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Springer A, Dreher A, Reimers J, Kaiser L, Bahlmann E, van der Schalk H, Wohlmuth P, Gessler N, Hassan K, Wietz J, Bein B, Spangenberg T, Willems S, Hakmi S, Tigges E. Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation. Front Cardiovasc Med 2024; 10:1265978. [PMID: 38292453 PMCID: PMC10824923 DOI: 10.3389/fcvm.2023.1265978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/30/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiac arrest (CA). In the light of increasing availability, the analyses of outcome-relevant predisposing characteristics are of growing importance. We evaluated the prognostic influence of gender in patients presenting with out-of-hospital cardiac arrest (OHCA) treated with eCPR. Methods We retrospectively analysed the data of 377 consecutive patients treated for OHCA using eCPR in our cardiac arrest centre from January 2016 to December 2022. The primary outcome was defined as the survival of patients until they were discharged from the hospital, with a favourable neurological outcome [cerebral performance category (CPC) score of ≤2]. Statistical analyses were performed using baseline comparison, survival analysis, and multivariable analyses. Results Out of the 377 patients included in the study, 69 (21%) were female. Female patients showed a lower prevalence rate of pre-existing coronary artery disease (48% vs. 75%, p < 0.001) and cardiomyopathy (17% vs. 34%, p = 0.01) compared with the male patients, while the mean age and prevalence rate of other cardiovascular risk factors were balanced. The primary reason for CA differed significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 10%; p = 0.001). The prevalence rate of witnessed collapse (97% vs. 86%; p = 0.016) and performance of bystander CPR (94% vs. 85%; p = 0.065) was higher in female patients. The mean time from collapse to the initiation of eCPR did not differ between the two groups (77 ± 39 min vs. 80 ± 37 min; p = 0.61). Overall, female patients showed a higher percentage of neurologically favourable survival (23% vs. 12%; p = 0.027) despite a higher prevalence of procedure-associated bleeding complications (33% vs. 16%, p = 0.002). The multivariable analysis identified a shorter total CPR duration (p = 0.001) and performance of bystander CPR (p = 0.03) to be associated with superior neurological outcomes. The bivariate analysis showed relevant interactions between gender and body mass index (BMI). Conclusion Our analysis suggests a significant survival benefit for female patients who obtain eCPR, possibly driven by a higher prevalence of witnessed collapse and bystander CPR. Interestingly, the impact of patient age and BMI on neurologically favourable outcome was higher in female patients than in male patients, warranting further investigation.
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Affiliation(s)
- A. Springer
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - A. Dreher
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Reimers
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - L. Kaiser
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Bahlmann
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - H. van der Schalk
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - N. Gessler
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- Asklepios ProResearch, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K. Hassan
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Wietz
- Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany
| | - B. Bein
- Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - T. Spangenberg
- Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, Germany
| | - S. Willems
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Semmelweis-University, Budapest, Hungary
| | - S. Hakmi
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Springer A, Dreher A, Reimers J, Kaiser L, Bahlmann E, van der Schalk H, Wohlmuth P, Gessler N, Hassan K, Wietz J, Bein B, Spangenberg T, Willems S, Hakmi S, Tigges E. Prognostic influence of mechanical cardiopulmonary resuscitation on survival in patients with out-of-hospital cardiac arrest undergoing ECPR on VA-ECMO. Front Cardiovasc Med 2024; 10:1266189. [PMID: 38274309 PMCID: PMC10808304 DOI: 10.3389/fcvm.2023.1266189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (ECPR) in selected patients after out-of-hospital cardiac arrest (OHCA) is an established method if return of spontaneous circulation cannot be achieved. Automated chest compression devices (ACCD) facilitate transportation of patients under ongoing CPR and might improve outcome. We thus sought to evaluate prognostic influence of mechanical CPR using ACCD in patients presenting with OHCA treated with ECPR including VA-ECMO. Methods We retrospectively analyzed data of 171 consecutive patients treated for OHCA using ECPR in our cardiac arrest center from the years 2016 to 2022. A Cox proportional hazards model was used to identify characteristics related with survival. Results Of the 171 analyzed patients (84% male, mean age 56 years), 12% survived the initial hospitalization with favorable neurological outcome. The primary reason for OHCA was an acute coronary event (72%) followed by primary arrhythmia (9%) and non-ischemic cardiogenic shock (6.7%). In most cases, the collapse was witnessed (83%) and bystander CPR was performed (83%). The median time from collapse to VA-ECMO was 81 min (Q1: 69 min, Q3: 98 min). No survival benefit was seen for patients resuscitated using ACCD. Patients in whom an ACCD was used presented with overall longer times from collapse to ECMO than those who were resuscitated manually [83 min (Q1: 70 min, Q3: 98 min) vs. 69 min (Q1: 57 min, Q3: 84 min), p = 0.004]. Conclusion No overall survival benefit of the use of ACCD before ECPR is established was found, possibly due to longer overall CPR duration. This may arguably be because of the limited availability of ACCD in pre-clinical paramedic service at the time of observation. Increasing the availability of these devices might thus improve treatment of OHCA, presumably by providing efficient CPR during transportation and transfer.
