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Amorós-Figueras G, Casabella-Ramon S, Moreno-Weidmann Z, Ivorra A, Guerra JM, García-Sánchez T. Dynamics of High-Density Unipolar Epicardial Electrograms During PFA. Circ Arrhythm Electrophysiol 2023; 16:e011914. [PMID: 37577822 DOI: 10.1161/circep.123.011914] [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: 02/22/2023] [Accepted: 07/16/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation technology based on irreversible electroporation (IRE). While areas of IRE lead to durable lesions, the surrounding regions, where reversible electroporation occurs, recover. The behavior of local electrograms in areas of different electroporation levels remains unknown. The goal of this study is to characterize electrogram dynamics after PFA in IRE and reversible electroporation areas. METHODS A total of 6 domestic swine were used. PFA was applied in the epicardium of the right and left ventricles using a focal monopolar catheter. Additional radiofrequency ablations were performed. Epicardial unipolar electrograms were acquired at baseline and for 60 minutes post PFA/radiofrequency ablation using a high-density electrode matrix attached to the epicardium. Electrogram dynamics were analyzed in areas corresponding to different levels of electroporation. Acute lesion formation was assessed after 3 to 5 hours by triphenyl tetrazolium chloride staining. RESULTS Electrogram analysis demonstrated a clear association between electrogram changes and the level of electroporation. Immediately after PFA, electrograms displayed the following: a significant decrease in R/S-wave amplitude; a large elevation of the ST-segment; and a large decrease in their |(dV/dt)|max. Marked changes in electrograms were observed beyond the lesion area. Thereafter, a gradual recovery was observed. The evolution of all the electrogram parameters throughout the 60 minutes after PFA was significantly different (P<0.05) between the IRE and reversible electroporation areas. Acute lesion staining showed significantly larger depth for PFA lesions compared with radiofrequency ablation. CONCLUSIONS This study shows that unipolar electrograms can differentiate between reversible electroporation and IRE areas during the first 30 minutes post ablation. Differences after the first 30 minutes are less evident. Our findings could result useful for immediate lesion assessment after PFA and warrant further investigation.
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Affiliation(s)
- Gerard Amorós-Figueras
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Sergi Casabella-Ramon
- Instituto de Investigaciones Biomédicas de Barcelona, (IIBB-)CSIC, CIBERCV, IIB SANT PAU, Spain (S.C.-R.)
| | - Zoraida Moreno-Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (A.I., T.G.-S.)
- Serra Hunter Fellow Programme (A.I.)
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.)
| | - Tomás García-Sánchez
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain (A.I., T.G.-S.)
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Campos-García B, Alonso-Martín C, Guerra JM, Moreno-Weidmann Z, Méndez-Zurita F, Montiel-Quintero R, Betancur-Gutiérrez A, Viñolas-Prat X, Rodríguez-Font E. Reassessment of the electrical connection between the pulmonary veins and the left atrium: A study to determine the different contributions of myocardial fibers along the standard ablation circumference. Front Cardiovasc Med 2023; 10:1162197. [PMID: 37346283 PMCID: PMC10280734 DOI: 10.3389/fcvm.2023.1162197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Background Circumferential ablation around the ipsilateral pulmonary veins (PVs) is the standard strategy for atrial fibrillation ablation. The present study seeks to assess which regions of the standard ablation circumference are the main contributors to the venoatrial electrical connection. Methods A total of 41 patients were included under a specific atrial fibrillation ablation protocol in which the anterior and posterior segments of the standard circumference, between the equatorial line of the superior and the inferior ipsilateral PVs, were ablated first. If PV isolation was not achieved, ablation was extended superiorly or inferiorly, on the basis of the earliest atrial activation recorded during pacing from inside the PV. Complete PV isolation and the length of the areas not requiring ablation (ANRA) at the time of electrical isolation were evaluated. Results Ablation of the anterior and posterior segments of the standard circumference led to the isolation of 77% left-PV pairs and 51% right-PV pairs (p = 0,015). A superior extension was required in 23% left-PV pairs and in 46% right-PV pairs, while an inferior extension was required only in 10% left-PV pairs and in 11% right-PV pairs. PV isolation was achieved before completing the standard ablation circumference in 97% left-PV pairs and in 94% right-PV pairs, with a median ANRA of 36.9 (IQR: 30.9-42.1) mm in the left PVs [16.0 (IQR: 12.0-19.0) mm superior and 18.8 (IQR: 16.1-24.9) mm inferior, p < 0.01] and 36.9 (IQR: 30.2-41.0) mm in the right PVs [15.1 (IQR: 10.7-19.1) mm superior and 20.6 (IQR: 16.9-23.3) mm inferior, p < 0.01]. Conclusions The myocardial fibers along the anterior and posterior regions of the standard ablation circumference are the main contributors to the electrical connection between the pulmonary veins and the left atrium. Ablation of these regions results in PV isolation in the majority of patients.
