECG signal of 414±136 hours/patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were sinus node dysfunction in 14 patients (1.8%), AVB in 41 (5.2%), supraventricular tachycardia in 42 (5.3%), and ventricular tachycardia in 2 (0.3%). Second-degree AVB was found in 23 patients (2.9%), 2:1 AVB in 10 (1.3%), and complete AVB in 8 (1%). Subsequently, 8 patients underwent pacemaker implantation, 1 for sinus node dysfunction (post-AF conversion pause of 9 seconds) and 7 for advanced AVB. One patient had an implantable cardioverter-defibrillator implanted for syncopal ventricular tachycardia. CONCLUSIONS Incidental arrhythmias were frequently detected during screening for AF in the STAR-FIB study and resulted in device therapy in 1.1% of our cohort patients.
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Affiliation(s)
- Eleni Goulouti
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Anna Lam
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Nikolas Nozica
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Elena Elchinova
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Chrisoula Dernektsi
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Felix Neugebauer
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | | | - Helge Servatius
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Fabian Noti
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Andreas Haeberlin
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship University of Bern Switzerland
| | - Gregor Thalmann
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Nikola Asenov Kozhuharov
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Antonio Madaffari
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Hildegard Tanner
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Tobias Reichlin
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Laurent Roten
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
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Blaser I, Papadis A, Kassar M, Nozica N, Gräni C, Seiler C, de Marchi S, Buffle E. Aortic Valve Planimetry in Aortic Stenosis Quantification: Reliability of Three-Dimensional-Multiplane Reconstruction and Comparison With Established Methods. Am J Cardiol 2024; 211:287-290. [PMID: 37952755 DOI: 10.1016/j.amjcard.2023.11.018] [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: 08/21/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
We aim to evaluate the reliability and consistency of measuring the aortic valve area (AVA) using 3-dimensional (3D) transesophageal echocardiography and compare it with invasive and noninvasive methods using a continuity equation (CE). Measurements were taken from 119 patients with different severity of aortic stenosis and with normal aortic valve who underwent elective transesophageal echocardiography encompassing the whole spectrum of aortic opening. Three methods were compared to determine AVA. First, the effective AVA was calculated with the standard CE, where the left ventricular outflow tract area was calculated from its 2-dimensional diameter (AVA-CEstd). Second, a modified CE method (AVA-CEmod) was used, in which the left ventricular outflow tract area was measured using 3D-multiplane reconstruction. Third, the geometric AVA was directly measured using 3D-multiplane reconstruction planimetry (AVA-3D). Interobserver and intraobserver variability were analyzed using intraclass correlation coefficients (ICCs). The values were measured by two blinded readers for interobserver variability and by one observer on the same dataset. AVA-3D was significantly larger than AVA-CEmod and AVA-CEstd (1.87 ± 1.00 cm2 vs 1.81 ± 0.92 cm2 p = 0.03 and 1.87 ± 1.00 cm2 vs 1.71 ± 0.85 cm2 p <0.001). However, in the subset of patients with AVA-3D <1.5 cm2, there was no significant difference between AVA-3D and AVA-CEmod (1.06 ± 0.24 vs 1.08 ± 0.26 cm2, paired t test: t = 0.77, degree of freedom = 58, p = 0.44). The ICC between the measurements of AVA-3D and AVA-CEmod (ICC 0.979), and AVA-3D and AVA- CEstd (ICC 0.940), were excellent. AVA-3D delivers very similar results as compared with more established echocardiographic parameters. The difference between effective and geometric AVA did not appear to be clinically relevant in patients with a higher degree of stenosis.
