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Englert F, Bahlke F, Erhard N, Krafft H, Popa MA, Risse E, Lennerz C, Lengauer S, Telishevska M, Reents T, Kottmaier M, Kolb C, Hessling G, Deisenhofer I, Bourier F. VT ablation based on CT imaging substrate visualization: results from a large cohort of ischemic and non-ischemic cardiomyopathy patients. Clin Res Cardiol 2023:10.1007/s00392-023-02321-1. [PMID: 38112744 DOI: 10.1007/s00392-023-02321-1] [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: 04/07/2023] [Accepted: 10/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The eradication of ventricular tachycardia (VT) isthmus sites constitutes the minimal procedural endpoint for VT ablation procedures. Contemporary high-resolution computed tomography (CT) imaging, in combination with computer-assisted analysis and segmentation of CT data, facilitates targeted elimination of VT isthmi. In this context, inHEART offers digitally rendered three-dimensional (3D) cardiac models which allow preoperative planning for VT ablations in ischemic and non-ischemic cardiomyopathies. To date, almost no data have been collected to compare the outcomes of VT ablations utilizing inHEART with those of traditional ablation approaches. METHODS The presented data are derived from a retrospective analysis of n = 108 patients, with one cohort undergoing VT ablation aided by late-enhancement CT and subsequent analysis and segmentation by inHEART, while the other cohort received ablation through conventional methods like substrate mapping and activation mapping. The ablations were executed utilizing a 3D mapping system (Carto3), with the mapping generated via the CARTO® PENTARAY™ NAV catheter and subsequently merged with the inHEART model, if available. RESULTS Results showed more successful outcome of ablations for the inHEART group with lower VT recurrence (27% vs. 42%, p < 0.06). Subsequent analyses revealed that patients with ischemic cardiomyopathies appeared to derive a significant benefit from inHEART-assisted VT ablation procedures, with a higher rate of successful ablation (p = 0.05). CONCLUSION Our findings indicate that inHEART-guided ablation is associated with reduced VT recurrence compared to conventional procedures. This suggests that employing advanced imaging and computational modeling in VT ablation may be valuable for VT recurrences.
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Affiliation(s)
- F Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - N Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - H Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M-A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Kolb
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany.
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2
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Popa MA, Hessling G, Deisenhofer I, Bourier F. Electrical isolation of the right ventricular outflow tract in idiopathic ventricular tachycardia: A case report. European Heart Journal - Case Reports 2023; 7:ytad118. [PMID: 36969511 PMCID: PMC10032301 DOI: 10.1093/ehjcr/ytad118] [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] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/15/2022] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
Abstract
Background
Ventricular tachycardia (VT) originating in the right ventricular outflow tract (RVOT) is the most common form of idiopathic VT. Catheter ablation of RVOT-VT is associated with high success rates. However, non-inducibility of VT on electrophysiological (EP) study can severely impact ablation outcome. We describe a novel catheter ablation strategy which proved feasible and safe in a case of highly symptomatic, non-inducible RVOT-VT.
Case summary
A 51-year-old male with a history of non-sustained VT (NSVT) was referred to our hospital after two syncopal episodes resulting in collapse. Upon admission, a cluster of monomorphic NSVT (250-270 bpm) resulted in haemodynamic instability and required transfer to the intensive care unit. On 12-lead ECG, NSVT showed inferior axis and left bundle branch block, suggestive of RVOT-VT. Diagnostic work-up including echocardiography, coronary angiography and late-enhancement computed tomography (CT) revealed no evidence of structural heart disease. On two EP studies, non-inducibility of clinical VT despite repeated ventricular pacing and isoproterenol infusion rendered precise mapping of triggered activity unfeasible. Therefore, a bailout ablation strategy was developed by performing a circumferential electrical RVOT isolation using a 3.5 mm irrigated-tip ablation catheter under the guidance of high-density electroanatomic mapping (CARTO® 3) and CT reconstruction of cardiac anatomy. No procedural complications occurred and the patient remained arrhythmia-free during a 6-month follow-up period.
Discussion
Catheter ablation is a first-line therapy for symptomatic and therapy-refractory idiopathic RVOT-VT. Non-inducibility of RVOT-VT represents a relevant limitation for successful ablation which might be overcome by electrical RVOT isolation as a bailout ablation strategy.
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Affiliation(s)
- M A Popa
- Department of Electrophysiology, German Heart Center Munich , Munich , Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich , Munich , Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich , Munich , Germany
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich , Munich , Germany
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3
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Telishevska M, Lengauer S, Schwendt M, Deisenhofer I, Hessling G. Radiofrequency Ablation of an Unusual Focal Atrial Tachycardia. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761831] [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: 03/22/2023]
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4
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Martini E, Kantenwein V, Haller B, Telishevska M, Bourier F, Reents T, Kottmaier M, Popa M, Risse E, Lengauer S, Lennerz C, Hessling G, Deisenhofer I, Kolb C. Long term outcome after ablation of persistent atrial fibrillation in patients with postprocedurally unmasked sinus node disease. Europace 2022. [DOI: 10.1093/europace/euac053.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
About three percent of patients with persistent atrial fibrillation [AF] additionally suffer from a concealed sinus node disease [SND]. We sought to determine the ablation success one year after ablation of persistent AF in patients with postprocedurally unmasked SND.
Methods and Results
In total 2239 patients with an ablation of persistent AF at our center were screened for a postprocedurally unmasked SND, which made cardiac pacing necessary within one week after ablation. In a propensity score matched case control study, the longterm ablation success of 51 patients (mean age 73±8years, 58% male) with postprocedurally unmasked SND after ablation of persistent AF was compared to that of 102 patients without SND after ablation of persistent AF. Controls were matched to cases based on the propensity score considering age, body mass index, left ventricular ejection fraction, gender, blood pressure, diabetes mellitus, atrial low voltage, previous number of ablations and method of ablation.