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Huang T, Nairn D, Chen J, Mueller-Edenborn B, Pilia N, Mayer L, Eichenlaub M, Moreno-Weidmann Z, Allgeier J, Trenk D, Ahlgrim C, Westermann D, Arentz T, Loewe A, Jadidi A. Structural and electrophysiological determinants of atrial cardiomyopathy identify remodeling discrepancies between paroxysmal and persistent atrial fibrillation. Front Cardiovasc Med 2023; 9:1101152. [PMID: 36712269 PMCID: PMC9874680 DOI: 10.3389/fcvm.2022.1101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
Background Progressive atrial fibrotic remodeling has been reported to be associated with atrial cardiomyopathy (ACM) and the transition from paroxysmal to persistent atrial fibrillation (AF). We sought to identify the anatomical/structural and electrophysiological factors involved in atrial remodeling that promote AF persistency. Methods Consecutive patients with paroxysmal (n = 134) or persistent (n = 136) AF who presented for their first AF ablation procedure were included. Patients underwent left atrial (LA) high-definition mapping (1,835 ± 421 sites/map) during sinus rhythm (SR) and were randomized to training and validation sets for model development and evaluation. A total of 62 parameters from both electro-anatomical mapping and non-invasive baseline data were extracted encompassing four main categories: (1) LA size, (2) extent of low-voltage-substrate (LVS), (3) LA voltages and (4) bi-atrial conduction time as identified by the duration of amplified P-wave (APWD) in a digital 12-lead-ECG. Least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to identify the factors that are most relevant to AF persistency in each category alone and all categories combined. The performance of the developed models for diagnosis of AF persistency was validated regarding discrimination, calibration and clinical usefulness. In addition, HATCH score and C2HEST score were also evaluated for their performance in identification of AF persistency. Results In training and validation sets, APWD (threshold 151 ms), LA volume (LAV, threshold 94 mL), bipolar LVS area < 1.0 mV (threshold 4.55 cm2) and LA global mean voltage (GMV, threshold 1.66 mV) were identified as best determinants for AF persistency in the respective category. Moreover, APWD (AUC 0.851 and 0.801) and LA volume (AUC 0.788 and 0.741) achieved better discrimination between AF types than LVS extent (AUC 0.783 and 0.682) and GMV (AUC 0.751 and 0.707). The integrated model (combining APWD and LAV) yielded the best discrimination performance between AF types (AUC 0.876 in training set and 0.830 in validation set). In contrast, HATCH score and C2HEST score only achieved AUC < 0.60 in identifying individuals with persistent AF in current study. Conclusion Among 62 electro-anatomical parameters, we identified APWD, LA volume, LVS extent, and mean LA voltage as the four determinant electrophysiological and structural factors that are most relevant for AF persistency. Notably, the combination of APWD with LA volume enabled discrimination between paroxysmal and persistent AF with high accuracy, emphasizing their importance as underlying substrate of persistent AF.
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Affiliation(s)
- Taiyuan Huang
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Deborah Nairn
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Juan Chen
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany,Department of Cardiology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bjoern Mueller-Edenborn
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nicolas Pilia
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Louisa Mayer
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Zoraida Moreno-Weidmann
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Juergen Allgeier
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dietmar Trenk
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Ahlgrim
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dirk Westermann
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Amir Jadidi
- Arrhythmia Division, Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany,*Correspondence: Amir Jadidi,
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Creta A, Venier S, Tampakis K, Providencia R, Sunny J, Defaye P, Earley MJ, Finlay M, Hunter RJ, Lambiase PD, Papageorgiou N, Schilling RJ, Sporton S, Andrikopoulos G, Deschamps E, Albenque JP, Cardin C, Combes N, Combes S, Vinolas X, Moreno-Weidmann Z, Huang T, Eichenlaub M, Müller-Edenborn B, Arentz T, Jadidi AS, Boveda S. Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study. Front Cardiovasc Med 2023; 10:1110165. [PMID: 37051067 PMCID: PMC10083273 DOI: 10.3389/fcvm.2023.1110165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Outcomes of catheter ablation for non-paroxysmal atrial fibrillation (AF) remain suboptimal. Non-invasive stratification of patients based on the presence of atrial cardiomyopathy (ACM) could allow to identify the best responders to pulmonary vein isolation (PVI). Methods Observational multicentre retrospective study in patients undergoing cryoballoon-PVI for non-paroxysmal AF. The duration of amplified P-wave (APW) was measured from a digitally recorded 12-lead electrocardiogram during the procedure. If patients were in AF, direct-current cardioversion was performed to allow APW measurement in sinus rhythm. An APW cut-off of 150 ms was