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Hartl S, Makimoto H, Gerguri S, Clasen L, Kluge S, Brinkmeyer C, Schmidt J, Rana O, Kelm M, Bejinariu A. Wide Antral Circumferential Re-Ablation for Recurrent Atrial Fibrillation after Prior Pulmonary Vein Isolation Guided by High-Density Mapping Increases Freedom from Atrial Arrhythmias. J Clin Med 2023; 12:4982. [PMID: 37568384 PMCID: PMC10419947 DOI: 10.3390/jcm12154982] [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: 06/17/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Performing repeated pulmonary vein isolation (re-PVI) after recurrent atrial fibrillation (AF) following prior PVI is a standard procedure. However, no consensus exists regarding the most effective approach in redo procedures. We assessed the efficacy of re-PVI using wide antral circumferential re-ablation (WACA) supported by high-density electroanatomical mapping (HDM) as compared to conventional re-PVI. Consecutive patients with AF recurrences showing true PV reconnection (residual intra-PV and PV antral electrical potentials within the initial ablation line) or exclusive PV antral potentials (without intra-PV potentials) in the redo procedure were prospectively enrolled and received HDM-guided WACA (Re-WACA group). Conventional re-PVI patients treated using pure ostial gap ablation guided by a circular mapping catheter served as a historical control (Re-PVI group). Patients with durable PVI and no antral PV potentials were excluded. Arrhythmia recurrences ≥30 s were calculated as recurrences. In total, 114 patients were investigated (Re-WACA: n = 56, 68 ± 10 years, Re-PVI: n = 58, 65 ± 10 years). There were no significant differences in clinical characteristics including the AF type or the number of previous PVIs. In the Re-WACA group, 11% of patients showed electrical potentials only in the antrum but not inside any PV. At 402 ± 71 days of follow-up, the estimated freedom from arrhythmia was 89% in the Re-WACA group and 69% in the Re-PVI group (p = 0.01). Re-WACA independently predicted arrhythmia-free survival (HR = 0.39, 95% CI 0.16-0.93, p = 0.03), whereas two previous PVI procedures predicted recurrences (HR = 2.35, 95% CI 1.20-4.46, p = 0.01). The Re-WACA strategy guided by HDM significantly improved arrhythmia-free survival as compared to conventional ostial re-PVI. Residual PV antral potentials after prior PVI are frequent and can be easily visualized by HDM.
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Affiliation(s)
- Stefan Hartl
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, 45131 Essen, Germany
- Department of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
- Data Science Center/Cardiovascular Center, Jichi Medical University, Shimotsuke 329-0431, Japan
| | - Shqipe Gerguri
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Lukas Clasen
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
- Department of Cardiology, Rhythmology and Angiology, Josephs-Hospital Warendorf Academic Teaching Hospital, University of Münster, 48149 Warendorf, Germany
| | - Sophia Kluge
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Christoph Brinkmeyer
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Jan Schmidt
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Obaida Rana
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Alexandru Bejinariu
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
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Makimoto H, Gerguri S, Hartl S, Kluge S, Clasen L, Bejinariu A, Brinkmeyer C, Schmidt J, Kelm M. Wide antral circumferential re-ablation in case of recurrent atrial fibrillation despite of prior pulmonary vein isolation increases freedom from atrial tachyarrhythmias. Europace 2022. [DOI: 10.1093/europace/euac053.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite repeated pulmonary vein isolation (re-PVI) due to recurrent atrial fibrillation (AF) after PVI has been a standard procedure, the detailed ablation strategy in case of re-PVI remains disputable.
Objective
The aim of this study was to assess the efficacy of re-PVI using wide antral circumferential ablation (WACA) supported by high density mapping (HDM) for recurrent AF after PVI as compared to simple repeated PVI supported by circular mapping catheter.
Methods
Consecutive patients with recurrent AF after PVI were prospectively enrolled in this study, who underwent left atrial HDM and subsequently WACA antral (re-)isolation ("Re-WACA" group). The historical controls with re-PVI between 2016 and 2018 using circular mapping catheter, but without HDM were also enrolled ("control group"). These control patients underwent re-PVI with gap ablation at the pulmonary vein ostium. Primary endpoint was defined as any recurrence and ECG documentation of atrial tachyarrhythmias (AT) including AF or atrial tachycardias over 30 seconds. The patients were routinely followed up for 1 year with at least twice annual holter-monitoring.