One year after ablation of persistent AF, 20 (39%) patients with postprocedurally unmasked SND and 61 (60%) patients without postprocedurally unmasked SND were in sinus rhythm (p=0.025). The number of repeat ablation procedures within the follow up year did not differ significantly between cases and controls (0.60±0.68 vs 0.53±0.80, p=0.574).
Conclusion
In patients with a postprocedurally unmasked SND after ablation of persistent AF, longterm ablation success seems to be worse compared to patients without postprocedurally unmasked SND.
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Affiliation(s)
- E Martini
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - V Kantenwein
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - B Haller
- Hospital Rechts der Isar of the TU Munich, Institute of Medical Statistics and Epidemiology, Munich, Germany
| | - M Telishevska
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - F Bourier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - T Reents
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Kottmaier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Popa
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - E Risse
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - S Lengauer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Lennerz
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - G Hessling
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - I Deisenhofer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Kolb
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
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5
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Wachter A, Bahlke F, Popa M, Foerschner L, Krafft H, Maurer S, Telishevska M, Englert F, Lengauer S, Kottmaier M, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. Correlation of local impedance, global impedance and contact force with resulting lesion size in RF ablation. Europace 2022. [DOI: 10.1093/europace/euac053.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
During clinical application of RF-energy, several parameters are constantly observed, e.g. RF time, power, global impedance and temperature. The new parameter "local impedance" is gaining importance and might be a possible real-time marker for predicting long-lasting RF-lesions and increasing safety. The aim of this study was to investigate the correlation between local and global impedance as well as RF power and contact force.
Methods
RF-lesions were created using an ex vivo model with porcine cardiac preparations. These were put in a saline-filled container with a dispersive electrode. Global impedance was held at 120 Ohm by adjusting saline and water. Additionally, a heated thermostat and a circulation pump were installed to imitate blood flow. RF-lesions were produced with different settings of energy and contact force (20, 30, 40 and 50 watts; contact force of 0-5g, 10-15g and 20-25g). While creating the lesions, global and local impedance, temperature, energy and RF time were documented, as well as the current lesion width and depth. Local and global impedance drops were calculated as the difference between baseline impedance and current impedance.
Results
In total, 1223 measurements were made during application of RF-energy. 6 steam pops occurred. Contact force, local and global impedance changes showed highly significant correlations with lesion depth and diameter. Amongst analyzed values, local impedance drop showed highest correlation with lesion diameter and depth (r = 0,391 and 0,613; p<0,001). Visualized in Figure 1 and 2, global and local impedance correlate with lesion diameter and depth.
Discussion
Local impedance was found to be a suitable real-time marker for lesion size, showing significantly higher correlations with RF lesion size than contact force and global impedance. Further investigation is necessary to find a cut off for a safe but long-lasting RF-lesion.
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Affiliation(s)
- A Wachter
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Bahlke
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Popa
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - L Foerschner
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - H Krafft
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - S Maurer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Telishevska
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Englert
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - S Lengauer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Kottmaier
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - C Lennerz
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - T Reents
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - G Hessling
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - I Deisenhofer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Bourier
- German Heart Center Munich, Technical University of Munich, Munich, Germany
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6
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Oconnor M, Schmid P, Knoll K, Schaarschmidt C, Bock M, Bahlke F, Georgi M, Froehlich R, Kottmaier M, Reents T, Bourier F, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Safety and efficacy of transvenous lead extraction using mechanical (non-laser) extraction tools. Europace 2022. [DOI: 10.1093/europace/euac053.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The rate of transvenous lead extraction (TLE) is increasing with an increasing rate of complex devices being implanted. TLE is now a routine part of cardiac device management and up to date data on the safety and efficacy of TLE with modern tools and techniques is essential to management decisions regarding non-infectious indications for lead extraction.
Purpose
To evaluate the safety and efficacy of TLE in a contemporary cohort using mechanical (non-laser) extraction tools.
Methods
We present a contemporary, prospective review of TLE at our high-volume cardiac centre. All patients undergoing TLE from June 2016 and June 2019 were enrolled in our local database and baseline clinical data, procedural information and outcome data were collected.
Results
In total 561 leads were explanted (n=153) or extracted (n=408) from 341 patients over the study period. Patients were predominantly male (71%) with a mean age of 65 ± 17 years. The most common indication for lead removal was lead failure (45.2%, n=154) followed by infection of the pocket or device (29.3%, n=100). The mean dwell time of the 408 extracted leads was 7.2 years; 35% had a dwell time of 5-10 years, 23% had a dwell time >10 years and 4% had a dwell time >20 years (Figure 1). In total, complete success was achieved in 96.4% (n=541) leads, clinical success in a further 2.1% (n=12) and failure only in 1.4% (n=8). Clinical success was high (93%) even in leads with dwell time >20 years (Figure 2). There was an overall complication rate of 0.9% (3/341) for major complications and 1.5% (5/341) for minor complications. There were no deaths.
Conclusions
Our data would suggest that there are ongoing improvements in the safety profile and success rates of lead extraction undertaken by experienced operators now with a major complication rate of <1%.
