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Bahlke F, Englert F, Popa M, Bourier F, Reents T, Lennerz C, Kraft H, Martinez AT, Kottmaier M, Syväri J, Tydecks M, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Erhard N. First clinical data on artificial intelligence-guided catheter ablation in long-standing persistent atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:406-414. [PMID: 38197476 DOI: 10.1111/jce.16184] [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: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Despite advanced ablation strategies and major technological improvements, treatment of persistent atrial fibrillation (AF) remains challenging and the underlying pathophysiology is not fully understood. This study analyzed the multiple procedure outcome and safety of catheter ablation of spatiotemporal dispersions (DISPERS) detected by artificial intelligence (AI)-guided software in patients with long-standing persistent AF. METHODS AND RESULTS The Volta VX1 software was used for 50 consecutive patients undergoing catheter ablation for persistent AF. First, high-density mapping (78% biatrial) with a multipolar mapping catheter was performed. In addition to pulmonary vein isolation (PVI), ablation of DISPERS was performed aiming at homogenizing, dissecting, isolating, or connecting DISPERS areas to nonconducting anatomical structures. Follow-up contained regular visits at our outpatient clinic at 1, 3, 6, and 12 months including 7-day Holter electrocardiograms. Patients were mainly suffering from long-standing persistent AF (mean AF duration 50.30 ± 54.28 months). Following PVI, ablation of left atrial and right atrial DISPERS areas led to AF cycle length prolongation (mean of 162.0 ± 16.6 to 202.2 ± 21.6 ms after) and AF termination to atrial tachycardia (AT) or sinus rhythm (SR) in 12 patients (24%). No stroke or pericardial effusion occurred; major groin complications (pseudoaneurysm n = 1, atrioventricular fistula n = 1) were detected in two patients. After a blanking period of 6 weeks, recurrence of any atrial arrhythmia was documented in 26 patients (52%). The majority of patients presented with organized AT (n = 15) while AF was present in n = 9 patients and AT/AF was observed in n = 2 patients. Twenty-two patients underwent reablation. During a mean follow-up of 363.14 ± 187.42 days and after an average of 1.46 ± 0.68 procedures, 82% of patients remained in stable SR. CONCLUSION DISPERS-guided ablation using machine learning software (the Volta VX1 software) in addition to PVI in long-standing persistent AF ablation resulted in high long-term success rates regarding AF and AT elimination. Most arrhythmia recurrences were reentrant AT. After a total of 1.46 ± 0.68 procedures, freedom from AF/AT was 82%. Despite prolonged procedure times complication rates were low. Randomized studies are necessary to evaluate long-term efficacy of dispersion-guided ablation using AI.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alex Tunsch Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Popa MA, Bahlke F, Kottmaier M, Foerschner L, Bourier F, Lengauer S, Telishevska M, Krafft H, Englert F, Reents T, Lennerz C, Caluori G, Jaïs P, Hessling G, Deisenhofer I. Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:317-327. [PMID: 38105426 DOI: 10.1111/jce.16157] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is an established treatment strategy for atrial fibrillation (AF). To improve PVI efficacy and safety, high-power short-duration (HPSD) ablation and pulsed-field ablation (PFA) were recently introduced into clinical practice. This study aimed to determine the extent of myocardial injury and systemic inflammation following PFA, HPSD, and standard RFA using established biomarkers. METHODS We included 179 patients with paroxysmal AF receiving first-time PVI with different ablation technologies: standard RFA (30-40 W/20-30 s, n = 52), power-controlled HPSD (70 W/5-7 s, n = 60), temperature-controlled HPSD (90 W/4 s, n = 32), and PFA (biphasic, bipolar waveform, n = 35). High-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), CK MB isoform (CK-MB), and white blood cell (WBC) count were determined before and after ablation. RESULTS Baseline characteristics were well-balanced between groups (age 63.1 ± 10.3 years, 61.5% male). Postablation hs-cTnT release was significantly higher with PFA (1469.3 ± 495.0 ng/L), HPSD-70W (1322.3 ± 510.6 ng/L), and HPSD-90W (1441.2 ± 409.9 ng/L) than with standard RFA (1045.9 ± 369.7 ng/L; p < .001). CK and CK-MB release was increased with PFA by 3.4-fold and 5.8-fold, respectively, as compared to standard RFA (p < .001). PFA was associated with the lowest elevation in WBC (Δ1.5 ± 1.5 × 109 /L), as compared to standard RFA (Δ3.8 ± 2.5 × 109 /L, p < .001), HPSD-70W (Δ2.7 ± 1.7 × 109 /L, p = .037), and HPSD-90W (Δ3.6 ± 2.5 × 109 /L, p < .001). CONCLUSION Among the four investigated ablation technologies, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction.