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Affiliation(s)
- Isaac Blaser
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Athanasios Papadis
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Nikolas Nozica
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Stefano de Marchi
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Eric Buffle
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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Nozica N, Asatryan B, Aur S, Clement JB, Schwerzmann M, Guan F, Pascale P, Gass M, Duru F, Reichlin T, Pruvot E, Wolber T, Roten L. Arrhythmias and Clinical Outcomes in a Swiss Multicenter Cohort of Patients With Dextro-Transposition of the Great Arteries and Atrial Switch. J Am Heart Assoc 2023:e028956. [PMID: 37345794 DOI: 10.1161/jaha.122.028956] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background Data on the incidence of arrhythmias, associated cardiac interventions, and outcome in patients with dextro-transposition of the great arteries and atrial switch are scarce. Methods and Results In this multicenter analysis, we included adult patients with dextro-transposition of the great arteries and atrial switch regularly followed up at 3 Swiss tertiary care hospitals. The primary outcome was a composite of left ventricular assist device, heart transplantation, and death. The secondary outcome was occurrence of ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. We identified 207 patients (34% women; median age at last follow-up, 35 years) with dextro-transposition of the great arteries and atrial switch. Arrhythmias occurred in 97 patients (47%) at a median age of 22 years. A pacemaker or an implantable cardioverter-defibrillator was implanted in 39 (19%) and 13 (6%) patients, respectively, and 33 (16%) patients underwent a total of 51 ablation procedures to target 60 intra-atrial re-entry tachycardias, 4 atrioventricular nodal re-entry tachycardias, and 1 atrial fibrillation. The primary outcome occurred in 21 patients (10%), and the secondary outcome occurred in 18 patients (9%); both were more common in patients with concomitant ventricular septum defect than in those without (hazard ratio [HR], 3.06 [95% CI, 1.29-7.27], P=0.011; and HR, 3.62 [95% CI, 1.43-9.18], P=0.007, respectively). Conclusions In patients with dextro-transposition of the great arteries and atrial switch reaching adulthood, arrhythmias occur in almost half of patients, and associated rhythm interventions are frequent. One-tenth of those patients do not survive until the age of 35 years free from left ventricular assist device or heart transplantation, and the outcome is worse in patients with concomitant ventricular septum defect.
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Affiliation(s)
- Nikolas Nozica
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Stefania Aur
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Judith Bouchardy Clement
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Fu Guan
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
| | - Patrizio Pascale
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Matthias Gass
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Department of Cardiology University Children's Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
| | - Etienne Pruvot
- Department of Cardiology Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland
| | - Thomas Wolber
- Department of Cardiology Zurich University Hospital University of Zurich Zurich Switzerland
- Center for Integrative Human Physiology University of Zurich Zurich Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital Bern University Hospital University of Bern Bern Switzerland
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Tanner H, Goulouti E, Lam A, Elchinova E, Nozica N, Servatius H, Noti F, Seiler J, Baldinger SH, Haeberlin A, Franzeck F, Asatryan B, Reichlin T, Roten L. Gender gap in study inclusion: Insights from the STAR-FIB cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Swiss Heart Foundation
Background
The underrepresentation of women in cardiovascular clinical trials is well described but cannot be fully explained by sex-specific differences in the prevalence of cardiovascular diseases. Data on potential sex- and gender-related differences in study exclusion reasons are scarce.
The STAR-FIB cohort study aimed to estimate the age and sex-specific prevalence of screening-detected atrial fibrillation (AF) in 800 hospitalized patients aged 65-84 years using serial seven-day ECGs. Recruitment for study inclusion was stratified by sex (female/male, as stated in the patient’s records) and age (four age bands, ≥65 to <70, ≥70 to <75, ≥75 to <80, and ≥80 to <85 years), and was truncated for each subgroup after the inclusion of 100 participants.
Purpose
To assess sex and gender differences in patient recruitment for inclusion in the STAR-FIB cohort study.
Methods
A screening log containing sex-category, age, and reasons for exclusion was maintained. Exclusion criteria are shown in the figure. For the purpose of the present study, an explorative analysis of all exclusion criteria with respect to sex category was done.
Results
Overall, 11’470 patients were identified for eligibility, 795 patients (49% women; mean age 75 years) were enrolled, and 10’675 patients (52% women vs. 48% men, p =0.13) were not enrolled. The two major exclusion reasons were unwillingness to participate, which was more frequent in women (27.9% of women vs. 18.4% of men, p < 0.01), and the presence of clinical AF, which was more prevalent in men (27.1% of men vs. 20.5 % of women, p < 0.01). A detailed analysis of all exclusion criteria analysed by sex category is provided in the figure.
Conclusions
Clinical AF was more frequent in men, in accordance with the well described sex-driven (biological) higher prevalence of AF in men. In contrast, we found a higher percentage of women unwilling to participate in this study, which may represent a more gender-based (sociocultural) phenomenon. A further exploration of these findings should be performed and may help to identify and potentially overcome modifiable obstacles for study participation.