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Affiliation(s)
- M Oconnor
- Royal Bournemouth Hospital, Bournemouth, United Kingdom of Great Britain & Northern Ireland
| | - P Schmid
- German Heart Centre Munich, Munich, Germany
| | - K Knoll
- German Heart Centre Munich, Munich, Germany
| | | | - M Bock
- German Heart Centre Munich, Munich, Germany
| | - F Bahlke
- German Heart Centre Munich, Munich, Germany
| | - M Georgi
- German Heart Centre Munich, Munich, Germany
| | | | | | - T Reents
- German Heart Centre Munich, Munich, Germany
| | - F Bourier
- German Heart Centre Munich, Munich, Germany
| | - G Hessling
- German Heart Centre Munich, Munich, Germany
| | | | - C Kolb
- German Heart Centre Munich, Munich, Germany
| | - C Lennerz
- German Heart Centre Munich, Munich, Germany
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7
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Wachter A, Bahlke F, Popa M, Foerschner L, Krafft H, Maurer S, Englert F, Telishevska M, Lengauer S, Kottmaier M, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. Electrode tissue coupling is a new main determinant of RF lesion creation, experience from a cardiac animal model. Europace 2022. [DOI: 10.1093/europace/euac053.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Radiofrequency (RF) current is a classic ablation technology used in the EP lab. By now it is assumed that RF lesion size is mainly determined by RF power, duration and contact force. This ex vivo animal model study shows that a new parameter - "electrode tissue coupling" (ETC) - plays an additional major role in RF lesion creation. The ETC level describes the amount of electric contact between the RF electrode and cardiac tissue: In minor ETC levels, only the distal electrode connects to tissue. In full ETC levels, the whole RF electrode is embedded in cardiac tissue.
Methods
RF-lesions were created using an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size.
Results
In total, 1923 measurements during application of RF-current were analyzed. In ETC III (full tissue coupling), lesions became significantly wider and deeper. In 20W ablations, lesion diameters were significantly (1.68 fold) larger when applying ETC III instead of ETC I. This relation was found in variations of RF parameters (Table 1).
Interestingly, baseline local impedance and local impedance drop showed a high correlation with selected ETC levels. The average baseline local impedance in ETC I was 207.2 Ohm, compared to 267.3 Ohm in ETC III (p < 0.01).
Discussion
In addition to by now known parameters (power, duration, contact force), electrode tissue coupling is a main determinant of lesion size. Higher ETC levels result in higher amounts of RF current going into adjacent tissue instead of current dissipation into the blood pool. In clinical practice, the ETC level can be predicted by baseline local and global impedance. Observation of these parameters should become clinical practice during RF ablation.
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Affiliation(s)
- A Wachter
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Bahlke
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Popa
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - L Foerschner
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - H Krafft
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - S Maurer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Englert
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Telishevska
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - S Lengauer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - M Kottmaier
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - C Lennerz
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - T Reents
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - G Hessling
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - I Deisenhofer
- German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - F Bourier
- German Heart Center Munich, Technical University of Munich, Munich, Germany
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8
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Knoll K, Oconnor M, Chouchane A, Haller B, Schaarschmidt C, Bock M, Foerschner L, Froehlich R, Kottmaier M, Bourier F, Reents T, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Procalcitonin as a biomarker of cardiac implantable electronic device pocket infection: a prospective validation study. Europace 2022. [DOI: 10.1093/europace/euac053.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The implantation of cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators is increasing along with the complexitly of these devices. CIED infection is an uncommon, but severe complication associated with the presence of a device and is associated with a high mortality and morbidity. Lead-related infections and frank endocarditis are associated with a systemic inflammatory response and, in general, are readily identified. Isolated pocket infections do not produce such a systemic response and are thus more complex to diagnose. There is a reliance on clinical accumen and examination of local signs of infection. There is thus a need for a reliable biomaker to help identify cases of pocket infection.
Aim
Our group have previously shown procalcitonin (PCT) to be a potentially useful biomaker in the clinial situation of possible pocket infection. We aim to prospectively validate the proposed cut-off value of 0.05ng/ml for the procalcitonin (PCT) biomaker in an independent cohort, which we have previously identified as showing promise in this clinical situation.
Methods
In this prospective case-control validation study the PCT levels of 81 patients with confirmed pocket infections were compared to 81 controls, matched for age and renal function, presenting for elective generator replacement or lead revision unrelated to infection. Exclusion criteria included: concomitant infectious or inflammatory diseases, end-stage renal failure, active malignancy or receiving immunosuppressive therapy.
Results
A PCT over 0.05 ng/ml was found in 68% (n= 55) of pocket infections and 24% (n= 19) of controls. Using the predefined cut-off value of 0.05 ng/ml PCT had a sensitivity of 68% and a specificity of 77% for diagnosing pocket infections. ROC analysis revealed area under the curve of 0.752 (standard error 0.039, p <0.001 ) for PCT. In patients presenting with minimal infective signs the sensivity remained high (67% vs 70% with extensive inflammation) and similarly remained high in thus who had received anti-biotic therapy prior to PCT sampling (65% vs 69%).
Conclusion
PCT is a potentially useful biomarker to aid the diagnosis of a pocket infection when used with the prospecitvely validated cut-off value of 0.05ng/ml. The sensitivity of the PCT positive result remained high even in patients pre-treated with antibiotics or with minimal clinical signs of inflammation.
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Affiliation(s)
- K Knoll
- German Heart Centre Munich, Munich, Germany
| | - M Oconnor
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | | | - B Haller
- Clinic rechts der Isar of the University of Technology, Institut für KI und Informatik in der Medizin, Munich, Germany
| | | | - M Bock
- German Heart Centre Munich, Munich, Germany
| | | | | | | | - F Bourier
- German Heart Centre Munich, Munich, Germany
| | - T Reents
- German Heart Centre Munich, Munich, Germany
| | - G Hessling
- German Heart Centre Munich, Munich, Germany
| | | | - C Kolb
- German Heart Centre Munich, Munich, Germany
| | - C Lennerz
- German Heart Centre Munich, Munich, Germany
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Bartkowiak M, Kottmaier M, Reents T, Bourier FJ, Telishevska M, Koch-Buettner K, Risse E, Maurer S, Krafft H, Popa MA, Otgonbayar U, Lennerz C, Hessling G, Deisenhofer I. Safety of high power and short duration ablation (70 watts over 5–7 seconds) in patients with persistent atrial fibrillation undergoing pulmonary vein isolation and additional substrate modification. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In paroxysmal atrial fibrillation (AF), pulmonary vein isolation using HPSD has shown a promising success rate compared to ablation using conventional power settings, as well as a significant reduction in procedural and ablation time. In persistent atrial fibrillation, left atrial substrate modification seems to be a promising additional ablation approach besides pulmonary vein isolation (PVI). However, results after additional substrate ablation are not consistently positive, which may be related to non-transmural lesions and tissue oedema. An extended time of the procedure may also influence safety. Recent publications showed that HPSD ablation provides more sufficient lesions due to acute cell necrosis instead of cell oedema.