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Affiliation(s)
- Miruna A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Leonie Foerschner
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
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Erhard N, Bahlke F, Spitzauer L, Englert F, Popa M, Bourier F, Reents T, Lennerz C, Kraft H, Maurer S, Tunsch-Martinez A, Syväri J, Tydecks M, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kottmaier M. Renal function and periprocedural complications in patients undergoing left atrial catheter ablation: A comparison between uninterrupted direct oral anticoagulants and phenprocoumon administration. Clin Res Cardiol 2024:10.1007/s00392-024-02374-w. [PMID: 38261026 DOI: 10.1007/s00392-024-02374-w] [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: 07/05/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation. METHODS AND RESULTS We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71). CONCLUSION The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.
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Affiliation(s)
- Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Lovis Spitzauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Susanne Maurer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alexander Tunsch-Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabrielle Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
- Kardiologie Neusäß, Oskar-Vonon-Miller-Str. 2a 86356, Neusäß, Germany.
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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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Telishevska M, Lengauer S, Reents T, Kantenwein V, Popa M, Bahlke F, Englert F, Erhard N, Deisenhofer I, Hessling G. Long-Term Follow-Up of Empirical Slow Pathway Ablation in Pediatric and Adult Patients with Suspected AV Nodal Reentrant Tachycardia. J Clin Med 2023; 12:6532. [PMID: 37892670 PMCID: PMC10607303 DOI: 10.3390/jcm12206532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim of this study was to assess long-term efficacy and safety of empirical slow pathway (ESP) ablation in pediatric and adult patients with a special interest in patients without dual AV nodal physiology (DAVNP). METHODS A retrospective single-center review of patients who underwent ESP ablation between December 2014 and September 2022 was performed. Follow-up included telephone communication, letter questionnaire and outpatient presentation. Recurrence was based on typical symptoms. RESULTS 115 patients aged 6-81 years (median age 36.3 years, 59.1% female; 26 pts < 18 years) were included. A typical history was present in all patients (100%), an ECG documentation of narrow complex tachycardia in 97 patients (84%). Patients were divided into three groups: Group 1 without DAVNP (n = 23), Group 2 with AH jump (n = 30) and Group 3 with AH jump and at least one AV nodal echo beat (n = 62). No permanent AV block was observed. During a median follow-up of 23.6 ± 22.7 months, symptom recurrence occurred in 7/115 patients (6.1%) with no significant difference between the groups (p = 0.73, log-rank test). Symptom recurrence occurred significantly more often in patients without (5/18 patients; 27%) as compared to patients with ECG documentation (2/97 patients; 2.1%; p = 0.025). No correlation between age and success rate was found (p > 0.1). CONCLUSIONS ESP ablation is effective and safe in patients with non-inducible AVNRT. Overall, recurrence of symptoms during long-term follow-up is low, even if no DAVNP is present. Tachycardia documentation before the EP study leads to a significantly lower recurrence rate following ESP ablation.
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Affiliation(s)
- Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstr. 36, 80636 Munich, Germany; (S.L.); (T.R.); (V.K.); (M.P.); (F.B.); (F.E.); (N.E.); (I.D.); (G.H.)
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Bahlke F, Wachter A, Erhard N, Englert F, Krafft H, Popa M, Risse E, Kottmaier M, Telishevska M, Lengauer S, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. The influence of electrode-tissue-coverage on RF lesion formation and local impedance: Insights from an ex vivo model. Pacing Clin Electrophysiol 2023; 46:1170-1181. [PMID: 37616376 DOI: 10.1111/pace.14807] [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: 06/02/2023] [Revised: 07/16/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model. METHODS AND RESULTS An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC. CONCLUSIONS ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Andreas Wachter
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
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7
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Bock M, O’Connor M, Chouchane A, Schmidt P, Schaarschmidt C, Knoll K, Bahlke F, Englert F, Storz T, Kottmaier M, Trenkwalder T, Reents T, Bourier F, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis. J Clin Med 2023; 12:4900. [PMID: 37568301 PMCID: PMC10420171 DOI: 10.3390/jcm12154900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. METHODS We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. RESULTS The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). CONCLUSION Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.