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Affiliation(s)
- H Tanner
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Goulouti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - SH Baldinger
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Franzeck
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Asatryan
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Cardiology, Bern, Switzerland
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Goulouti E, Lam A, Nozica N, Elchinova E, Spirito A, Servatius H, Noti F, Seiler J, Baldinger S, Haeberlin A, Babken A, Franzeck F, Tanner H, Reichlin T, Roten L. Incidental arrhythmias during atrial fibrillation screening in a hospital-based patient population. Europace 2022. [DOI: 10.1093/europace/euac053.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Screening for atrial fibrillation may reveal other, incidental arrhythmias of relevance. We sought to describe such incidental arrhythmias in the prospective STARFIB cohort study, which screened for silent atrial fibrillation in hospitalized patients aged 65-84 years.
Method
Patients included in the STARFIB cohort study had up to three 7-day Holter ECGs, performed in two-month intervals. We analysed all the 7-day Holter ECGs of study participants for the presence of one of the following incidental arrhythmias: 1) sick-sinus-syndrome (SSS), defined as sinus arrest of ≥3 seconds duration; 2) second or higher degree atrioventricular block (AVB); 3) sustained atrial tachycardia of ≥30 seconds duration (AT); and 4) sustained ventricular tachycardia of ≥30 seconds duration (VT).
Results
A total of 2’077 Holter ECGs were performed in 794 patients (mean age 74.7 years; 49% females), resulting in a mean cumulative duration of an analyzable ECG signal of 414±136 hours per patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were SSS in 14 patients (1.8%), AVB in 41 (5.2%), AT in 41 (5.2%), and VT in two (0.3%). The median pause duration in SSS was 4 seconds and SSS resulted in pacemaker implantation in one patient with a pause of 9 seconds duration. The most severe type of AVB found per patient was second degree AVB type Wenkebach in 23 patients (2.9%), second degree AVB type Mobitz or 2:1 AV conduction in 10 patients (1.3%) and complete AVB in 8 (1%; maximum pause 18 seconds). AVB led to pacemaker implantation in 9 patients (1.1%). The median duration and heart rate of AT was 2.2 minutes and 144 bpm, respectively. Initiation of betablocker therapy was recommended in 3 patients (0.4%) due to symptomatic AT. The duration and heart rate of VT was 3 minutes at 216 bpm in one patient and 38 seconds at 150 bpm in another. The former patient with VT experienced syncope and an ICD was implanted, whereas in the latter the betablocker dose was increased. One patient died from a non-cardiac cause during a Holter ECG, which showed progressive bradycardia and finally asystole.
Conclusion
Incidental arrhythmias were frequently discovered during screening for atrial fibrillation and resulted in device therapy in 1.4% of our cohort patients.
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Affiliation(s)
- E Goulouti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Lam
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - N Nozica
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - E Elchinova
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Spirito
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Servatius
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Noti
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - J Seiler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - S Baldinger
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Haeberlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - A Babken
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Franzeck
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - H Tanner
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - L Roten
- Bern University Hospital, Inselspital, Bern, Switzerland
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Nozica N, Asatryan B, Aur S, Greutmann M, Schwerzmann M, Bouchardy J, Gass M, Duru F, Pascale P, Reichlin T, Pruvot E, Wolber T, Roten L. Arrhythmia burden, rhythm interventions and outcome in a large Swiss multicenter population of d-TGA patients with atrial switch. Europace 2022. [DOI: 10.1093/europace/euac053.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with dextro-transposition of the great arteries (d-TGA) and atrial switch face a high life-time risk of arrhythmias.
Purpose
To describe the incidence of arrhythmias, associated cardiac interventions and outcome in a large Swiss population of patients with d-TGA and atrial switch.
Methods
In this multicenter analysis we included all consecutive patients with d-TGA and atrial switch treated at three Swiss tertiary care hospitals. The primary outcome was survival free from left ventricular assist device (LVAD), heart transplantation (HTx) and death. The secondary outcome was survival free from ventricular tachycardia, ventricular fibrillation and sudden cardiac death.