used to identify patients with significant ACM. We assessed freedom from arrhythmia recurrence at long-term follow-up in patients with APW ≥ 150 ms vs. APW < 150 ms. Results We included 295 patients (mean age 62.3 ± 10.6), of whom 193 (65.4%) suffered from persistent AF and the remaining 102 (34.6%) from long-standing persistent AF. One-hundred-forty-two patients (50.2%) experienced arrhythmia recurrence during a mean follow-up of 793 ± 604 days. Patients with APW ≥ 150 ms had a significantly higher recurrence rate post ablation compared to those with APW < 150 ms (57.0% vs. 41.6%; log-rank p < 0.001). On a multivariable Cox-regression analysis, APW≥150 ms was the only independent predictor of arrhythmia recurrence post ablation (HR 2.03 CI95% 1.28-3.21; p = 0.002). Conclusion APW duration predicts arrhythmia recurrence post cryoballoon-PVI in persistent and long-standing persistent AF. An APW cut-off of 150 ms allows to identify patients with significant ACM who have worse outcomes post PVI. Analysis of APW represents an easy, non-invasive and highly reproducible diagnostic tool which allows to identify patients who are the most likely to benefit from PVI-only approach.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Sandrine Venier
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Konstantinos Tampakis
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Juno Sunny
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Mark J. Earley
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Ross J. Hunter
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | - Simon Sporton
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - George Andrikopoulos
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
| | - Elodie Deschamps
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | | | | | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Xavier Vinolas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Taiyuan Huang
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Björn Müller-Edenborn
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Amir S. Jadidi
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulose, France
- Correspondence: Serge Boveda
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Campos-García B, Alonso-Martín C, Moreno-Weidmann Z, Rodríguez-Font E, Méndez-Zurita FJ, Viñolas X. Impact on early patient mobilization of the use of a single vascular closure device in patients undergoing leadless pacemaker implantation. Rev Esp Cardiol (Engl Ed) 2022; 76:276-278. [PMID: 36572098 DOI: 10.1016/j.rec.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Bieito Campos-García
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Concepción Alonso-Martín
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Zoraida Moreno-Weidmann
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Enrique Rodríguez-Font
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco J Méndez-Zurita
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Xavier Viñolas
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Amoros-Figueras G, Casabella-Ramon S, Moreno-Weidmann Z, Company-Ramon G, Jorge E, Rosell-Ferrer J, Cinca J, Guerra JM. Real-time electrophysiological characterization of acute and chronic radiofrequency ablation lesions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2972] [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
Assessment of lesion formation remains one of the most important goals to guide radiofrequency (RF) procedures in the cardiac electrophysiology laboratory. Cardiac navigation systems use specific algorithms to predict the effective lesion size, but these metrics are based only on ablation parameters and ignore local electric tissue characteristics. [1] Recent studies show that local multiparametric impedance is influenced by the intrinsic structural characteristics of the tissue. [2]
Purpose
This study aimed to assess the ability of local multiparametric impedance to characterize acute and chronic RF ablation lesions in the right atrium of pigs.
Methods
Four anesthetized closed-chest pigs were submitted to two interventions. The first intervention aimed at creating RF ablation lesions (30W, 60s, 55°) in the right atrium using an electrocatheter connected to a conventional cardiac navigation system, while mapping the local multiparametric impedance (LMI), the generator impedance (GI) and the bipolar voltage (BiV). All RF ablation lesions were performed with a stable contact force. Four weeks later, the second intervention aimed at mapping again the previous ablation sites. After the second intervention animals were euthanized and the hearts were removed and processed to identify the presence of fibrosis in the previously ablated lesions (Figure).
Results
We performed 19 ablations (5±2 per animal) with an average contact force of 14.2±4.6g. Four weeks later, 14/19 (74%) ablation lesions were identified as fibrotic points in the explanted heart (Figure 1). These showed decreased acute LMI and BiV values that persisted low after 4 weeks (Table 1). The remaining 5/19 ablations that did not present fibrosis had lower baseline LMI and bipolar values that resulted in lower LMI and BiV drops (Table 1). The absolute drop in LMI between effective and non-effective lesions was around 50%, while GI drop was only 21% (LMI drop @51KHz: From −3.0±1.4° to −1.5±0.3°, T-TEST p<0.05; GI drop: From 12.7±27.6Ω to 10.5±21.3Ω, T-TEST p=0.89).