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Affiliation(s)
- A. Springer
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - A. Dreher
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Reimers
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - L. Kaiser
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Bahlmann
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - H. van der Schalk
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - N. Gessler
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- Asklepios ProResearch, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K. Hassan
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - J. Wietz
- Department of Emergency Medicine, Asklepios Clinic St. Georg, Hamburg, Germany
| | - B. Bein
- Department of Anaesthesiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - T. Spangenberg
- Department of Cardiology and Critical Care, Asklepios Clinic Altona, Hamburg, Germany
| | - S. Willems
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Semmelweis-University, Budapest, Hungary
| | - S. Hakmi
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - E. Tigges
- Department of Cardiology and Critical Care, Asklepios Clinic St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Rongen APM, Willems S, Bruhn J, Rex S, Devroe S, Özkan S, van de Velde M. Unwarranted association between epidural analgesia and emergency delivery: critical review of methodological shortcomings. Ultrasound Obstet Gynecol 2023; 62:754-755. [PMID: 37910796 DOI: 10.1002/uog.27487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023]
Abstract
Linked articles: This Correspondence comments on Damhuis et al. and Tabernée Heijtmeijer et al.
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Affiliation(s)
- A P M Rongen
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Willems
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Bruhn
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Rex
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - S Devroe
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - S Özkan
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M van de Velde
- Department of Anesthesiology, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Metzner A, Straube F, Tilz RR, Kuniss M, Noelker G, Tebbenjohanns J, Andresen D, Wieneke H, Stellbrink C, Franke J, Dorwarth U, Carion PL, Holbrook R, Hochadel M, Senges J, Hoffmann E, Kuck KH, Garcia-Alberola A, Massa T, Sabin G, Franke A, Souza JJ, Stanley A, Spitzer SG, Willems S, Dierk T, Chun KRJ, Borchard R, Seidl KH, Zahn R, Groschup G, Obel IWP, Brachmann J, Gerds-Li JH, Gopal RR, Schrickel J, Lewalter T, Stanley A, Moshage W, Eckardt L, Jung W, Kremer P, Lubinski A, Schumacher B, Lickfett L, Münzel T, Steinwender C, Efremidis M, Deneke T, Nguyen DQ. Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study. BMC Cardiovasc Disord 2023; 23:8. [PMID: 36624380 PMCID: PMC9830778 DOI: 10.1186/s12872-022-03015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). METHODS The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. RESULTS The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). CONCLUSION CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Cardiology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 70, 20246, Hamburg, Germany.