Results
We identified 207 patients (34% females; median age at last follow-up 35 years) with d-TGA and atrial switch. Arrhythmias occurred in 97 patients (47%) at a median age of 22 years. A pacemaker or an implantable cardioverter/defibrillator was implanted in 39 (19%) and 13 (6%) patients, respectively, and 33 (16%) underwent a total of 51 ablation procedures to target 60 intra-atrial reentry tachycardias, 4 AV nodal reentry tachycardias and one atrial fibrillation (Figure 1). The primary outcome occurred in 21 patients (10%) and the secondary outcome in 18 (9%) (Figure 2). Primary and secondary outcomes were more common in patients with concomitant ventricular septum defect (VSD) than in those without (hazard ratio [HR] 3.06; 95% confidence interval [CI] 1.29-7.27, p=0.011; and HR 3.62; 95% CI 1.43-9.18, p=0.007, respectively).
Conclusions
At a median age of 35 years, arrhythmias occur in almost half of patients with d-TGA and atrial switch and associated rhythm interventions are frequent. One in ten patients does not survive free from LVAD and HTx and outcome is worse in patients with concomitant VSD.
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Affiliation(s)
- N Nozica
- Heart Center of Bern, Bern, Switzerland
| | | | - S Aur
- Lausanne University Hospital, Lausanne, Switzerland
| | - M Greutmann
- University Heart Center, Zurich, Switzerland
| | | | - J Bouchardy
- Lausanne University Hospital, Lausanne, Switzerland
| | - M Gass
- University Heart Center, Zurich, Switzerland
| | - F Duru
- University Heart Center, Zurich, Switzerland
| | - P Pascale
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - E Pruvot
- Lausanne University Hospital, Lausanne, Switzerland
| | - T Wolber
- University Heart Center, Zurich, Switzerland
| | - L Roten
- Heart Center of Bern, Bern, Switzerland
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7
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Nozica N, Siontis GCM, Elchinova EG, Goulouti E, Asami M, Bartkowiak J, Baldinger S, Servatius H, Seiler J, Tanner H, Noti F, Haeberlin A, Branca M, Lanz J, Stortecky S, Pilgrim T, Windecker S, Reichlin T, Praz F, Roten L. Assessment of New Onset Arrhythmias After Transcatheter Aortic Valve Implantation Using an Implantable Cardiac Monitor. Front Cardiovasc Med 2022; 9:876546. [PMID: 35651903 PMCID: PMC9149277 DOI: 10.3389/fcvm.2022.876546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscatheter aortic valve implantation (TAVI) is associated with new onset brady- and tachyarrhythmias which may impact clinical outcome.AimsTo investigate the true incidence of new onset arrhythmias within 12 months after TAVI using an implantable cardiac monitor (ICM).MethodsOne hundred patients undergoing TAVI received an ICM within 3 months before or up to 5 days after TAVI. Patients were followed-up for 12 months after discharge from TAVI for the occurrence of atrial fibrillation (AF), bradycardia (≤30 bpm), advanced atrioventricular (AV) block, sustained ventricular and supraventricular tachycardia.ResultsA previously undiagnosed arrhythmia was observed in 31 patients (31%) and comprised AF in 19 patients (19%), advanced AV block in 3 patients (3%), and sustained supraventricular and ventricular tachycardia in 10 (10%) and 2 patients (2%), respectively. Three patients had a clinical diagnosis of sick-sinus-syndrome. A permanent pacemaker (PPM) was implanted in six patients (6%). The prevalence of pre-existing AF was 28%, and 47% of the patients had AF at the end of the study period. AF burden was significantly higher in patients with pre-existing [26.7% (IQR 0.3%; 100%)] compared to patients with new-onset AF [0.0% (IQR 0.0%; 0.06%); p = 0.001]. Three patients died after TAVI without evidence of an arrhythmic cause according to the available ICM recordings.ConclusionsRhythm monitoring for 12 months after TAVI revealed new arrhythmias, mainly AF, in almost one third of patients. Atrial fibrillation burden was higher in patients with prevalent compared to incident AF. Selected patients may benefit from short-term remote monitoring.Trial Registrationhttps://clinicaltrials.gov/: NCT02559011.