Conclusion
The local baseline electrical properties of atrial myocardium are directly related to the effectiveness of RF ablation lesions. RF ablation sites that resulted into persistent fibrosis points had larger LMI and BiV values, with higher absolute drops than non-effective lesions. The use of LMI in clinical practice could improve the outcome of the procedures of arrhythmia ablation in the electrophysiology lab.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grants from ISCI-MINECO (FIS PI21/00392), FEDER, CIBERCV (CB16/11/00276)
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Affiliation(s)
- G Amoros-Figueras
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - S Casabella-Ramon
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - Z Moreno-Weidmann
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - G Company-Ramon
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - E Jorge
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - J Rosell-Ferrer
- Universitat Politècnica de Catalunya, Electronic and Biomedical Instrumentation Group, CIBERCV , Barcelona , Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
| | - J M Guerra
- Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV , Barcelona , Spain
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Campos Garcia B, Hernandez-Ontiveros H, Avila-Parcet A, Garcia-Hernando V, Carceller-Sindreu M, Salazar-Blanco J, Rodriguez-Santiago B, Juanes-Borrego A, Alonso-Martin C, Rodriguez-Font E, Moreno-Weidmann Z, Mendez-Zurita F, Vinolas-Prat X, Guerra Ramos JM. Clinical features of drug-induced long QT syndrome in a large prospective cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Drug-induced long QT syndrome (DI-LQTS) is a clinical entity with prevalence and arrhythmic risk not well defined.
Purpose
To determine the clinical characteristics of patients with DI-LQTS diagnosed in the setting of a tertiary hospital center.
Methods
Prospective observational study with consecutive inclusion of patients with the diagnosis of DI-LQTS as per standard criteria, in a tertiary hospital, between 2018 and 2022.
Results
Eighty-five patients were included (age 65±15 years, 59% male). The mean corrected QT interval (QTc) of the entire cohort was 545±56 ms. The drugs responsible for QTc prolongation were: psychotropic drugs 51%, antiarrhythmics 38%, anesthetics 29%, antibiotics 15%, antineoplastics 3%, other 2%. QTc prolongation was due to the combination of ≥2 responsible drugs in 46 (54%) patients, and to the use of a single drug in 39 (46%).
Twenty-one patients (25%) presented ventricular arrhythmias at the time of drug-induced QT prolongation: 10 (12%) ventricular fibrillation, 7 (8%) sustained ventricular tachycardia, 3 (3%) non-sustained ventricular tachycardia, 1 (1%) frequent ventricular extrasystole. Patients with ventricular arrhythmias were older (73±12 vs 62±15 years, p<0.05) and exhibited longer QTc prolongation (600±59 vs 528±42 ms, p<0.05).
Conclusion
The DI-LQTS is a rare clinical entity but may be cause of clinically-relevant ventricular arrhythmias. Older age and greater prolongation of the QTc interval are associated with an increased risk of ventricular arrhythmic events.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Institute Carlos III, Spain
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Affiliation(s)
- B Campos Garcia
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | | | - A Avila-Parcet
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - V Garcia-Hernando
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | | | - J Salazar-Blanco
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | | | - A Juanes-Borrego
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - C Alonso-Martin
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - E Rodriguez-Font
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - Z Moreno-Weidmann
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - F Mendez-Zurita
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - X Vinolas-Prat
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
| | - J M Guerra Ramos
- Hospital de la Santa Creu i Sant Pau, Cardiology , Barcelona , Spain
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Müller-Edenborn B, Moreno-Weidmann Z, Venier S, Defaye P, Park CI, Guerra J, Alonso-Martín C, Bazan V, Vinolas X, Rodriguez-Font E, Garcia BC, Boveda S, Combes S, Albenque JP, Guy-Moyat B, Trenk D, Eichenlaub M, Chen J, Lehrmann H, Neumann FJ, Arentz T, Jadidi A. Determinants of fibrotic atrial cardiomyopathy in atrial fibrillation. A multicenter observational study of the RETAC (reseau européen de traîtement d'arrhythmies cardiaques)-group. Clin Res Cardiol 2021; 111:1018-1027. [PMID: 34854991 PMCID: PMC9424172 DOI: 10.1007/s00392-021-01973-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Aims Despite advances in interventional treatment strategies, atrial fibrillation (AF) remains associated with significant morbidity and mortality. Fibrotic atrial myopathy (FAM) is a main factor for adverse outcomes of AF-ablation, but complex to diagnose using current methods. We aimed to derive a scoring system based entirely on easily available clinical parameters to predict FAM and ablation-success in everyday care. Methods In this multicenter, prospective study, a new risk stratification model termed AF-SCORE was derived in 220 patients undergoing high-density left-atrial(LA) voltage-mapping to quantify FAM. AF-SCORE was validated for FAM in an external mapping-validation cohort (n = 220) and for success following pulmonary vein isolation (PVI)-only (without adjunctive left- or right atrial ablations) in an external outcome-validation cohort (n = 518). Results FAM was rare in patients < 60 years (5.4%), but increased with ageing and affected 40.4% (59/146) of patients ≥ 60 years. Sex and AF-phenotype had additional predictive value in older patients and remained associated with FAM in multivariate models (odds ratio [OR] 6.194, p < 0.0001 for ≥ 60 years; OR 2.863, p < 0.0001 for female sex; OR 41.309, p < 0.0001 for AF-persistency). Additional clinical or diagnostic variables did not improve the model. AF-SCORE (+ 1 point for age ≥ 60 years and additional points for female sex [+ 1] and AF-persistency [+ 2]) showed good discrimination to detect FAM (c-statistic 0.792) and predicted arrhythmia-freedom following PVI (74.3%, 54.7% and 45.5% for AF-SCORE ≤ 2, 3 and 4, respectively, and hazard ratio [HR] 1.994 for AF-SCORE = 3 and HR 2.866 for AF-SCORE = 4, p < 0.001). Conclusions Age, sex and AF-phenotype are the main determinants for the development of FAM. A low AF-SCORE ≤ 2 is found in paroxysmal AF-patients of any age and younger patients with persistent AF irrespective of sex, and associated with favorable outcomes of PVI-only. Freedom from arrhythmia remains unsatisfactory with AF-SCORE ≥ 3 as found in older patients, particularly females, with persistent AF, and future studies investigating adjunctive atrial ablations to PVI-only should focus on these groups of patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01973-1.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany. .,Department of Cardiology, Julius-Hospital, Würzburg, Germany.