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Affiliation(s)
- Matthias Bock
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Matthew O’Connor
- Auckland City Hospital, Department of Cardiology, Auckland 1023, New Zealand
| | - Amir Chouchane
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Philip Schmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Claudia Schaarschmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Katharina Knoll
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Fabian Bahlke
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Florian Englert
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Theresa Storz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marc Kottmaier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Tilko Reents
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Felix Bourier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marta Telishevska
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Sarah Lengauer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Gabriele Hessling
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Isabel Deisenhofer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Christof Kolb
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
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8
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Hessling G, Telishevska M, Lengauer S, Deisenhofer I. ["Asymptomatic WPW" : Is treatment necessary?]. Herzschrittmacherther Elektrophysiol 2023; 34:114-121. [PMID: 36939928 DOI: 10.1007/s00399-023-00930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 03/21/2023]
Abstract
The term "asymptomatic WPW" (Wolff-Parkinson-White) is often used as a synonym for ventricular pre-excitation of the WPW type due to an accessory pathway characterized by a short PR interval and a delta wave on the electrocardiogram (ECG) without the clinical occurrence of paroxysmal tachycardia. Asymptomatic WPW is often diagnosed in young and otherwise healthy people. There is a small associated risk of sudden cardiac death due to rapid antegrade conduction over the accessory pathway during atrial fibrillation. This paper highlights aspects of noninvasive and invasive risk stratification, therapy by catheter ablation, and the ongoing risk-benefit discussion in asymptomatic WPW.
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Affiliation(s)
- Gabriele Hessling
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Marta Telishevska
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sarah Lengauer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Isabel Deisenhofer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
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9
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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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10
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Popa MA, Bourier F, Lengauer S, Krafft H, Bahlke F, Förschner LV, Dorfmeister S, Kathan S, Telishevska M, Englert F, Lennerz C, Reents T, Hessling G, Deisenhofer I, Kottmaier M. Safety profile and long-term efficacy of very high-power short-duration (60-70 W) catheter ablation for atrial fibrillation: results of a large comparative analysis. Europace 2022; 25:408-416. [PMID: 36504120 PMCID: PMC9935037 DOI: 10.1093/europace/euac215] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 06/25/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS This retrospective study sought to compare complication rates and efficacy of power-controlled very high-power short-duration (vHPSD) and conventional catheter ablation in a large cohort of patients with atrial fibrillation (AF). METHODS AND RESULTS We analyzed 1115 consecutive patients with AF (38.7% paroxysmal, 61.3% persistent) who received first-time catheter ablation at our centre from 2015 to 2021. Circumferential pulmonary vein isolation ± additional substrate ablation using an irrigated-tip catheter was performed with vHPSD (70 W/5-7 s or 60 W/7-10 s) in 574 patients and with conventional power (30-35 W/15-30 s) in 541 patients. Baseline characteristics were well-balanced between groups (mean age 65.1 ± 11.2 years, 63.4% male). The 30-day incidence of cardiac tamponade [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598], pericardial effusion ≥ 10 mm [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598] and transient ischaemic attack [1/574 (0.17%) vs. 2/541 (0.37%), P = 0.529] was not significantly different between vHPSD and conventional ablation. No stroke, atrio-esophageal fistula, cardiac arrest or death occurred. Procedure (122.2 ± 46.8 min vs. 155.0 ± 50.5 min, P < 0.001), radiofrequency (22.4 ± 19.3 min vs. 52.9 ± 22.0 min, P < 0.001), and fluoroscopy (8.1 ± 7.2 vs. 9.2 ± 7.4, P = 0.016) duration were significantly shorter in the vHPSD group. At 12 months follow-up, freedom of any atrial arrhythmia was 44.1% vs. 34.2% (P = 0.010) in persistent AF and 78.1% vs. 70.2% in paroxysmal AF (P = 0.068). CONCLUSION vHPSD ablation is as safe as conventional ablation and is associated with an improved long-term efficacy in persistent AF.