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Affiliation(s)
- Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C. M. Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Georgieva Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Joanna Bartkowiak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Laurent Roten
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8
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Servatius H, Raab S, Asatryan B, Haeberlin A, Branca M, de Marchi S, Brugger N, Nozica N, Goulouti E, Elchinova E, Lam A, Seiler J, Noti F, Madaffari A, Tanner H, Baldinger SH, Reichlin T, Wilhelm M, Roten L. Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes' Hearts. J Clin Med 2022; 11:jcm11051316. [PMID: 35268407 PMCID: PMC8910879 DOI: 10.3390/jcm11051316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.
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Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
- Correspondence: ; Tel.: +41-31-664-17-01
| | - Simon Raab
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Mattia Branca
- CTU Bern, University of Bern, 3010 Bern, Switzerland;
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Samuel H. Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
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Lam A, Küffer T, Hunziker L, Nozica N, Asatryan B, Franzeck F, Madaffari A, Haeberlin A, Mühl A, Servatius H, Seiler J, Noti F, Baldinger SH, Tanner H, Windecker S, Reichlin T, Roten L. Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation. J Cardiovasc Electrophysiol 2021; 32:1610-1619. [PMID: 33928711 DOI: 10.1111/jce.15064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate the achievement of mitral isthmus block. This study sought to describe the efficacy and safety of this technique. METHODS AND RESULTS Twenty-two consecutive patients (14 males, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and the mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary for 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in 4 and 3 patients, respectively. The low-voltage area of the mitral isthmus region increased from 3.1 cm2 (interquartile range [IQR] 0-7.9) before to 13.2 cm2 (IQR: 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (p = .03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR: 221-516) the evening of the procedure to 598 ng/L (IQR: 382-769; p = .02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%), and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR: 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%). CONCLUSION VOM-EI is feasible, safe, and effective to achieve acute mitral isthmus block.
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Affiliation(s)
- Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Florian Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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Nozica N, Lam A, Goulouti E, Elchinova E, Spirito A, Branca M, Servatius H, Noti F, Seiler J, Baldinger SH, Haeberlin A, de Marchi SF, Asatryan B, Rodondi N, Donzé J, Aujesky D, Tanner H, Reichlin T, Jüni P, Roten L. The SilenT AtRial FIBrillation (STAR-FIB) study programme - design and rationale. Swiss Med Wkly 2021; 151:w20421. [PMID: 33641108 DOI: 10.4414/smw.2021.20421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Anticoagulation of patients with screen-detected atrial fibrillation may prevent ischaemic strokes. The STAR-FIB study programme aims to determine the age- and sex-specific prevalence of silent atrial fibrillation and to develop a clinical prediction model to identify patients at risk of undiagnosed atrial fibrillation in a hospitalised patient population. METHODS The STAR-FIB study programme includes a prospective cohort study and a case-control study of hospitalised patients aged 65–84 years, evenly distributed for both age and sex. We recruited 795 patients without atrial fibrillation for the cohort study (49.2% females; median age 74.8 years). All patients had three serial 7-day Holter ECGs to screen for silent atrial fibrillation. The primary endpoint will be any episode of atrial fibrillation or atrial flutter of ≥30 seconds duration. The age- and sex-specific prevalence of newly diagnosed atrial fibrillation will be estimated. For the case-control study, 120 patients with paroxysmal atrial fibrillation were recruited as cases (41.7% females; median age 74.6 years); controls will be randomly selected from the cohort study in a 2:1 ratio. All participants in the cohort study and all cases were prospectively evaluated including clinical, laboratory, echocardiographic and electrical parameters. A clinical prediction model for undiagnosed atrial fibrillation will be derived in the case-control study and externally validated in the cohort study. CONCLUSIONS The STAR-FIB study programme will estimate the age- and sex-specific prevalence of silent atrial fibrillation in a hospitalised patient population, and develop and validate a clinical prediction model to identify patients at risk of silent atrial fibrillation.
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Affiliation(s)
- Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland / Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Stefano F de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland / Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland / Department of internal medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Raab S, Roten L, Branca M, Nozica N, Wilhelm M, De Marchi S, Brugger N, Elchinova E, Seiler J, Asatryan B, Tanner H, Baldinger SH, Lam A, Reichlin T, Servatius H. P311Hypertrophic cardiomyopathy and other forms of left ventricular hypertrophy. The P wave can make the difference. Europace 2020. [DOI: 10.1093/europace/euaa162.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Structural disarray of hypertrophied myocytes and interstitial fibrosis characterize hypertrophic cardiomyopathy (HCM). These morphological changes also affect atrial myocytes and, together with hemodynamic alterations because of HCM, may lead to atrial cardiomyopathy.