| | - Zoraida Moreno-Weidmann
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Sandrine Venier
- Department of Cardiology, University Hospital Grenoble, Grenoble, France
| | - Pascale Defaye
- Department of Cardiology, University Hospital Grenoble, Grenoble, France
| | - Chan-Il Park
- Department of Cardiology, Clinique de la Tour, Geneva, Switzerland
| | - José Guerra
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Concepcion Alonso-Martín
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Victor Bazan
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Xavier Vinolas
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Enrique Rodriguez-Font
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Bieito Campos Garcia
- Department of Electrophysiology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | | | - Benoit Guy-Moyat
- Department of Cardiology, University Hospital Limoges, Limoges, France
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, Section for Pharmacology, Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology II, Section for Electrophysiology, Heart Center, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
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9
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Garcia-Hernando V, Mendez-Zurita F, Rodriguez-Font E, Alonso-Martin C, Guerra-Ramos JM, Campos-Garcia B, Moreno-Weidmann Z, Maestro Benedicto A, Viñolas P X. ICD shock below the detection rate therapy zone-When appropriate is inadequate. J Cardiovasc Electrophysiol 2021; 32:3214-3216. [PMID: 34532919 DOI: 10.1111/jce.15241] [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: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Victor Garcia-Hernando
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Mendez-Zurita
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Rodriguez-Font
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jose M Guerra-Ramos
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Bieito Campos-Garcia
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Maestro Benedicto
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Xavier Viñolas P
- Arrhythmia Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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10
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Müller-Edenborn B, Chen J, Allgeier J, Didenko M, Moreno-Weidmann Z, Neumann FJ, Lehrmann H, Weber R, Arentz T, Jadidi A. Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation. Europace 2021; 22:240-249. [PMID: 31782781 DOI: 10.1093/europace/euz297] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Presence of arrhythmogenic left atrial (LA) low-voltage substrate (LVS) is associated with reduced arthythmia freedom rates following pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). We hypothesized that LA-LVS modifies amplified sinus-P-wave (APW) characteristics, enabling identification of patients at risk for arrhythmia recurrences following PVI. METHODS AND RESULTS Ninety-five patients with persistent AF underwent high-density (>1200 sites) voltage mapping in sinus rhythm. Left atrial low-voltage substrate (<0.5 and <1.0 mV) was quantified in a 10-segment LA model. Amplified sinus-P-wave-morphology and -duration were evaluated using digitized 12-lead electrocardiograms (40-80 mm/mV, 100-200 mm/s). 12-months arrhythmia freedom following circumferential PVI was assessed in 139 patients with persistent AF. Left atrial low-voltage substrate was most frequently (84%) found at the anteroseptal LA. Characteristic changes of APW were related to the localization and extent of LA-LVS. At an early stage, LA-LVS predominantly located to the LA-anteroseptum and was associated with APW-prolongation (≥150 ms). More extensive LA-LVS involved larger areas of LA-anteroseptum, leading to morphological changes of APW (biphasic positive-negative P-waves in inferior leads). Severe LA-LVS involved the LA-anteroseptum, roof and posterior LA, but spared the inferior LA, lateral LA, and LA appendage. In this advanced stage, widespread LVS at the posterior LA abolished the