Results
In total, 116 patients were enrolled in this study (Re-WACA group [N=56, 68±10 years], control group [N=58, 65±10 years]). There were no significant differences in clinical characteristics including the number of previous left atrial ablation procedures between two groups. In all 56 patients with Re-WACA, residual PV antral potentials were demonstrated (100%), whereas 7 patients (13%) showed no electrical potentials inside any PVs. During a mean follow-up period of 402±71 days, 6 out of 56 Re-WACA patients (11%) and 18 out of 58 controls (31%) experienced AT recurrences. Kaplan-Meier analysis demonstrated that the patients who underwent Re-WACA showed significantly lower AT recurrence after the index Re-PVI procedure as compared to the controls (log-rank, P = 0.010). Multivariate Cox regression showed that Re-WACA was an independent predictor of freedom from AT recurrence (hazard ratio = 0.39; 95% confidence-interval 0.16-0.93; P=0.034). The number of previous PVI procedures predicted AT recurrence during follow-up (hazard ratio = 2.35; 95% confidence-interval 1.20-4.46; P=0.010).
Conclusions
Residual pulmonary vein antral potential in patients with recurrent AF after previously performed PVI is a frequent finding. These antral potentials can be easily visualized by HDM. Repeated isolation of wide PV antrum (Re-WACA) is an effective strategy to reduce further AF recurrence as compared to conventional re-PVI without left atrial HDM.
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Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Hartl
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Kluge
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
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Makimoto H, Shiraga T, Kohlmann B, Magnisali CE, Gerguri S, Motoyama N, Clasen L, Bejinariu A, Klein K, Makimoto A, Jung C, Westenfeld R, Zeus T, Kelm M. Efficient screening for severe aortic valve stenosis using understandable artificial intelligence: a prospective diagnostic accuracy study. Eur Heart J Digit Health 2022; 3:141-152. [PMID: 36713014 PMCID: PMC9707975 DOI: 10.1093/ehjdh/ztac029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/08/2022] [Indexed: 02/01/2023]
Abstract
Aims The medical need for screening of aortic valve stenosis (AS), which leads to timely and appropriate medical intervention, is rapidly increasing because of the high prevalence of AS in elderly population. This study aimed to establish a screening method using understandable artificial intelligence (AI) to detect severe AS based on heart sounds and to package the built AI into a smartphone application. Methods and results In this diagnostic accuracy study, we developed multiple convolutional neural networks (CNNs) using a modified stratified five-fold cross-validation to detect severe AS in electronic heart sound data recorded at three auscultation locations. Clinical validation was performed with the developed smartphone application in an independent cohort (model establishment: n = 556, clinical validation: n = 132). Our ensemble technique integrating the heart sounds from multiple auscultation locations increased the detection accuracy of CNN model by compensating detection errors. The established smartphone application achieved a sensitivity, specificity, accuracy, and F1 value of 97.6% (41/42), 94.4% (85/90), 95.7% (126/132), and 0.93, respectively, which were higher compared with the consensus of cardiologists (81.0%, 93.3%, 89.4%, and 0.829, respectively), implying a good utility for severe AS screening. The Gradient-based Class Activation Map demonstrated that the built AIs could focus on specific heart sounds to differentiate the severity of AS. Conclusions Our CNN model combining multiple auscultation locations and exported on smartphone application could efficiently identify severe AS based on heart sounds. The visual explanation of AI decisions for heart sounds was interpretable. These technologies may support medical training and remote consultations.