Purpose
The aim of this study is to evaluate the safety of HPSD ablation in patients undergoing ablation of persistent atrial fibrillation with PVI and additional substrate modification.
Methods
We studied and compared n=300 patients from our register undergoing the first ablation of persistent atrial fibrillation with HPSD settings (n=150) between May 2018 and January 2019 and standard settings (n=150) between July 2017 and January 2018. Patients were followed up for three months to report procedure-related adverse events. In all patients, a modified stepwise approach using PVI followed by electrogram-guided substrate modification and linear-ablation, if necessary, was performed. A HPSD ablation was performed with 70 watts with a maximum duration of 5–7 seconds. Catheter irrigation was set to 20 ml/min using the Flexability™ ablation catheter and the Ampere™ generator. The patients were compared with a historical cohort that underwent PVI using a conventional power protocol with 30–40 watts over 20–40 seconds, using the same ablation catheter. A transthoracic echocardiogram was performed in all patients after the ablation-procedure and on the following day. Duplex sonography or clinical control were performed to assess groin complications.
Results
Baseline characteristics and procedural data are shown in table 1. No significant difference in the complication rates in both groups was observed by a significant procedure-time reduction in HPSD-Group (2:13h vs 2:31h p<0,001) and overall low risk of the procedure. No deaths, thromboembolic complications or atrioesophageal fistula were registered. Complication rates with statistical relevancy are shown in table 2.
Conclusion
Complex ablation using PVI and additional substrate modification in persistent atrial fibrillation using HPSD seems to be equally as safe regarding procedure-related outcomes as standard power settings ablation and can significantly reduce the time of the overall procedure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - T Reents
- German Heart Centre Munich, Munich, Germany
| | | | | | | | - E Risse
- German Heart Centre Munich, Munich, Germany
| | - S Maurer
- German Heart Centre Munich, Munich, Germany
| | - H Krafft
- German Heart Centre Munich, Munich, Germany
| | - M A Popa
- German Heart Centre Munich, Munich, Germany
| | | | - C Lennerz
- German Heart Centre Munich, Munich, Germany
| | - G Hessling
- German Heart Centre Munich, Munich, Germany
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10
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Mair J, Diller GP, Geiger H, Greutmann M, Hessling G, Tobler D. [Adults with congenital heart disease presenting to the emergency department : Potential pitfalls]. Med Klin Intensivmed Notfmed 2020; 117:100-111. [PMID: 33103219 PMCID: PMC8897372 DOI: 10.1007/s00063-020-00752-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
Die Patientengruppe der Erwachsenen mit angeborenen Herzfehlern (EMAH) ist mittlerweile bereits größer als die der Kinder mit angeborenen Herzfehlern. EMAH-Patienten weisen auch nach Reparaturoperationen oft komplexe pathophysiologische und anatomische Verhältnisse auf. Bei Komplikationen kann es sehr rasch zu Notfallsituationen auch bei ansonsten asymptomatischen oder nur wenig symptomatischen Patienten kommen. Gemessen an der Gesamtzahl der Patienten, die von Notärzten und in den Notaufnahmen versorgt werden, sind EMAH-Notfallsituationen nach wie vor sehr selten. Diese Übersicht soll die Notfallbetreuung von EMAH-Patienten erleichtern. Für ca. zwei Drittel aller Notfälle sind Rhythmusstörungen und akute Herzinsuffizienz verantwortlich. Rhythmusstörungen müssen in der Regel zügig terminiert werden, weil sie unbehandelt rasch zur kardialen Dekompensation führen können. Bei Scheitern der medikamentösen Therapie oder hämodynamischer Instabilität müssen EMAH-Patienten mit tachykarden Rhythmusstörungen rasch elektrisch kardiovertiert werden. Symptomatische Bradykardien können eine rasche Schrittmacherversorgung erforderlich machen. Aufgrund der komplexen Anatomie kann das Einschwemmen eines transvenösen Interim-Schrittmachers bei einzelnen Vitien unmöglich sein. Die akute kardiale Dekompensation bei EMAH ist oft durch ein akutes Rechtsherzversagen verursacht. Weitere relativ häufige Aufnahmegründe sind Infektionen, Synkopen, Thromboembolien und Aortendissektion. Der Herzpass der Patienten informiert über das vorliegende Vitium. Die umgehende Kontaktaufnahme mit dem behandelnden EMAH-Zentrum wird dringend empfohlen.
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Affiliation(s)
- J Mair
- Universitätsklinik für Innere Medizin III - Kardiologie und Angiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - G-P Diller
- Klinik für Kardiologie III - Angeborene Herzfehler und erworbene Klappenerkrankungen, Universitätsklinikum Münster, 48149, Münster, Deutschland
| | - H Geiger
- Abteilung Interne II - Kardiologie, Ordensklinikum Linz GmbH - Barmherzige Schwestern, 4010, Linz, Österreich
| | - M Greutmann
- Universitäres Herzzentrum, Kardiologie, Universitätsspital Zürich, 8091, Zürich, Schweiz
| | - G Hessling
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, 80636, München, Deutschland
| | - D Tobler
- Kardiologie, Universitätsspital Basel, 4031, Basel, Schweiz
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Telishevska M, Kalinsek TP, Reents T, Bourier F, Deisenhofer I, Hessling G. Case Report: Ventricular Preexcitation Masking Complete Atrioventricular Conduction Block. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705554] [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: 10/24/2022]
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Westphal DS, Burkard T, Moscu-Gregor A, Gebauer R, Hessling G, Wolf CM. Reclassification of Genetic Variants in Children with Long QT Syndrome. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705528] [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: 10/24/2022]
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13
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Telishevska M, Berger F, Deisenhofer I, Hessling G. Case Report: Radiofrequency Ablation of an Epicardial Left Lateral Accessory Pathway. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705552] [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: 10/24/2022]
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14
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Kottmaier M, Bourier F, Wünscher S, Kornmayer M, Semmler V, Lengauer S, Telishevska M, Koch-Büttner K, Risse E, Brooks S, Hessling G, Deisenhofer I, Reents T. Repeat ablation for paroxysmal atrial fibrillation - Does adenosine play a role in predicting pulmonary vein reconnection patterns? Indian Pacing Electrophysiol J 2018; 18:203-207. [PMID: 30290206 PMCID: PMC6302775 DOI: 10.1016/j.ipej.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. METHODS We included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. RESULTS Fifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). CONCLUSIONS In repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.