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Affiliation(s)
- Miruna A Popa
- Corresponding author. Tel: +49 89 1218 2020, Fax: +49 89 1218 4593. E-mail address:
| | - Felix Bourier
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Sarah Lengauer
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Hannah Krafft
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Fabian Bahlke
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Leonie V Förschner
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Stephan Dorfmeister
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Susanne Kathan
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Marta Telishevska
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Florian Englert
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Carsten Lennerz
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Tilko Reents
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Gabriele Hessling
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Isabel Deisenhofer
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
| | - Marc Kottmaier
- German Heart Center Munich, Department of Electrophysiology, Lazarettstraße 36, 80636 Munich, Germany,Munich Arrhythmia Research and Study Center (MARS), Lazarettstraße 36, 80636 Munich, Germany
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11
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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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12
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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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13
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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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14
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Kantenwein V, Telishevska M, Bourier F, Kottmaier M, Brkic A, Risse E, Popa M, Lengauer S, Kolb C, Deisenhofer I, Hessling G, Reents T. Feasibility and safety of left atrial access for ablation of atrial fibrillation in patients with persistent left superior vena cava. Pacing Clin Electrophysiol 2022; 45:357-364. [PMID: 35015906 DOI: 10.1111/pace.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure. METHODS AND RESULTS In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33,3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48,2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3,7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred. CONCLUSION In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marta Telishevska
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Felix Bourier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marc Kottmaier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Amir Brkic
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Elena Risse
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Miruna Popa
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Sarah Lengauer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
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15
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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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16
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Deisenhofer I, Foerschner L, Kriesmair J, Kottmaier M, Bourier FJ, Reents T, Telishevska M, Lengauer S, Lennerz C, Kraft H, Popa Minura SM, Kolb C, Hessling G. B-PO03-136 CATHETER ABLATION IN ADULT CONGENITAL HEART DISEASE ON UNINTERRUPTED ORAL ANTICAOGULATION: IS IT SAFE? - DATA FROM A LARGE SINGLE CENTER STUDY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.610] [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: 10/20/2022]
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17
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Deisenhofer I, Lengauer S, Telishevska M, Richter S, Rajappan K, Kottmaier M, Bertagnolli L, Moreno J, Hunter R, Tao C, Della Bella P. European early experience with a novel 3D mapping system. Europace 2021. [DOI: 10.1093/europace/euab116.071] [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
Catheter navigation and 3-dimensional (3D) cardiac mapping are critical for successful electrophysiological ablation procedures. A novel 3D mapping system received CE Mark in July 2020. The system offers two imaging modalities: magnetic-based (VoXel) and impedance-based (NavX). Real-time display of 3D location and catheter movements is achieved via a magnetic field frame and magnetic sensors with supplemental impedance data when operating in VoXel mode or primarily via an impedance field generated from surface electrodes in NavX mode. To address limitations in data collection commonly experienced during 3D mapping, a new respiratory compensation algorithm, patient movement detection module, and metal compensation algorithm have been developed to enable consistent data collection throughout the full respiratory cycle even in challenging cases and lab environments.
Purpose
To examine the clinical utility and procedural characteristics associated with the use of this novel 3D mapping system among participating centers.
Methods
Procedural data was collected in cases utilizing the newly cleared mapping system during the initial evaluation phase in Europe. Procedural characteristics recorded included indication for mapping and ablation, rhythm mapped, chambers mapped, and procedure time.
Results
Procedural data was collected from over 250 cases across 12 European centers. A total of 12 indications for mapping and ablation were represented including de novo and redo atrial fibrillation (paroxysmal, persistent, long-standing persistent), ventricular tachycardia (ischemic, non-ischemic) or premature ventricular contraction, and supraventricular arrhythmias (typical and atypical atrial flutter, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia). Over 70% of the cases were performed in VoXel mode. Impedance mode was mostly used in SVT cases or when the case was intended to be completed with minimal fluoroscopy. The most commonly mapped rhythms were sinus rhythm during voltage mapping and atrial tachycardia. The majority of cases (over 65%) were completed under conscious sedation; general anesthesia was used in 20% of the cases (15% not reported). The respiratory compensation algorithm was utilized in over 90% of the cases. For cases in which pre-procedural computed tomography or magnetic resonance imaging were available, operators indicated that the model shape was accurate when compared to pre-procedural imaging in 96% of the cases performed in VoXel mode.