Purpose
To investigate the incremental value of P-wave parameters to differentiate left ventricular hypertrophy (LVH) because of HCM from LVH in hypertensive heart disease (HHD) and athletes heart.
Methods
In a prospective study, we compared electrocardiographic (including signal-averaged ECG of the P wave) and echocardiographic data of patients with HCM, HHD and athletes heart. We developed a predictive model with a simple scoring system to identify HCM.
Results
We compared data of 27 patients with HCM (70% males, 49.8 ± 14.5 years), 324 patients with HHD (52% males, 74.8 ± 5.5 years), and 215 subjects with athletes heart (72% males, 42.3 ± 7.5). The table shows the significant differences among the 3 groups. We included the following parameters into a predictive score to differentiate HCM from other forms of LVH: QRS width (>88ms = 1 point), P-wave integral (>688µVs = 1 point) and septum thickness (>12mm = 2 points). A score >2 (Youden index 0.626) correctly classified HCM in 81% of the cases with a sensitivity and specificity of 82% an 81%, respectively.
Conclusion Differentiation of HCM from other forms of LVH is improved by including atrial parameters. A simple scoring system including septum thickness, QRS width and P wave integral allowed identification of patients with HCM with a sensitivity and specificity of >80%. This score needs to be validated prospectively.
Table 1 HCM HHD Athletes P-value HCM vs HHD* HCM vs Athletes* 95%-CI P-value 95%-CI P-value P-wave duration [ms] 152.7 ± 25.8 143.9 ± 16.5 133.5 ± 14.2 <0.001 -16.9 -24.6 to -9.1 <0.001 -16.3 -22.7 to -9.9 <0.001 P-wave integral [µVs] 850.4 ± 272.4 672.0 ± 235.4 773.1 ± 260.1 <0.001 -198.6 -320.8 to -76.3 0.002 -68.2 -169.7 to 33.2 0.187 QRS [ms] 110.3 ± 27.3 96.9 ± 20.3 95.1 ± 9.8 <0.001 -16.4 -24.7 to -8.1 <0.001 -13.8 -20.8 to -6.9 <0.001 QTc [ms] 447.9 ± 27.2 438.6 ± 24.5 414.0 ± 22.9 <0.001 -21.1 -32.7 to -9.5 <0.001 -30.8 -40.5 to -21.2 <0.001 LVMMI [g/m2] 153.6 ± 55.5 133.5 ± 30.3 98.6 ± 19.7 <0.001 -15.3 -29.7 to -0.9 0.038 -56.1 -67.7 to -44.6 <0.001 IVS [ms] 16.8 ± 4.2 11.8 ± 2.2 10.3 ± 1.5 <0.001 -5.2 -6.3 to -4.1 <0.001 -6.4 -7.3 to -5.6 <0.001 LAVI [ml/m2] 43.2 ± 13.9 30.5 ± 9.7 30.8 ± 9.5 <0.001 -14.6 -20.0 to -9.3 <0.001 -12.2 -16.6 to -7.9 <0.001 The table shows the study result after univariate and multivariate (*; adjusting for age and sex) analysis.
Abstract Figure 1
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Affiliation(s)
- S Raab
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Branca
- CTU Bern, University of Bern, Bern, Switzerland
| | - N Nozica
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - M Wilhelm
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S De Marchi
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Brugger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - E Elchinova
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - B Asatryan
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S H Baldinger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Lam
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Servatius
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Maurhofer J, Tanner H, Haeberlin A, Noti F, Seiler J, Baldinger SH, Roten L, Lam A, Asatryan B, Nozica N, Franzeck F, Kueffer T, Reichlin T, Servatius H. P1492Comparison of the long-term performance of the quadripolar IS-4 and the bipolar IS-1 left ventricular lead for cardiac resynchronization therapy. Europace 2020. [DOI: 10.1093/europace/euaa162.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The implantation of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) and the management of lead-related complications can be challenging. The introduction of the quadripolar IS-4 LV lead may have facilitated the implantation procedure and may have reduced lead-related complications. Data of long-term follow-up (FU) comparing the IS-4 lead with the IS-1 LV lead are rare and conflicting.