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Affiliation(s)
- Hisaki Makimoto
- Corresponding author. Tel: +49 211 81 18800, Fax: +49 211 81 19520, E-mail:
| | | | - Benita Kohlmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christofori Eleni Magnisali
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Kathrin Klein
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Asuka Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany,CARID - Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
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Makimoto H, Shiraga T, Kohlmann B, Magnisali CE, Schenk R, Gerguri S, Motoyama N, Clasen L, Bejinariu A, Schmidt J, Brinkmeyer C, Westenfeld R, Zeus T, Kelm M. On-device artificial intelligence: mobile solution for detecting severe aortic valve stenosis based on heart sounds. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis is still one of the major causes of sudden cardiac death in the elderly. Noninvasive screening for severe aortic valve stenosis (AS) may result in early cardiac diagnostic leading to an appropriate and timely medical intervention.
Purpose
The aims of this study were 1) to develop an artificial intelligence to detect severe AS based on heart sounds and 2) to build an application to screen patients using electronic stethoscope and smartphones, which will provide an efficient diagnostic workflow for screening as a complementary tool in daily clinical practice.
Methods
We enrolled 100 patients diagnosed with severe AS and 200 patients without severe AS (no echocardiographic sign of AS [n=100], mild AS [n=50], moderate AS [n=50]). The heart sounds were recorded in 4000 Hz waveform audio format at the following 3 sites of each patient; the 2nd intercostal right sternal border, the Erb's area and the apex. Each record was divided into multiple data of 4 seconds duration, which built 10800 sound records in total. We developed multiple convolutional neural networks (CNN) designed to recognize severe AS in heart sounds according to the recorded 3 sites. We adopted a stratified 4-fold cross-validation method by which the CNN was trained with 60% of the whole data, validated with 20% data and tested with the remaining 20% data not used during training and validation. As performance metrics we adopted the accuracy, F1 value and the area under the curve (AUC) calculated as the average of all cross-validation folds.
For the smartphone application, we combined the best CNN-models from each recorded site for the best performance. Further 40 patients were newly enrolled for its clinical validation (no AS [n=10], mild AS [n=10], moderate AS [n=10], severe AS [n=10]).
Results
The accuracy, F1 value and AUC of each model were 88.9±5.7%, 0.888±0.006 and 0.953±0.008, respectively. The sensitivity and specificity were 87.9±2.2% and 89.9±2.4%. The recognition accuracy of moderate AS was significantly lower as compared to the other AS grades (moderate AS 74.1±6.1% vs no AS 98.0±1.4%, mild AS 97.6±1.2%, severe AS 87.9±2.2%, respectively, P<0.05).
Our smartphone application showed a sensitivity of 100% (10/10), a specificity of 73.3% (22/30), and an accuracy of 80.0% (32/40), which implicated a good utility for screening. In the detailed analysis of 8 mistaken decisions, these were highly affected by the presence of severe mitral or tricuspid valve regurgitation despite of non-severe AS (7/8 [87.5%]).
Conclusions
This study demonstrated the promising possibility of an end-to-end screening for severe aortic valve stenosis using an electronic stethoscope and a smartphone application. This technology may improve the efficacy of daily medicine particularly where the human resource is limited or support a remote medical consultation. Further investigations are necessary to increase accuracy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Shiraga
- Mitsubishi Electric Inc., Kamakura, Japan
| | - B Kohlmann
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C.-E Magnisali
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Schenk
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - N Motoyama
- Mitsubishi Electric Inc., Kamakura, Japan
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Westenfeld
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Zeus
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, CARID, Dusseldorf, Germany
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Dannenberg L, Afzal S, Gerguri S, Piayda K, Kelm M, Zeus T, Polzin A, Veulemans V. Duplex echocardiography in multivalvular heart disease after percutaneous mitral valve repair? Eur J Clin Invest 2020; 50:e13340. [PMID: 32649782 DOI: 10.1111/eci.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lisa Dannenberg
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
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Makimoto H, Höckmann M, Lin T, Glöckner D, Gerguri S, Clasen L, Schmidt J, Assadi-Schmidt A, Bejinariu A, Müller P, Angendohr S, Babady M, Brinkmeyer C, Makimoto A, Kelm M. Performance of a convolutional neural network derived from an ECG database in recognizing myocardial infarction. Sci Rep 2020; 10:8445. [PMID: 32439873 PMCID: PMC7242480 DOI: 10.1038/s41598-020-65105-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
Abstract
Artificial intelligence (AI) is developing rapidly in the medical technology field, particularly in image analysis. ECG-diagnosis is an image analysis in the sense that cardiologists assess the waveforms presented in a 2-dimensional image. We hypothesized that an AI using a convolutional neural network (CNN) may also recognize ECG images and patterns accurately. We used the PTB ECG database consisting of 289 ECGs including 148 myocardial infarction (MI) cases to develop a CNN to recognize MI in ECG. Our CNN model, equipped with 6-layer architecture, was trained with training-set ECGs. After that, our CNN and 10 physicians are tested with test-set ECGs and compared their MI recognition capability in metrics F1 (harmonic mean of precision and recall) and accuracy. The F1 and accuracy by our CNN were significantly higher (83 ± 4%, 81 ± 4%) as compared to physicians (70 ± 7%, 67 ± 7%, P < 0.0001, respectively). Furthermore, elimination of Goldberger-leads or ECG image compression up to quarter resolution did not significantly decrease the recognition capability. Deep learning with a simple CNN for image analysis may achieve a comparable capability to physicians in recognizing MI on ECG. Further investigation is warranted for the use of AI in ECG image assessment.