| | - Florian Straube
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Roland R. Tilz
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany ,grid.412468.d0000 0004 0646 2097Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Centre Luebeck, Lübeck, Germany
| | - Malte Kuniss
- grid.419757.90000 0004 0390 5331Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Georg Noelker
- grid.418457.b0000 0001 0723 8327Herz- Und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Juergen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I – Kardiologie, Hildesheim, Germany
| | - Dietrich Andresen
- grid.417953.d0000 0004 0560 5172Department of Cardiology Paul Gerhardt Diakonie gAG, Evangelisches Krankenhaus Hubertus, Berlin, Germany
| | - Heinrich Wieneke
- Klinik Für Kardiologie und Angiologie, Contilia Herz- Und Gefäßzentrum, Essen, Germany
| | - Christoph Stellbrink
- grid.461805.e0000 0000 9323 0964Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany
| | - Jennifer Franke
- grid.476904.8CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Uwe Dorwarth
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Phuong Lien Carion
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Reece Holbrook
- grid.419673.e0000 0000 9545 2456Medtronic, Inc., Mounds View, MN USA
| | - Matthias Hochadel
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Jochen Senges
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Ellen Hoffmann
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Karl-Heinz Kuck
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Willems S, Brouwers J, Eefting D. Aortic and Iliac Involvement in Brucellosis: a Rare But Life Threatening Manifestation. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.027] [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: 04/08/2023] Open
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Pecha S, Burger H, Chung DU, Möller V, Madej T, Maali A, Osswald B, De Simone R, Monsefi N, Ziaukas V, Erler S, Perthel M, Wehbe MS, Ghaffari N, Sandhaus T, Busk H, Schmitto JD, Bärsch V, Easo J, Albert M, Treede H, Nägele H, Zenker D, Hegazy Y, Gessler N, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. Safety and Efficacy of Laser Lead Extraction in Octo- and Nonagenarians: A Subgroup Analysis from the GALLERY Registry. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761823] [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]
Affiliation(s)
- S. Pecha
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - H. Burger
- Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Deutschland
| | - D. U. Chung
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - V. Möller
- Immanuel Herzzentrum Brandenburg, Bernau bei Berlin, Deutschland
| | - T. Madej
- University Hospital Carl Gustav Carus Dresden Heart Center, Dresden, Deutschland
| | - A. Maali
- Herzzentrum, Coswig (Anhalt), Deutschland
| | - B. Osswald
- Johanniter-Krankenhaus Duisburg-Rheinhausen, Duisburg, Deutschland
| | - R. De Simone
- Universitätsklinikum Heidelberg Klinik für Herzchirurgie, Heidelberg, Deutschland
| | - N. Monsefi
- Helios Klinikum Siegburg, Siegburg, Deutschland
| | - V. Ziaukas
- Schüchtermann-Klinik, Bad Rothenfelde, Deutschland
| | - S. Erler
- Department of Cardiothoracic Surgery, Bad Bevensen, Deutschland
| | - M. Perthel
- Heart Centre Bad Segeberg, Bad Segeberg, Deutschland
| | - M. S. Wehbe
- Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Deutschland
| | - N. Ghaffari
- Helios Heart Surgery Clinic Karlsruhe, Karlsruhe, Deutschland
| | | | - H. Busk
- Uniklinik Magdeburg, Magdeburg, Deutschland
| | - J. D. Schmitto
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - V. Bärsch
- St. Marien-Krankenhaus Siegen—Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Siegen, Deutschland
| | - J. Easo
- Hospital Oldenburg, Oldenburg, Deutschland
| | - M. Albert
- Robert-Bosch Hospital, Stuttgart, Deutschland
| | - H. Treede
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - H. Nägele
- Albertinen Krankenhaus, Hamburg, Deutschland
| | - D. Zenker
- Robert-Koch-Str. 40, Göttingen, Deutschland
| | - Y. Hegazy
- MediClin Heart Center Lahr/Baden, Lahr/Schwarzwald, Deutschland
| | - N. Gessler
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - M. Knaut
- Herzzentrum Dresden Universitätsklinik, Herzchirurgie, Dresden, Deutschland
| | | | - S. Willems
- Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - C. Butter
- Immanuel Herzzentrum Brandenburg, Bernau bei Berlin, Deutschland
| | - S. Hakmi
- Asklepios Klinik St. Georg, Hamburg, Deutschland
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Gunawardene MA, Lemoine M, Deneke T, Wakili R, Steven D, Schaeffer B, Rillig A, Nentwich K, Siebermair J, Filipovic K, Simu G, Riesinger L, Sultan A, Willems S, Metzner A. Pulsed field ablation for atrial fibrillation: acute procedural efficacy and safety of an initial German multicenter experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.473] [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
Pulsed field ablation (PFA) is a novel non-thermal energy source to conduct catheter ablation of atrial fibrillation (AF). However, real-world multi-center data regarding acute procedural efficacy and safety is sparse.
Purpose
To study acute procedural success and safety in patients undergoing PFA for catheter ablation of AF in a multicenter registry.
Methods
Consecutive paroxysmal and persistent AF patients undergoing PFA-based catheter ablation using a multispline catheter were enrolled. The cohort included first and repeat ablation procedures. Procedural parameters, acute success and in-hospital safety were evaluated. A follow-up of all patients was conducted.
Results
Five German centers enrolled a total of 154 patients undergoing PFA in this study. Mean age was 68±12 years, median CHA2DS2-VASc Score was 3 (Q1-Q3: 2–4).