PURPOSE
Comparison of lead-related complications and all-cause mortality between CRT patients who received an IS-4 or an IS-1 LV lead in the long-term FU.
METHODS
Adults with an indication for a CRT-Defibrillator or CRT-Pacemaker, a successful endovascular IS-4 or IS-1 LV lead implantation, and a minimal FU of three years were included in this retrospective study. The combined primary endpoint was freedom from lead-related complications defined as (i) occurrence of persisting high pacing threshold (>2.75V/0.4ms), (ii) unresolved phrenic nerve stimulation, (iii) LV lead dislodgement/disruption, (iv) the necessity of re-interventions affecting the LV lead, and (v) LV lead deactivation/explantation. Secondary endpoints were all singular complications and all-cause mortality.
RESULTS
Eligible for the study were 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years. Baseline characteristics of both patient groups did not differ significantly. Freedom from lead-related complications was higher in patients with an IS-4 lead as compared to an IS-1 lead (Figure 1; 87.9% vs. 65.7%; p = 0.002). The secondary outcomes showed a higher rate of LV lead dislodgement/disruption (4.5% vs. 17.9%; p = 0.015) in the IS-1 patient group and more patients suffered from unresolved phrenic nerve stimulation with an IS-1 lead (3.0% vs. 13.4%; p = 0.029). LV lead deactivation/explantation during FU and LV lead-related re-interventions were fewer in case of an IS-4 lead (4.5% vs 22.4%; p = 0.003; 6.1% vs. 17.9%; p = 0.036, respectively). The rate of persisting high pacing thresholds and all-cause mortality did not differ (4.5% vs. 9.0%; p = 0.492; 22.7% vs 25.4%; p = 0.721, respectively).
CONCLUSION
The quadripolar IS-4 LV lead showed in this retrospective study a better long-term performance than the bipolar IS-1 lead.
Abstract Figure 1
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Affiliation(s)
- J Maurhofer
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Tanner
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Haeberlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Noti
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - J Seiler
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - S H Baldinger
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - L Roten
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - A Lam
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - B Asatryan
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - N Nozica
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Franzeck
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Kueffer
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - T Reichlin
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - H Servatius
- University of Bern, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
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Anwander M, Kueffer T, Branca M, Sweda R, Nozica N, Asatryan B, Lam A, Baldinger S, Haeberlin A, Seiler J, Servatius H, Tanner H, Reichlin T, Roten L, Noti F. P2855Unexpectedly high rate of lead failure of the Microport (formerly Sorin/Livanova) Beflex and Vega pacemaker electrodes: A single centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Pacing leads remain the weak link of current pacemaker systems. Various differences in design and material exist among companies. Lead performance is mainly assessed via post-marketing studies of the manufacturing companies. Reliable independent reports are rare. We aimed to study the early and long-term performance of the Microport (formerly Sorin/Livanova) Beflex and Vega leads at our centre, for which a lead survival >99% at 3 years has been reported by the company.
Method
In this single centre, retrospective study we analysed the performance of all right ventricular Microport pacemaker leads implanted at our centre between January 2014 and January 2018. Only first pacemaker implants were considered. Lead failure was defined as any lead issue requiring reintervention during follow-up (dislocation, perforation, electrical abnormalities such as lead noise or excessively high thresholds).
Results
A total of 271 Microport right ventricular pacing leads were implanted (233 Beflex and 38 Vega leads). Mean patient age was 76±13.1 years (66% men). Dual chamber pacemakers were implanted in 162 patients (60%) and single chamber in 109 (40%). Mean threshold at implant was 0.6V/0.5ms (range 0.3–1.2V), mean R wave 13.2 mV (range 1.5–30mV) and mean impedance 816 Ohm (range 469–1639 Ohm). Patients without available follow-up information were excluded (N=18, 6.6%). The remaining 253 patients (93.4%) were analysed. Median follow-up was 1.26 years, IQR [25%=0.91 and 75%=2.24]. We observed a total of 25 lead failures (10%). Lead dislocation occurred in 2 cases (0.8%), lead perforation in 5 cases (2%), electrical abnormalities in 6 cases (2.4%) and excessively high threshold in 12 cases (4.8%; mean voltage 4V, range 2–7.5V; mean pulse width 0.75ms, range 0.35–1ms). Yearly incidence of lead failure per 100 leads was 6.1% (95%-CI [4.09–8.98] with a failure rate of 12.74% at 3 year in Kaplan-Meier analysis (Figure).