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Affiliation(s)
- Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany.
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany.
| | - Moritz Höckmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Tina Lin
- GenesisCare, Victoria, Australia
| | - David Glöckner
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Athena Assadi-Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Alexandru Bejinariu
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Stephan Angendohr
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Mehran Babady
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Asuka Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine-University Düsseldorf, Duesseldorf, Germany
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Makimoto H, Zielke S, Clasen L, Lin T, Gerguri S, Müller P, Schmidt J, Bejinariu A, Kurt M, Brinkmeyer C, Stern M, Kelm M, Fürnkranz A. Clinical significance of precedent asymptomatic non-sustained ventricular tachycardias on subsequent ICD interventions and heart failure hospitalization in primary prevention ICD patients. Eur J Med Res 2020; 25:5. [PMID: 32183891 PMCID: PMC7076933 DOI: 10.1186/s40001-020-0401-x] [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: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The prognostic implications of non-sustained ventricular tachycardia (NSVT) and their significance as therapeutic targets in patients without prior sustained ventricular arrhythmias remain undetermined. The aim of this study was to investigate the prognostic significance of asymptomatic NSVT in patients who had primary prevention implantable cardioverter-defibrillator (ICD) implantation due to ischemic or non-ischemic cardiomyopathy (ICM, NICM). Methods We enrolled 157 consecutive primary prevention ICD patients without previous appropriate ICD therapy (AIT). Patients were allocated to two groups depending on the presence or absence of NSVT in a 6-month period prior to enrollment. The incidence of AIT and unplanned hospitalization due to decompensated heart failure (HF) were assessed during follow-up. Results In 51 patients (32%), precedent NSVT was documented. During a median follow-up of 1011 days, AIT occurred in 36 patients (23%) and unplanned HF hospitalization was observed in 32 patients (20%). In precedent NSVT patients, the incidence of AIT and unplanned HF hospitalization was significantly higher as compared to patients without precedent NSVT (AIT: 29/51 [57%] vs. 7/106 [7%], P < 0.001, log-rank; HF hospitalization: 16/51 [31%] vs. 16/106 [15%], P = 0.043, log-rank). Cox-regression demonstrated that precedent NSVT independently predicted AIT (P < 0.0001). In subgroup analyses, precedent NSVT predicted AIT in both ICM and NICM (P < 0.0001, P = 0.020), but predicted HF hospitalization only in patients with ICM (P = 0.0030). Conclusions Precedent non-sustained VT in patients with primary prevention ICDs is associated with subsequent appropriate ICD therapies, and is an independent predictor of unplanned heart failure hospitalizations in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany. .,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany.