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Affiliation(s)
- M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany.
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Wünscher
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - V Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - K Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Brooks
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
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15
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Zeilberger M, Pracht L, Hofmann M, Kathan S, Kottmaier M, Reents T, Hessling G, Bourier F, Deisenhofer I. P986Mechanical inducibility of atrial fibrillation in pulmonary vein isolation procedures is associated with inferior outcome: a propensity score matched analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Zeilberger
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - L Pracht
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - M Hofmann
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - S Kathan
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - M Kottmaier
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - T Reents
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- Deutsches Herzzentrum Technische Universitat, Department of Electrophysiology, Munich, Germany
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Pracht L, Hofmann M, Kathan S, Zeilberger M, Reents T, Hessling G, Bourier F, Deisenhofer I. P4804Oral anticoagulation continuation vs. discontinuation after catheter-ablation of paroxysmal atrial fibrillation - incidence of cerebral insults and severe hemorrhagic complications. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Pracht
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M Hofmann
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S Kathan
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M Zeilberger
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T Reents
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - G Hessling
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - F Bourier
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I Deisenhofer
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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17
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Bourier F, Hofmann M, Kathan A, Reents T, Zeilberger M, Pracht L, Kottmaier M, Risse E, Brooks S, Koch-Buttner K, Telishevska M, Lengauer S, Kornmayr ML, Hessling G, Deisenhofer I. P3834Early recurrence of atrial fibrillation after pulmonary vein isolation is associated with poor outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Bourier
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Hofmann
- Technical University of Munich, German Heart Center, Munich, Germany
| | - A Kathan
- Technical University of Munich, German Heart Center, Munich, Germany
| | - T Reents
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Zeilberger
- Technical University of Munich, German Heart Center, Munich, Germany
| | - L Pracht
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Kottmaier
- Technical University of Munich, German Heart Center, Munich, Germany
| | - E Risse
- Technical University of Munich, German Heart Center, Munich, Germany
| | - S Brooks
- Technical University of Munich, German Heart Center, Munich, Germany
| | - K Koch-Buttner
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Telishevska
- Technical University of Munich, German Heart Center, Munich, Germany
| | - S Lengauer
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M L Kornmayr
- Technical University of Munich, German Heart Center, Munich, Germany
| | - G Hessling
- Technical University of Munich, German Heart Center, Munich, Germany
| | - I Deisenhofer
- Technical University of Munich, German Heart Center, Munich, Germany
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18
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Kottmaier M, Reents T, Bourier F, Reiter A, Semmler V, Telishevska M, Berger F, Koch-Buettner K, Brooks S, Kornmayer M, Risse E, Lengauer S, Hessling G, Deisenhofer I. P5757Mapping and ablation of complex left atrial tachycardia using an automated high resolution mapping algorithm. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - A Reiter
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevska
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - E Risse
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
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19
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Kottmaier M, Mayer S, Bourier F, Reents T, Semmler V, Telishevska M, Kornmayer M, Brooks S, Lengauer S, Berger F, Koch-Buettner K, Risse E, Hessling G, Deisenhofer I, Holdenrieder S. P989Association between circulating biomarkers of fibrosis and left atrial voltage in patients undergoing atrial fibrillation ablation. A pilot study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Mayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevska
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - E Risse
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Holdenrieder
- German Heart Center of Munich, Institut of Laboratory Medicine, Munich, Germany
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20
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Von Krogh F, Semmler V, Reents T, Bourier F, Telishevska M, Kornmayer M, Kottmaier M, Brooks S, Koch-Buettner K, Lennerz C, Brkic A, Grebmer C, Hessling G, Kolb C, Deisenhofer I. P843Incidence of acute pacemaker implantation after ablation of persistent atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.446] [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)
- F Von Krogh
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - V Semmler
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - T Reents
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - F Bourier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Telishevska
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Kornmayer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Kottmaier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - S Brooks
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - K Koch-Buettner
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Lennerz
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - A Brkic
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Grebmer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - G Hessling
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Kolb
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - I Deisenhofer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
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21
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Kottmaier M, Bourier F, Pausch H, Reents T, Semmler V, Telishevska M, Koch-Buettner K, Lengauer S, Brooks S, Kornmayer M, Berger F, Rousseva E, Kolb C, Hessling G, Deisenhofer I. P379Safety of uninterrupted periprocedural edoxaban versus phenprocoumon for patients undergoing left atrial catheter ablation procedures. Europace 2018. [DOI: 10.1093/europace/euy015.190] [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)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - H Pausch
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevska
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - E Rousseva
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - C Kolb
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
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22