Conclusions
Initial European experience with this novel 3D mapping system included a wide variety of arrhythmias in the atria and ventricles. This new mapping system offered operators the flexibility to tailor to specific procedure needs with two imaging modalities which were both widely utilized.
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Affiliation(s)
| | - S Lengauer
- German Heart Centre Munich, Munich, Germany
| | | | - S Richter
- Heart Center - University of Leipzig, Leipzig, Germany
| | - K Rajappan
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - L Bertagnolli
- Heart Center - University of Leipzig, Leipzig, Germany
| | - J Moreno
- Hospital Ramón y Cajal, Madrid, Spain
| | - R Hunter
- St Bartholomew"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Tao
- Abbott, Minneapolis, United States of America
| | - P Della Bella
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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18
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Bourier F, Popa M, Kottmaier M, Maurer S, Bahlke F, Telishevska M, Lengauer S, Koch-Büttner K, Kornmayer M, Risse E, Brkic A, Reents T, Hessling G, Deisenhofer I. RF electrode-tissue coverage significantly influences steam pop incidence and lesion size. J Cardiovasc Electrophysiol 2021; 32:1594-1599. [PMID: 33928696 DOI: 10.1111/jce.15063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Steam pops are a rare complication associated with radiofrequency (RF) ablation and are hard to predict. The aim of this study was to assess the influence of coverage between the RF ablation electrode and cardiac tissue on steam pop incidence and lesion size. METHODS AND RESULTS An ex vivo model using porcine cardiac preparations and contact force sensing catheters was designed to perform RF ablations at different coverage levels between the RF electrode and cardiac tissue. During coverage level I, only the distal part of the ablation electrode was in contact with tissue. During coverage level II half of the ablation electrode, and during coverage level III the entire ablation electrode was embedded in tissue. RF applications (n = 60) at different coverage levels I-III were systematically performed using the same standardized ablation protocol. Ablations during coverage level III resulted in a significantly higher rate of steam pops (100%) when compared to ablations during coverage level II (10%) and coverage level I (0%), log rank p < .001. Coverage level I ablations resulted in significantly smaller lesion depths, diameters, and impedance drops when compared to higher coverage level ablations, p < .001. In the controlled ex vivo model, there was no difference in applied contact force or energy between different coverage levels. CONCLUSIONS The level of coverage between RF electrode, cardiac tissue, and the surrounding fluid significantly influenced the incidence of steam pops in an ex vivo setup. Larger coverage between RF electrode and tissue resulted in significantly larger lesion dimensions.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Susanne Maurer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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Kalinsek TP, Kottmaier M, Telishevska M, Berger F, Semmler V, Popa M, Brkic A, Lengauer S, Otgonbayar U, Koch-Büttner K, Bartowiak M, Kornmayer M, Brooks S, Risse E, Kathan S, Hofmann M, Grebmer C, Reents T, Hessling G, Deisenhofer I, Bourier F. Early recurrence after pulmonary vein isolation is associated with inferior long-term outcomes: Insights from a retrospective cohort study. Pacing Clin Electrophysiol 2020; 43:1156-1164. [PMID: 32895960 DOI: 10.1111/pace.14060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long-term outcomes and to identify clinical variables associated with ER. METHODS We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan-Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long-term outcomes. RESULTS ER was observed in 13% of patients. Kaplan-Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14-day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30-day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. CONCLUSIONS ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long-term outcomes.