| | - Sophie Zielke
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany
| | - Tina Lin
- GenesisCare, East Melbourne, VIC, Australia
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Manuel Stern
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorensstrasse 5, 40225, Düsseldorf, Germany
| | - Alexander Fürnkranz
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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Kurt M, Jathanna N, Babady M, Schmidt J, Müller P, Gerguri S, Clasen L, Bejinariu A, Kelm M, Fürnkranz A, Makimoto H. Avoiding inappropriate therapy of single-lead implantable cardioverter-defibrillator by using atrial-sensing electrodes. J Cardiovasc Electrophysiol 2018; 29:1682-1689. [PMID: 30203568 DOI: 10.1111/jce.13736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The single-chamber implantable cardioverter-defibrillator (ICD) can be associated with more frequent inappropriate therapies compared with dual-chamber ICDs, when they are accompanied by a simpler implantation procedure. The aim of this study was to investigate whether the use of a single-lead ICD system with atrial-sensing electrodes results in a reduction of inappropriate ICD therapy. METHODS AND RESULTS The study population consisted of 212 consecutive patients, who underwent primary prophylactic single-lead ICD implantation at our institute. A ventricular lead with atrial-sensing electrodes was implanted in 77 patients (36%; Group-VDD) and a ventricular lead without atrial-sensing electrodes was implanted in 135 patients (64%; Group-VVI). Procedural and follow-up data were collected in a prospective registry. A higher prevalence of atrial fibrillation was present in Group-VDD. There were no other significant differences in patient baseline characteristics (age, sex, and other comorbidities) or follow-up period between the two groups. The operative parameters including fluoroscopic burden showed no significant differences between Group-VDD and Group-VVI. During a mean follow-up period of 697 ± 392 days, 26 patients (12%) experienced appropriate ICD therapies and 13 patients (6%) suffered inappropriate ICD therapies. The incidence of inappropriate ICD therapies in Group-VDD was significantly lower as compared to that of Group-VVI (1/77 [1%] vs 12/135 [9%]; log-rank, P = 0.028). The incidence of appropriate ICD therapies and the occurrence of device-related complications showed no significant difference between the two groups. CONCLUSION Single-lead ICD with atrial-sensing electrodes shows a lower incidence of inappropriate ICD therapy compared with the absence of atrial-sensing electrodes, without additional operative burden or increased complications.
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Affiliation(s)
- Muhammed Kurt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikesh Jathanna
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mehran Babady
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shqipe Gerguri
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lukas Clasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
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9
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Gerguri S, Jathanna N, Lin T, Müller P, Clasen L, Schmidt J, Kurt M, Shin DI, Blockhaus C, Kelm M, Fürnkranz A, Makimoto H. Clinical impact of "pure" empirical catheter ablation of slow-pathway in patients with non-ECG documented clinical on-off tachycardia. Eur J Med Res 2018; 23:16. [PMID: 29580297 PMCID: PMC5870342 DOI: 10.1186/s40001-018-0314-0] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Catheter ablation of slow-pathway (CaSP) has been reported to be effective in patients with dual atrioventricular nodal conduction properties (dcp-AVN) and clinical ECG documentation but without the induction of tachycardia during electrophysiological studies (EPS). However, it is unknown whether CaSP is beneficial in the absence of pre-procedural ECG documentation and without the induction of tachycardia during EPS. The aim of this study was to evaluate long-term results after a “pure” empirical CaSP (peCaSP). Methods 334 consecutive patients who underwent CaSP (91 male, 47.5 ± 17.6 years) were included in this study. Sixty-three patients (19%) who had no pre-procedural ECG documentation, and demonstrated dcp-AVN with a maximum of one echo-beat were assigned to the peCaSP group. The remaining 271 patients (81%) were assigned to the standard CaSP group (stCaSP). Clinical outcomes of the two groups were compared, based on ECG documented recurrence or absence of tachycardia and patients’ recorded symptoms. Results CaSP was performed in all patients without any major complications including atrioventricular block. During follow-up (909 ± 435 days), 258 patients (77%) reported complete cessation of clinical symptoms. There was no statistically significant difference in the incidence of AVNRT recurrence between the peCaSP and stCaSP groups (1/63 [1.6%] vs 3/271 [1.1%], P = 0.75). Complete cessation of clinical symptoms was noted significantly less frequently in patients after peCaSP (39/63 [62%] vs 219/271 [81%], P = 0.0013). The incidence of non-AVNRT atrial tachyarrhythmias (AT) was significantly higher in patients after peCaSP (5/63 [7.9%] vs 1/271 [0.4%], P = 0.0011). Conclusion A higher incidence of other AT and subjective symptom persistence are demonstrated after peCaSP, while peCaSP improves clinical symptoms in 60% of patients with non-documented on–off tachycardia.