negative portion of P-wave in the inferior leads. The delayed activation of the lateral LA and LA appendage produced the late positive deflections in the anterolateral leads, resulting in the "late-terminal P"-pattern. Structured analysis of APW-duration and -morphology stratified patients to their individual extent of LA-LVS (Grade 1: mean LA-LVS 4.9 cm2 at <1.0 mV; Grade 2: 28.6 cm2; Grade 3: 42.3 cm2; P < 0.01). The diagnostic value of APW-duration for identification of LA-LVS was significantly superior to standard P-wave-amplification (c-statistic 0.945 vs. 0.647). Arrhythmia freedom following PVI differed significantly between APW-predicted grades of LA-LVS-severity [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.18-4.83; P = 0.015 for Grade 1 vs. Grade 2; HR 1.79, 95% CI 1.00-3.21, P = 0.049 for Grade 2 vs. Grade 3). Arrhythmia freedom 12 months after PVI was 77%, 53%, and 33% in Grades 1, 2 and 3, respectively. CONCLUSION Localization and extent of LA-LVS modifies APW-morphology and -duration. Analysis of APW allows accurate prediction of LA-LVS and enables rapid and non-invasive estimation of arrhythmia freedom following PVI.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Maxim Didenko
- Cardiovascular Surgery Department, Military Medical Academy Named After S.M. Kirov, Saint-Petersburg, Russia.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands
| | - Zoraida Moreno-Weidmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Reinhold Weber
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
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11
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Moreno-Weidmann Z, Müller-Edenborn B, Jadidi AS, Bazan-Gelizo V, Chen J, Park CI, Vivekanantham H, Rodriguez-Font E, Alonso-Martín C, Guerra JM, Campos-García B, Espinosa-Viamonte H, Combes S, Albenque JP, Eichenlaub M, Guy-Moyat B, de Roy L, Defaye P, Boveda S, Arentz T, Viñolas X. Easily available ECG and echocardiographic parameters for prediction of left atrial remodeling and atrial fibrillation recurrence after pulmonary vein isolation: A multicenter study. J Cardiovasc Electrophysiol 2021; 32:1584-1593. [PMID: 33772926 DOI: 10.1111/jce.15013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The assessment of noninvasive markers of left atrial (LA) low-voltage substrate (LVS) enables the identification of atrial fibrillation (AF) patients at risk for arrhythmia recurrence after pulmonary vein isolation (PVI). METHODS In this prospective multicenter study, 292 consecutive AF patients (72% male, 62 ± 11 years, 65% persistent AF) underwent high-density LA voltage mapping in sinus rhythm. LA-LVS (<0.5 mV) was considered as significant at 2 cm2 or above. Preprocedural clinical electrocardiogram and echocardiographic data were assessed to identify predictors of LA-LVS. The role of the identified LA-LVS markers in predicting 1-year arrhythmia freedom after PVI was assessed in 245 patients. RESULTS Significant LA-LVS was identified in 123 (42%) patients. The amplified sinus P-wave duration (APWD) best predicted LA-LVS, with a 148-ms value providing the best-balanced sensitivity (0.81) and specificity (0.88). An APWD over 160 ms was associated with LA-LVS in 96% of patients, whereas an APWD under 145 ms in 15%. Remaining gray zones improved their accuracy by introduction of systolic pulmonary artery pressure (sPAP) of 35 mmHg or above, age, and sex. According to COX regression, the risk of arrhythmia recurrence 12 months following PVI was twofold and threefold higher in patients with APWD 145-160 and over 160 ms, compared to APWD under 145 ms. Integration of pulmonary hypertension further improved the outcome prediction in the intermediate APWD group: Patients with APWD 145-160 ms and normal sPAP had similar outcome than patients with APWD under 145 ms (hazard ratio [HR] 1.62, p = .14), whereas high sPAP implied worse outcome (HR 2.56, p < .001). CONCLUSIONS The APWD identifies LA-LVS and risk for arrhythmia recurrence after PVI. Our prediction model becomes optimized by means of integration of the pulmonary artery pressure.