Figure 1
Conclusion
We found an unexpectedly high rate of lead failure of the Microport Beflex and Vega pacing leads at our centre. The two main reasons for premature lead failure were excessively high thresholds as well as electrical abnormalities during follow-up. Comparison of lead performance with other centres and against other leads are needed to further assess the magnitude of the problem.
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Affiliation(s)
- M Anwander
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Kueffer
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - M Branca
- University of Bern, Bern, Switzerland
| | - R Sweda
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - N Nozica
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - B Asatryan
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Lam
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S Baldinger
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Haeberlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Seiler
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Servatius
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Tanner
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - L Roten
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Noti
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
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Nozica N, Asatryan B, Noti F, Baldinger SH, Lam A, Haeberlin A, Servatius HS, Seiler J, Schwitz F, Tanner H, Wustmann KB, Delacretaz E, Schwerzmann M, Reichlin T, Roten L. P1007Efficacy and safety of atrial ablation procedures in patients with complete d-TGA and atrial switch at a Swiss tertiary center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0599] [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
Patients with complete transposition of the great arteries (d-TGA) and atrial switch face a high lifetime risk of arrhythmias. Interventions in these patients are challenging because of their particular anatomy. Reports on ablation procedures in this patient population are scarce and missing for Switzerland.
Method
We retrospectively analyzed all ablation procedures performed in the above-mentioned population at a Swiss tertiary care center.
Results
Among 73 d-TGA pts. (71% male; N=37 Senning; N=36 Mustard) followed at our center, 17 ablations were performed in 11 pts. (15%; one ablation in 8 pts., two in 2 pts. and five in 1 patient). Median age at first ablation was 34 years (range 15–49 years). A total of 17 different intra-atrial reentry tachycardias (IART) and 3 AVNRT were targeted. Of the IART, 10 were cavotricuspid isthmus (CTI)-dependent and 7 were not. In two procedures (12%) only the systemic venous (SV) baffle was accessed for ablation. In 15 procedures (88%), ablation was performed within the pulmonary venous (PV) baffle. Access to the PV baffle was retrograde via the aorta in 6 cases (35%), via a baffle leak in 3 (18%) and via baffle puncture in 6 (35%). All procedures with retrograde approach to the PV baffle or with SV baffle only ablation were performed up to January 2012 and all remaining procedures afterwards. The 3 pts. requiring repeat procedures had retrograde or SV baffle approaches initially, and one additional ablation via baffle puncture was successful. The CTI was targeted in 10 pts. (91%) and ablation was finally successful in all with bidirectional block demonstrated in 8 pts. The coronary sinus was found to drain into the SV baffle in 5 pts. (46%) and useful for assessment of CTI block. The seven CTI-independent IART were scar-related micro-reentries. Ablation of all 3 AVNRTs was successful after one procedure without recurrence. Slow pathway ablation was performed in the SV baffle in two and in the PV baffle in one case (Figure). After a median follow-up of 7 months (range 2–186 months) 9 pts. are without recurrence and in 2 pts. rare self-limited arrhythmias still occur. No procedural complications occurred.
Conclusion
Arrhythmias in patients with complete d-TGA and atrial switch are mainly CTI-dependent IART or scar-related micro-reentries, and a few patients also have AVNRT. Ablation of these arrhythmias is safe and successful if PV baffle access is achieved via a baffle leak or baffle puncture.
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Affiliation(s)
- N Nozica
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - B Asatryan
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Noti
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S H Baldinger
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Lam
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Haeberlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H S Servatius
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Seiler
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Schwitz
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Tanner
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - K B Wustmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - E Delacretaz
- Clinique Cecil de recherche cardio-vasculaire, Lausanne, Switzerland
| | - M Schwerzmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - L Roten
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
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