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Affiliation(s)
- Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Nikesh Jathanna
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Tina Lin
- Heart Care Victoria, Victoria, Australia
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Dong-In Shin
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christian Blockhaus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. .,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany.
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Blockhaus C, Müller P, vom Dahl S, Leonhardt S, Häussinger D, Gerguri S, Clasen L, Schmidt J, Kurt M, Brinkmeyer C, Kelm M, Shin DI, Makimoto H. Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe. Int Heart J 2017; 58:880-884. [DOI: 10.1536/ihj.16-382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/18/2022]
Affiliation(s)
- Christian Blockhaus
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Patrick Müller
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Stephan vom Dahl
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Silke Leonhardt
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Dieter Häussinger
- Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
| | - Shqipe Gerguri
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Lucas Clasen
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Jan Schmidt
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Muhammed Kurt
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Christoph Brinkmeyer
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Dong-In Shin
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
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Blockhaus C, Müller P, Leonhardt S, Dahl S, Gerguri S, Clasen L, Schmidt J, Kurt M, Brinkmeyer C, Katsianos E, Kelm M, Shin DI, Makimoto H. 16-20: Impact of Contact-Force guided Catheter Ablation for Atrial Fibrillation without usage of Esophageal Temperature Monitoring. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Makimoto H, Blockhaus C, Lukas C, Schmidt J, Kurt M, Brinkmeyer C, Müller P, Katsianos E, Gerguri S, Kelm M, Shin DI. 176-08: Break of circular catheter stuck in a right-inferior pulmonary vein during cryoballon pulmonary vein isolation. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gerguri S, Blockhaus C, Müller P, Lukas C, Schmidt J, Kurt M, Brinkmeyer C, Katsianos E, Kelm M, Shin DI, Makimoto H. 56-30: Clinical impact of slow-pathway ablation in patients with clinical on-off tachycardia symptoms; from a standpoint of symptomatic improvement. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i39a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Blockhaus C, Schmidt J, Kurt M, Clasen L, Brinkmeyer C, Katsianos E, Müller P, Gerguri S, Kelm M, Shin DI, Makimoto H. Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter. Int Heart J 2016; 57:299-303. [PMID: 27181037 DOI: 10.1536/ihj.15-399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
Pulmonary vein isolation (PVI) is a cornerstone therapy in patients with atrial fibrillation (AF). With increasing numbers of PVI procedures, demand arises to reduce the cumulative fluoroscopic radiation exposure for both the physician and the patient. New technologies are emerging to address this issue. Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed. All PVI procedures were performed by one experienced physician using a commercially available circular multipolar irrigated ablation catheter. All PVI procedures were successfully undertaken without major complications. Baseline characteristics of the two groups showed no significant differences. In the group using the FIS, the fluoroscopic time and DAP were significantly reduced from 571 ± 187 seconds versus 1011 ± 527 seconds (P = 0.0029) and 4342 ± 2073 cGycm(2) versus 6208 ± 3314 cGycm(2) (P = 0.049), respectively. Mean procedure time was not significantly affected and was 114 ± 31 minutes versus 104 ± 24 minutes (P = 0.23) by the FIS.The use of the new FIS with the current 3D-mapping system enables a significant reduction of the total fluoroscopy time and DAP compared to the previous combination of 3D-mapping system plus normal fluoroscopy during PVI utilizing a circular multipolar irrigated ablation catheter. However, the concomitant total procedure time is not affected. Thus, the new system reduces the radiation exposure for both the physicians and patients.
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Affiliation(s)
- Christian Blockhaus
- Cardiac Arrhythmia Service, Division of Cardiology, Pulmonology and Vascular Medicine, University Duesseldorf, Medical Faculty
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