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Affiliation(s)
- Tine Prolic Kalinsek
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Florian Berger
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Ulamnemekh Otgonbayar
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marcin Bartowiak
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Stephanie Brooks
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Susanne Kathan
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Monika Hofmann
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
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20
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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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21
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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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22
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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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23
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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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24
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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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25
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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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26
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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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27
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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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28
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Bourier F, Schwarz B, Brkic A, Wolff L, Semmler V, Kottmaier M, Risse E, Telishevska M, Brooks S, Lengauer S, Kornmayer M, Koch-Büttner K, Berger F, Hessling G, Deisenhofer I, Reents T. EP radiofrequency generators: Significant offsets between selected and delivered power? J Cardiovasc Electrophysiol 2017; 29:330-334. [DOI: 10.1111/jce.13386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Bernhard Schwarz
- Department of Medical Technology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Amir Brkic
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Lara Wolff
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Verena Semmler
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marc Kottmaier
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Elena Risse
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marta Telishevska
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Stephanie Brooks
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Sarah Lengauer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Florian Berger
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Gabriele Hessling
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Tilko Reents
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
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29
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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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30
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Papagiannis J, Beissel DJ, Krause U, Cabrera M, Telishevska M, Seslar S, Johnsrude C, Anderson C, Tisma-Dupanovic S, Connelly D, Avramidis D, Carter C, Kornyei L, Law I, Von Bergen N, Janusek J, Silva J, Rosenthal E, Willcox M, Kubus P, Hessling G, Paul T. Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004869. [DOI: 10.1161/circep.116.004869] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/22/2016] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Abstract
Background—
The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately.
Methods and Results—
A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients’ growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation). Procedure times (251±117 versus 174±94 minutes;
P
=0.0006) and fluoroscopy times (median 20.8 versus 16.6 minutes;
P
=0.037) were longer in group A versus group B. There were significant differences between groups in the acute success of ablation (82% versus 97%;
P
=0.04), risk of atrioventricular block (14 versus 0%;
P
=0.004), and need for chronic pacing (10% versus 0%;
P
=0.008). There was no permanent atrioventricular block in patients who underwent cryoablation. After 3.2±2.7 years of follow-up, long-term success was 86% in group A and 100% in group B (
P
=0.004).
Conclusions—
Atrioventricular nodal reentrant tachycardia can complicate the course of patients with CHD. This study demonstrates that the outcome of catheter ablation is favorable in patients with simple CHD. Patients with complex CHD have increased risk of procedural failure and atrioventricular block.
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Affiliation(s)
| | | | - Ulrich Krause
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | | | | | | | | | | | - Ian Law
- For the author affiliations, please see the Appendix
| | | | - Jan Janusek
- For the author affiliations, please see the Appendix
| | | | | | - Mark Willcox
- For the author affiliations, please see the Appendix
| | - Peter Kubus
- For the author affiliations, please see the Appendix
| | | | - Thomas Paul
- For the author affiliations, please see the Appendix
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31
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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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32
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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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33
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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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34
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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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35
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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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36
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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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37
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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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38
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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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39
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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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40
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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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41
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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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42
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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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43
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Telishevska M, Semmler V, Buiatti A, Reents T, Bourier F, Kornmayer M, Kottmaier M, Deisenhofer I, Hessling G. 16-30: Radiofrequency ablation of right-sided accessory pathways in children: how have 3-D mapping systems and cool-tip catheters changed success, fluoroscopy time and recurrence? Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i8a] [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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44
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Bourier F, Reents T, Ammar-Busch S, Buiatti A, Kottmaier M, Semmler V, Telishevska M, Brkic A, Grebmer C, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures. Europace 2015; 18:1406-10. [PMID: 26589627 PMCID: PMC5400031 DOI: 10.1093/europace/euv364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 06/17/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022] Open
Abstract
Aims This study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels. Methods and results From October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0). Conclusion The new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Sonia Ammar-Busch
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Alessandra Buiatti
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christof Kolb
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
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45
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Ammar-Busch S, Kaess BM, Bruhm A, Reents T, Bourier F, Buiatti A, Semmler V, Telishevska M, Kottmaier M, Hessling G, Deisenhofer I. Atrial Tachycardias Following Persistent Atrial Fibrillation Ablation: Predictors of Recurrence After the Repeat Ablation. J Cardiovasc Electrophysiol 2015; 26:1315-20. [PMID: 26290013 DOI: 10.1111/jce.12817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/02/2015] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Repeat procedures after persistent atrial fibrillation (AF) ablation are frequently performed for secondary atrial tachycardias (AT). Predictors of AT recurrence after the first repeat ablation have not yet been studied. METHODS We investigated predictors of AT recurrence in 117 patients who underwent ablation for secondary AT arising after a previous ablation for persistent AF using the Cox proportional hazards model. RESULTS Acute ablation success rate was 94%. Over a follow-up period of 12 months, 61 patients (53%) were free from AT recurrence. Of the assessed predictors of AT recurrence, the number of ablated AT forms (>1 vs. 1) was significantly associated with AT recurrence (hazard ratio 2.01, 95% CI 1.18-3.43, P = 0.01). Other variables including left atrial diameter, AT mechanism, or the characteristics of previous AF ablation did not have significant influence on AT recurrence (P>0.05). Men had a tendency toward fewer AT recurrences than women (OR 0.60, 95% CI 0.34-1.05, P = 0.07). During a second AT ablation procedure, 19 (49%) patients were identified to have a recurrence of the previously ablated AT, whereas in 20 patients (51%) a new AT form was diagnosed. CONCLUSION Ablation of atrial tachycardias following persistent AF ablation has a high acute success rate. However, a substantial number of patients develop new onset AT during follow-up. The occurrence of multiple AT forms during the repeat ablation procedure was the only predictive factor for AT recurrence.