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Affiliation(s)
- Zoraida Moreno-Weidmann
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain.,Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Björn Müller-Edenborn
- Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Amir S Jadidi
- Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Victor Bazan-Gelizo
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Juan Chen
- Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Chan-Il Park
- Arrhythmia Unit, Department of Cardiology, Hôpital de la Tour, Geneva, Switzerland
| | - Hari Vivekanantham
- Arrhythmia Unit, Department of Cardiology, Hôpital de la Tour, Geneva, Switzerland
| | - Enrique Rodriguez-Font
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | | | - José M Guerra
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Bieito Campos-García
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | | | - Stéphane Combes
- Arrhythmia Unit, Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Jean-Paul Albenque
- Arrhythmia Unit, Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Martin Eichenlaub
- Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Luc de Roy
- Arrhythmia Unit, Department of Cardiology, CHU, Namur, Belgium
| | - Pascal Defaye
- Arrhythmia Unit, Department of Cardiology, CHU, Grenoble-Alpes, France
| | - Serge Boveda
- Arrhythmia Unit, Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Thomas Arentz
- Arrhythmia Unit, Department of Cardiology, Universitäts Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Xavier Viñolas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
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12
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Mendez-Zurita F, Alonso-Martin C, Ramirez de Diego I, Rodriguez-Font E, Campos-Garcia B, Guerra-Ramos JM, Moreno-Weidmann Z, Viñolas X. Remote monitoring in a patient with multiple leadless pacemakers. J Arrhythm 2021; 37:259-260. [PMID: 33664915 PMCID: PMC7896465 DOI: 10.1002/joa3.12495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Enrique Rodriguez-Font
- Arrhythmia Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Bieito Campos-Garcia
- Arrhythmia Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | - Jose M Guerra-Ramos
- Arrhythmia Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | | | - Xavier Viñolas
- Arrhythmia Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain
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13
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El Amrani A, Campos B, Alonso-Martín C, Guerra-Ramos JM, Rodríguez-Font E, Moreno-Weidmann Z, Alcalde-Rodríguez Ó, Méndez-Zurita FJ, Santaló M, Espinosa-Viamonte H, Viñolas X. Rendimiento del marcapasos cardiaco Micra en nonagenarios. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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14
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Acceso epicárdico para ablación de taquicardia ventricular: experiencia con la técnica de micropunción. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.01.009] [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: 11/30/2022]
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15
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El Amrani A, Campos B, Alonso-Martín C, Guerra-Ramos JM, Rodríguez-Font E, Moreno-Weidmann Z, Alcalde-Rodríguez Ó, Méndez-Zurita FJ, Santaló M, Espinosa-Viamonte H, Viñolas X. Performance of the Micra cardiac pacemaker in nonagenarians. ACTA ACUST UNITED AC 2019; 73:307-312. [PMID: 31395499 DOI: 10.1016/j.rec.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/07/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years. METHODS We present a prospective observational study with consecutive patients aged >70 years who underwent implantation of a Micra pacemaker system. Patients were divided into 2 groups: ≥ 90 and<90 years. RESULTS The Micra system was implanted in 129 patients, of whom 41 were aged ≥ 90 years and 88<90 years. The device was successfully implanted in 40 (97.6%) patients ≥ 90 years and in 87 (98.9%) patients<90 years (P=.58). An adequate position was achieved with need for ≤ 2 repositions in 97.5% and 91.9% of patients, respectively (P=.32). Procedure time (26.1 ±11.6 vs 30.3 ±14.2minutes; P=.11) and fluoroscopy time (6.4 ±4.7 vs 7.2 ±4.9minutes; P=0.41) were similar in the 2 groups. There were 3 major complications (2.3%), all in the group aged<90 years: 1 cardiac perforation, 1 femoral hematoma, and 1 femoral pseudoaneurysm. Thirteen patients aged ≥ 90 years (31.7%) and 16 patients aged <90 years (18.2%) died during a mean follow-up of 230±233 days and 394±285 days, respectively. There were no device-related deaths. No infection, dislocation or migration of Micra were observed. The electrical performance was optimal at follow-up. CONCLUSIONS The Micra leadless pacing system seems to be safe and effective in patients older than 90 years. It may be considered a reasonable alternative to conventional transvenous pacing in this population.
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Affiliation(s)
- Amine El Amrani
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Bieito Campos
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Concepción Alonso-Martín
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - José M Guerra-Ramos
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Enrique Rodríguez-Font
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Óscar Alcalde-Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Francisco J Méndez-Zurita
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Miguel Santaló
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Hildemari Espinosa-Viamonte
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Xavier Viñolas
- Unidad de Arritmias, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain.
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16
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Chen J, Arentz T, Cochet H, Müller-Edenborn B, Kim S, Moreno-Weidmann Z, Minners J, Kohl P, Lehrmann H, Allgeier J, Trenk D, Hocini M, Jais P, Haissaguerre M, Jadidi A. Extent and spatial distribution of left atrial arrhythmogenic sites, late gadolinium enhancement at magnetic resonance imaging, and low-voltage areas in patients with persistent atrial fibrillation: comparison of imaging vs. electrical parameters of fibrosis and arrhythmogenesis. Europace 2019; 21:1484-1493. [DOI: 10.1093/europace/euz159] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Aims
Atrial fibrosis contributes to arrhythmogenesis in atrial fibrillation and can be detected by MRI or electrophysiological mapping. The current study compares the spatial correlation between delayed enhancement (DE) areas to low-voltage areas (LVAs) and to arrhythmogenic areas with spatio-temporal dispersion (ST-Disp) or continuous activity (CA) in atrial fibrillation (AF).
Methods and results
Sixteen patients with persistent AF (nine long-standing) underwent DE-magnetic resonance imaging (1.25 mm × 1.25 mm × 2.5 mm) prior to pulmonary vein isolation. Left atrial (LA) voltage mapping was acquired in AF and the regional activation patterns of 7680 AF wavelets were analysed. Sites with ST-Disp or CA were characterized (voltage, duration) and their spatial relationship to DE areas and LVAs <0.5 mV was assessed. Delayed enhancement areas and LVAs covered 55% and 24% (P < 0.01) of total LA surface, respectively. Delayed enhancement area was present at 61% of LVAs, whereas low voltage was present at 28% of DE areas. Most DE areas (72%) overlapped with atrial high-voltage areas (>0.5 mV). Spatio-temporal dispersion and CA more frequently co-localized with LVAs than with DE areas (78% vs. 63%, P = 0.02). Regional bipolar voltage of ST-Disp vs. CA was 0.64 ± 0.47 mV vs. 0.58 ± 0.51 mV. All 28 ST-Disp and 56 CA areas contained electrograms with prolonged duration (115 ± 14 ms) displaying low voltage (0.34 ± 0.11 mV).