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Kottmaier M, Bourier F, Reents T, Berglar S, Semmler V, Jilek C, Kornmayer M, Telishevksa M, Lengauer S, Brooks S, Berger F, Koch-Buettner K, Hadamitzky M, Hessling G, Deisenhofer I. 204Exclusion of left atrial thrombus by dual source cardiac computed tomography prior to catheter ablation for atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.053] [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: 11/12/2022] Open
Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Berglar
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - C Jilek
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevksa
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Radiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
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23
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Koch-Buettner K, Kottmaier M, Reents T, Holmgren E, Semmler V, Deiss M, Telishevska M, Kornmayer M, Brooks S, Grebmer C, Lennerz K, Kolb C, Hessling G, Deisenhofer I. P202Identification of predictors for atrial fibrillation-free survival after catheter ablation of persistent atrial fibrillation-results from a large prospective cohort. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Brendel LC, Dobler F, Hessling G, Michel J, Braun SL, Steinsiek AL, Groha P, Eckl R, Deisenhofer I, Hyseni A, Roest M, Ott I, Steppich B. The anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban or rivaroxaban. J Interv Card Electrophysiol 2017; 49:237-244. [PMID: 28735423 DOI: 10.1007/s10840-017-0274-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 07/10/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Measuring the anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban and rivaroxaban is challenging, since the activated coagulation time (ACT) does not seem to reflect the true anticoagulant activity of these drugs. We therefore evaluated coagulation properties of apixaban and rivaroxaban during RFA by different coagulation assays to better monitor periprocedural hemostasis. METHODS The study included 90 patients (61 ± 12 years) with atrial fibrillation who underwent RFA procedures. Patients received 20 mg rivaroxaban (n = 73) once or 5 mg apixaban (n = 17) twice daily 4 weeks prior to the procedure. During RFA, unfractionated heparin i.v. was given to maintain an ACT of 250-300 s. Blood samples were taken before and 10, 60, and 360 min after heparin administration. RESULTS Heparin displayed a lower anti-Xa activity in rivaroxaban-treated patients compared to apixaban-treated patients. In contrast, D-dimer and prothrombin fragment F1+2 plasma levels indicated a higher activation of the coagulation cascade in apixaban/heparin than in rivaroxaban/heparin patients. This discordant coagulative state measured in vitro had no clinical impact in terms of bleeding or thromboembolic complications. CONCLUSION We found different biochemical responses to rivaroxaban/heparin and apixaban/heparin during RFA. Precaution is necessary when monitoring periprocedural hemostasis in DOAC patients to avoid mismanagement.
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Affiliation(s)
- L C Brendel
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - F Dobler
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - G Hessling
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - J Michel
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - S L Braun
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - A L Steinsiek
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - P Groha
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - R Eckl
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - I Deisenhofer
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - A Hyseni
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Roest
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Ott
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - B Steppich
- Deutsches Herzzentrum der Technischen Universität München, Lazarettstr. 36, 80636, Munich, Germany.
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Koch-Buettner K, Kottmaier M, Reents T, Semmler V, Holmgren E, Deiss M, Telishevska M, Kornmayer M, Brooks S, Grebmer C, Lennerz K, Kolb C, Hessling G, Deisenhofer I. P894Identification of predictors for atrial fibrillation-free survival after catheter ablation of persistent atrial fibrillation-results from a large prospective cohort. Europace 2017. [DOI: 10.1093/ehjci/eux151.076] [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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26
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Rousseva E, Hofmann M, Koch Buettner K, Bourier F, Kottmaier M, Kornmayer M, Brooks S, Kathan S, Lennerz C, Grebmer C, Brikic A, Deiss M, Kolb C, Hessling G, Deisenhofer I. P274Occurrence of persistent atrial fibrillation after pulmonary vein isolation for paroxysmal atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux141.002] [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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Bourier F, Reents T, Semmler V, Brooks S, Kornmayer M, Kottmaier M, Telishevska M, Deiss M, Hessling G, Deisenhofer I. P332Very low dose fluoroscopic imaging for electrophysiology procedures. Europace 2017. [DOI: 10.1093/ehjci/eux141.059] [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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28
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Bourier F, Reents T, Kottmaier M, Kornmayer M, Telishevska M, Semmler V, Koch-Buettner K, Deiss M, Kolb C, Lennerz C, Hessling G, Deisenhofer I. P316New automatic mapping technology - Accuracy and efficacy. Europace 2017. [DOI: 10.1093/ehjci/eux141.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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29
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Deiss M, Rousseva E, Bourier F, Kottmaier M, Brkic A, Semmler V, Telishevska M, Koch-Buettner K, Brooks S, Kornmayer M, Lengauer S, Berger F, Hessling G, Deisenhofer I, Reents T. P939Catheter ablation of atrial flutter: (typical) right atrial and (atypical) left atrial flutter occur in similar patients but have different outcome of ablation. Europace 2017. [DOI: 10.1093/ehjci/eux151.121] [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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Bourier F, Reents T, Semmler V, Telishevska M, Brooks S, Kornmayer M, Kottmaier M, Hessling G, Deisenhofer I. P333Transseptal puncture guided by CT-derived 3D-augmented fluoroscopy. Europace 2017. [DOI: 10.1093/ehjci/eux141.060] [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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31
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Kottmaier M, Reents T, Bourier F, Semmler V, Telishevska M, Deiss M, Koch-Buettner K, Lengauer S, Kornmayer M, Brooks S, Rousseva E, Hessling G, Deisenhofer I. P864Reconnection patterns of pulmonary veins during a repeat paroxysmal atrial fibrillation ablation. Europace 2017. [DOI: 10.1093/ehjci/eux151.046] [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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32
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Kottmaier M, Reents T, Bourier F, Semmler V, Telishevska M, Deiss M, Koch-Buettner K, Lengauer S, Kornmayer M, Brooks S, Rousseva E, Hessling G, Deisenhofer I. P891Persistent atrial fibrillation ablation: What are the predictors for intraprocedural AF termination? Europace 2017. [DOI: 10.1093/ehjci/eux151.073] [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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Bourier F, Reents T, Telishevska M, Kottmaier M, Semmler V, Kornmayer M, Brooks S, Deisenhofer I, Hessling G. P927Atrial fibrillation after atrial septal defect device closure - How to access the left atrium? A case series. Europace 2017. [DOI: 10.1093/ehjci/eux151.109] [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: 11/15/2022] Open