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Affiliation(s)
- Sonia Ammar-Busch
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Bernhard M Kaess
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Alexandra Bruhm
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Alessandra Buiatti
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Verena Semmler
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universitaet München, Munich, Germany
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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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Reents T, Buiatti A, Ammar S, Dillier R, Semmler V, Telishevska M, Bourier F, Lennerz C, Grebmer C, Kaess B, Kolb C, Hessling G, Deisenhofer I. Catheter Ablation of Ventricular Arrhythmias using a Fluoroscopy Image Integration Module. Pacing Clin Electrophysiol 2015; 38:700-5. [PMID: 25790434 DOI: 10.1111/pace.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 02/15/2015] [Accepted: 03/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of the CartoUnivu™ technology (Biosense Webster, Diamond Bar, CA, USA) on fluoroscopy exposure compared to a conventional approach using electroanatomical mapping (Carto 3™) was evaluated in patients undergoing radiofrequency ablation for ventricular tachyarrhythmias (VT). METHODS AND RESULTS We prospectively evaluated 23 patients undergoing VT ablation using the CartoUnivu™ technology. The CartoUnivu™ Module integrates fluoroscopic images and cine loops into the electroanatomical mapping system. As a control group, 23 out of 88 VT patients (ablated using conventional fluoroscopy supplemented by electromagnetic mapping with the Carto 3™ System) were matched for age, gender, body surface area, operator, redo-procedure, presence of coronary artery disease, and left ventricular dysfunction using propensity score matching. A significant reduction in fluoroscopy exposure was observed in the CartoUnivu™ group when compared to the conventional group (10.57 ± 7.93 minutes vs 18.52 ± 11.24 minutes, P_= 0.008; 611 cGy/cm(2) vs 1650 cGy/cm(2) , P = 0.001). In multivariate analysis, the CartoUnivu™ module was an independent predictor of reduced fluoroscopy use. CONCLUSION This is a report on the clinical application of the CartoUnivu system for VT ablation. CartoUnivu™ markedly reduced fluoroscopy time and dose compared to conventional fluoroscopy/electroanatomical mapping.
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Affiliation(s)
- Tilko Reents
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Allessandra Buiatti
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sonia Ammar
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roger Dillier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Verena Semmler
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Grebmer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Bernhardt Kaess
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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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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Abstract
BACKGROUND A clear, up-to-date picture of smoking prevalence and its determinants is needed to inform the development of an effective tobacco control policy in Ukraine, particularly given the way in which the tobacco industry has targeted post-Soviet countries since transition. METHODS A nationally representative household survey was undertaken in Ukraine in February 2000. RESULTS Data were available on 1,590 individuals (response rate 72%). Fifty-seven percent of men and 10% of women were current smokers and an additional 21 and 7%, respectively, were ex-smokers. Smoking behavior has changed considerably over successive generations, with an increase in the proportion of women smoking and a reduction in the mean age at first smoking. Factors associated with smoking include young age, urban residence (among women), and material hardship, particularly unemployment. Involvement in social networks appears to reduce the probability of smoking. Smoking commonly occurs in public places and smokers differ from nonsmokers in their health beliefs about smoking. CONCLUSIONS Levels of smoking among men are already high and among young women are increasing rapidly. Unless an effective tobacco policy response is developed to address the issues identified, tobacco will continue to make an increasingly large contribution to premature morbidity and mortality in Ukraine.
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Affiliation(s)
- A B Gilmore
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
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