Conclusion
A small portion of DE areas and LVAs harbour the arrhythmogenic areas displaying ST-Disp or CA. Most arrhythmogenic activities co-localized with LVAs, while there was less co-localization with DE areas. There is an important mismatch between DE areas and LVAs which needs to be considered when used as target for catheter ablation.
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Affiliation(s)
- Juan Chen
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
- Cardiovascular Department, the First Peoplés Hospital of Jingmen, Jingmen, China
| | - Thomas Arentz
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Björn Müller-Edenborn
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Steven Kim
- Abbott Medical Inc., Department of Cardiac Arrhythmia, St. Paul, MN, USA
| | - Zoraida Moreno-Weidmann
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Jan Minners
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Heiko Lehrmann
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Juergen Allgeier
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Dietmar Trenk
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Meleze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Pierre Jais
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Amir Jadidi
- Arrhythmia Department, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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17
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Epicardial Access for Ventricular Tachycardia Ablation: Experience With the Needle-in-needle Technique. ACTA ACUST UNITED AC 2019; 72:873-874. [PMID: 30956036 DOI: 10.1016/j.rec.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ignasi Anguera
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marta Aceña
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo D Dallaglio
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Di Marco
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Jadidi A, Müller-Edenborn B, Chen J, Keyl C, Weber R, Allgeier J, Moreno-Weidmann Z, Trenk D, Neumann FJ, Lehrmann H, Arentz T. The Duration of the Amplified Sinus-P-Wave Identifies Presence of Left Atrial Low Voltage Substrate and Predicts Outcome After Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:531-543. [DOI: 10.1016/j.jacep.2017.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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19
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Mueller-Edenborn B, Chen J, Lehrmann H, Moreno-Weidmann Z, Arentz T, Jadidi A. P862Regional distribution of low-voltage-substrate in persistent atrial fibrillation - implications for atrial conduction and risk stratification. Europace 2018. [DOI: 10.1093/europace/euy015.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
| | - J Chen
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
| | - Z Moreno-Weidmann
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, electrophysiology, Bad Krozingen, Germany
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20
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Chen J, Jadidi A, Moreno-Weidmann Z, Mueller-Edenborn B, Lehrmann H, Markstein V, Allgeier J, Weber R, Trenk D, Arentz T. 525Correlation of left atrial low voltage and fractionation substrate between sinus rhythm and atrial fibrillation: high density mapping study in persistent AF. Europace 2018. [DOI: 10.1093/europace/euy015.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Chen
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - Z Moreno-Weidmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - V Markstein
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - R Weber
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
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21
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Chen J, Arentz T, Moreno-Weidmann Z, Mueller-Edenborn B, Lehrmann H, Kim S, Weber R, Markstein V, Allgeier J, Trenk D, Werner D, Hocini M, Jais P, Haissaguerre M, Jadidi A. P1148Spatial correlation of rotational and continuous electrical activities to late gadolinlium enhancement at left atrial MRI and low voltage areas in persistent atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Chen
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - Z Moreno-Weidmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - S Kim
- St. Jude Medical, St. Paul, American Samoa
| | - R Weber
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | | | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Werner
- St. Jude Medical, St. Paul, American Samoa
| | - M Hocini
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - P Jais
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - M Haissaguerre
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
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22
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Breidthardt T, Moreno-Weidmann Z, Uthoff H, Sabti Z, Aeppli S, Puelacher C, Stallone F, Twerenbold R, Wildi K, Kozhuharov N, Wussler D, Flores D, Shrestha S, Badertscher P, Boeddinghaus J, Nestelberger T, Gimenez MR, Staub D, Aschwanden M, Lohrmann J, Pfister O, Osswald S, Mueller C. How accurate is clinical assessment of neck veins in the estimation of central venous pressure in acute heart failure? Insights from a prospective study. Eur J Heart Fail 2018; 20:1160-1162. [PMID: 29314487 DOI: 10.1002/ejhf.1111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tobias Breidthardt
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Zoraida Moreno-Weidmann
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland.,Gefaesspraxis am See - Lakeside Vascular Center, Lucerne, Switzerland
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Sven Aeppli
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Fabio Stallone
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.,Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Dayana Flores
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Markus Aschwanden
- Department of Angiology, University Hospital Basel, University of Basel, Switzerland
| | - Jens Lohrmann
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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