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Kringeland EA, Deisenhofer I, Hessling G, Schuster PM. P938Difference in TnT release comparing manually and magnetically guided RFA for AVNRT. Europace 2017. [DOI: 10.1093/ehjci/eux151.120] [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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Kornmayer M, Brooks S, Semmler V, Telishevska M, Bourier F, Kochbuettner K, Kottmair M, Lengauer S, Rousseva E, Lennerz C, Grebmer C, Reents T, Kolb C, Hessling G, Deisenhofer I. P875Is atrial anatomy predictive for paroxysmal AF recurrence after PVI? Europace 2017. [DOI: 10.1093/ehjci/eux151.057] [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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36
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Kottmaier M, Oesterlein T, Reents T, Bourier F, Reiter A, Semmler V, Telishevska M, Deiss M, Koch-Buettner K, Lengauer S, Brooks S, Rousseva E, Kornmayer M, Hessling G, Deisenhofer I. P863How reliable are left atrial voltage maps assessed during atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux151.045] [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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Kottmaier M, Reents T, Bourier F, Busch S, Semmler V, Telishevska M, Deiss M, Koch-Buettner K, Lengauer S, Kornmayer M, Brooks S, Rousseva E, Hessling G, Deisenhofer I. P886Long-standing persistent atrial fibrillation: The impact of intraprocedural AF termination on freedom of any atrial arrhythmia. Europace 2017. [DOI: 10.1093/ehjci/eux151.068] [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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38
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Steppich B, Dobler F, Brendel LC, Hessling G, Braun SL, Steinsiek AL, Deisenhofer I, Hyseni A, Roest M, Ott I. Effect of the FXa inhibitors Rivaroxaban and Apixaban on platelet activation in patients with atrial fibrillation. J Thromb Thrombolysis 2017; 43:490-497. [DOI: 10.1007/s11239-017-1495-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Telishevska M, Hebe J, Nürnberg JH, Paul T, Krause U, Gebauer R, Gass M, Balmer C, Berger F, Molatta S, Emmel M, Lawrenz W, Kriebel T, Hessling G. Catheter Ablation in Asymptomatic Pediatric WPW Patients: Results from a Large Multicenter Study. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598976] [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: 10/20/2022]
Affiliation(s)
| | - J. Hebe
- Center f. Electrophysiology, Bremen, Germany
| | | | - T. Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany
| | - U. Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany
| | - R. Gebauer
- Department of Pediatric Cardiology, Heart Center, University Hospital, Leipzig, Germany
| | - M. Gass
- Department of Electrophysiology, Lake Heart Center, Constance, Germany
| | - C. Balmer
- Department of Pediatric Cardiology, University Children`s Hospital, Zurich, Switzerland
| | - F. Berger
- Department of Pediatric Cardiology, University Children`s Hospital, Zurich, Switzerland
| | - S. Molatta
- Clinic for Cardiology Heart and Diabetes Center, NRW Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - M. Emmel
- Department of Pediatric Cardiology, Heart Center, University Hospital, Cologne, Germany
| | - W. Lawrenz
- Department of Pediatric Cardiology, Congenital Heart Disease, Heart Center, Duisburg, Germany
| | - T. Kriebel
- Department of Pediatric Cardiology, Westpfalz-Klinikum, Kaiserslautern, Germany
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Hessling G. [Arrhythmia in adults with congenital heart disease : Acute and long-term management]. Herzschrittmacherther Elektrophysiol 2016; 27:81-87. [PMID: 27221083 DOI: 10.1007/s00399-016-0430-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/04/2016] [Indexed: 06/05/2023]
Abstract
During the last few decades, the management of cardiac arrhythmias in adult patients with congenital heart disease (CHD) has undergone a significant change from a conservative, mainly pharmacological approach, to interventional techniques such as catheter ablation or device implantation (pacemakers, implantable cardioverter defibrillators [ICD]). The long-term efficacy of these strategies is as dependent on the hemodynamic status of the patient and the type of arrhythmia as it is on the underlying heart defect and any preceding surgery. Pharmacological agents and electrical cardioversion are at the forefront of treatment for tachyarrhythmias. Individualized thromboprophylaxis plays an important role in acute and in long-term management. Catheter ablation seems to show a more favorable outcome compared with a pharmacological approach in the long-term management of supraventricular tachyarrhythmias. Surgical procedures, including arrhythmia surgery (such as the Fontan conversion operation), may improve the arrhythmia. In symptomatic patients with bradyarrhythmias, such as sinus node dysfunction, pacemaker implantation is usually indicated. In the management of ventricular arrhythmias catheter ablation is also increasingly used. This is dominated by the individual risk stratification for the prevention of sudden cardiac death (SCD). However, the ICD is still the therapeutic cornerstone in most cases. The management of cardiac arrhythmias in adult CHD patients should be performed at specialized centers where all aspects of diagnosis and treatment are covered.
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Affiliation(s)
- G Hessling
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland.
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Buiatti A, Kaess B, Reents T, Semmler V, Telishveska M, Bourier F, Kornmayer M, Kottmaier M, Hessling G, Deisenhofer I. Catheter Ablation for "Lone" Atrial Fibrillation: Efficacy and Predictors of Recurrence. J Cardiovasc Electrophysiol 2016; 27:536-41. [PMID: 26799683 DOI: 10.1111/jce.12936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atrial fibrillation in otherwise healthy young patients has been termed "lone" atrial fibrillation (AF). The best treatment choice is still under discussion. The aim of this study was to report on efficacy and safety of catheter ablation. METHODS Among 855 patients referred to our center between 2011 and 2013, 76 (9%) met the diagnostic criteria for lone AF (mean age 45 ± 8 years; mean LA diameter 37 ± 4 mm; paroxysmal AF 82%; persistent AF 18%). The primary endpoint was freedom from any atrial tachycardia after the first ablation; the secondary endpoint was freedom from any atrial tachycardia after the last ablation procedure without antiarrhythmic drugs. RESULTS The primary endpoint occurred in 56 patients (74%) after a mean follow-up time of 444 ± 344 days. The secondary endpoint occurred in 73 patients (96%) after a mean of 1.3 ablations/patient during a follow-up time of 459 ± 366 days. The risk of AF recurrence was not influenced by AF duration or by the type of AF (paroxysmal versus persistent). In a multivariate regression analysis smoking (P = 0.001), first degree atrioventricular block (P = 0.001), and early (< 3 months) AF recurrence (P = 0.001) were independently associated with a higher risk of AF recurrence. Major peri-procedural adverse events did not occur. CONCLUSIONS Catheter ablation in young healthy patients is highly effective and safe. The outcomes are maintained during long-term follow-up irrespective of preoperative AF duration. Patients with AF recurrence were more likely to smoke, have first degree AV block and early AF recurrence.
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Affiliation(s)
- A Buiatti
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - B Kaess
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - T Reents
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - V Semmler
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - M Telishveska
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - F Bourier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - M Kornmayer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - M Kottmaier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - G Hessling
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Backhoff D, Kerst G, Peters A, Lüdemann M, Frische C, Horndasch M, Hessling G, Paul T, Krause U. ICD Therapy after Atrial Switch Repair for d-Transposition of the Great Arteries—German Multicenter Experience. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555977] [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: 10/23/2022]
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Telishevska M, Buiatti A, Kaess B, Busch S, Reents T, Horndasch M, Ewert P, Deisenhofer I, Hessling G. Katheterablation einer AV-Knoten Reentry-Tachykardie bei Kindern: Einfluss von nicht- fluoroskopischen 3D Mapping-Systemen auf die Durchleuchtungszeit. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556006] [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: 10/23/2022]
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Ammar S, Luik A, Hessling G, Bruhm A, Reents T, Semmler V, Buiatti A, Kathan S, Hofmann M, Kolb C, Schmitt C, Deisenhofer I. Ablation of perimitral flutter: acute and long-term success of the modified anterior line. Europace 2015; 17:447-52. [DOI: 10.1093/europace/euu297] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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45
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Telishevska M, Buiatti A, Semmler V, Ammar S, Reents T, Ewert P, Deisenhofer I, Horndasch M, Schön P, Hessling G. Radiofrequency ablation of right-sided accessory pathways in children: how have 3 D systems and cool-tip catheters changed success and recurrence rates? Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394069] [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: 10/24/2022]
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46
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Ammar S, Hessling G, Paulik M, Reents T, Dillier R, Buiatti A, Semmler V, Kolb C, Haller B, Deisenhofer I. Impact of baseline atrial fibrillation cycle length on acute and long-term outcome of persistent atrial fibrillation ablation. J Interv Card Electrophysiol 2014; 41:253-9. [PMID: 25008255 DOI: 10.1007/s10840-014-9927-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 12/17/2013] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A short baseline atrial fibrillation (AF) cycle length (CL) has been associated with a worse outcome after catheter ablation for AF, whereas the impact of a long baseline AFCL is unknown. We investigated the influence of AFCL on acute and long-term success in a large series of patients undergoing catheter ablation for persistent AF. METHODS Overall, 177 consecutive patients undergoing catheter ablation of persistent AF using a sequential ablation approach were included in the analysis. AFCL was measured in the left atrial appendage (LAA) at baseline and following each ablation step. The primary endpoint was freedom from any atrial arrhythmia off antiarrhythmic drugs (AAD) with a single ablation procedure after 12 months. RESULTS Mean AFCL was 164 ± 24 ms. A shorter AFCL was associated with longer AF duration, larger LA diameter, and longer procedure duration. Termination to sinus rhythm (SR) was achieved in 57 (32 %) patients. Baseline AFCL was shorter (161 ± 24 ms) in patients without AF termination compared to patients with AF termination (169 ± 23 m, p = 0.03). The primary endpoint was reached less frequently in patients with a short (<155 ms) AFCL (18 vs. 38.5 %, p = 0.006). Patients with an AFCL between 155 and 200 ms had the best outcome compared to patients with AFCL <155 or ≥200 ms (40 vs. 18 %, p = 0.003). CONCLUSIONS Patients with a baseline AFCL between 155 and 200 ms have the best outcome after a single ablation procedure for persistent AF compared to patients with an AFCL of <155 or ≥200 ms.
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Affiliation(s)
- S Ammar
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany,
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Dillier R, Ammar S, Reents T, Pavaci H, Buiatti A, Semmler V, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Safety and efficacy of continuous periprocedural rivaroxaban for patients undergoing catheter ablation procedures: a retrospective registry analysis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48
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Abdul-Khaliq H, Hosse M, Rädle Hurst T, Rentzsch A, Abd El Rahman M, Zartner P, Laser K, Seliger T, Dittrich S, Nürnberg J, Hessling G, Hager A, Pees C, Orwat S, Baumgartner H, Issa H, Kerst G, Hövels-Gürich H, Hebe A, Mir TS, Stiller B, Will A, Berger F, Peters B. Erste Ergebnisse aus der Multizentrischen Resynchronisationstherapie Studie bei Angeborenen Herzfehlern (CARE-CHD-Studie) im Rahmen des Kompetenznetzes für Angeborene Herzfehler (KNAHF). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354478] [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: 10/26/2022]
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49
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Ammar S, Buiatti A, Reents T, Dillier R, Kathan S, Hofmann M, Semmller V, Kolb C, Hessling G, Deisenhofer I. Arrhythmia recurrence after pulmonary vein isolation for paroxysmal atrial fibrillation: there is more than the pulmonary veins. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Ammar S, Bruhm A, Reents T, Buiatti A, Dillier R, Kolb C, Hessling G, Deisenhofer I. Safety and efficacy of the modified anterior line for treatment of perimitral flutter: a single centre experience. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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