Patients suffered from paroxysmal AF (n=55; 36%), persistent AF (n=93; 60%) and consecutive atrial tachycardias (AT) due to previous CA (n=6; 4%).
The median left atrial (LA) PFA and total procedure times were 33 (Q1-Q3: 24–53) and 90 (Q1-Q3: 73–116) minutes, respectively. Mean LA PFA fluoroscopy and total fluoroscopy times were 12.1±5.5 and 20.2±8.7 minutes. Of all 154 procedures, 130 (84%) were index ablation procedures with isolation of pulmonary veins (PVI) only and 24 (16%) were repeat procedures (including re-PVI and ablation of consecutive AT).
Acute PV reconnection following primary PVI and the initial set of PFA-applications was found in 20/130 (15%) patients, necessitating additional PFA ablation. Finally, successful PFA-guided PVI was achieved in all patients.
Additional PFA lesion sets (including LA posterior wall isolation, anterior ablation, mitral isthmus ablation) were applied in 17/154 (11%) patients.
Complications occurred in a total of 6/154 (3.8%) patients (including three groin site complications, two pericardial tamponades, one transient coronary spasm without sequela). The follow up data is still being assessed and will be provided by the time of the ESC 2022 meeting.
Conclusion
PFA performed in patients with atrial fibrillation demonstrates high acute procedural success rates and a favorable safety profile in this first real-world multicenter registry.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Lemoine
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - T Deneke
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | - R Wakili
- University hospital Essen , Essen , Germany
| | - D Steven
- University of Cologne , Cologne , Germany
| | - B Schaeffer
- Asklepios Clinic St. Georg , Hamburg , Germany
| | - A Rillig
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - K Nentwich
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | | | | | - G Simu
- Heart Center Bad Neustadt , Bad Neustadt a. d. Saale , Germany
| | | | - A Sultan
- University of Cologne , Cologne , Germany
| | - S Willems
- Asklepios Clinic St. Georg , Hamburg , Germany
| | - A Metzner
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Wahedi R, Willems S, Jularic M, Hartmann J, Schaeffer B, Akbulak-Stegli Ö, Eickholt C, Anwar O, Maurer T, Hedenus K, Gunawardene M. Safety and efficacy of catheter ablation for atrial fibrillation in the very elderly. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The incidence and prevalence of atrial fibrillation (AF) increases with age. With an ageing general population, a 2.3-fold rise in AF prevalence is expected. Catheter ablation has emerged as an effective treatment option for rhythm control therapy. However, very elderly patients (≥80 years old) have been excluded in landmark clinical trials. Current data regarding the safety and efficacy of catheter ablation in the very elderly is therefore sparse.
Purpose
Due to the growing demand to manage AF in an increasingly ageing population, we investigated the safety and efficacy of catheter ablation in this particular patient population.
Methods
Patients with symptomatic paroxysmal, persistent and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency, cryoballoon and pulsed field ablation as energy sources. Re-ablation procedures included re-PVI and consecutive atrial tachycardia ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Endpoints included acute procedural success (complete isolation of pulmonary veins and/or non-inducibility in the case of atrial tachycardia), major complications and early arrhythmia-recurrence.
Results
A total of eighty-eight patients (mean age 83.1±1.9 years, mean CHA2DS2-VASc-Score 4.4±1, mean left ventricular ejection fraction 56.7±7%, direct oral anticoagulation 92.1%, vitamin-K antagonists 7.9%) were included from January 2021 to October 2021. Fifty cases (56.8%) involved PVI as an index procedure (radiofrequency 58%, n=29/50, cryoballoon 36%, n=18/50, pulsed field ablation 6%, n=3/50). Thirty-eight procedures (43.2%) involved re-ablation procedures (Re-PVI 60.5%, n=23/38, linear lesions 65.8%, n=25/38, atrial tachycardia ablation 26.3%, n=10/38 and ablation of CFAE 15.8%, n=6/38). Acute procedural success was achieved in 87/88 patients (98.9%). Major complications included stroke (n=1/88, 1.1%), pericardial tamponade (n=1/88, 1.1%) and bradycardia with subsequent pacemaker implantation (n=3/88, 3.4%). No further major complications were documented. In 13/88 patients (14.8%) early arrhythmia-recurrence occurred (38.5%, n=5/13 after the index procedure and 61.5%, n=8/13 after re-ablation) during the 90-day blanking period.
Conclusions
Catheter ablation for atrial fibrillation in the very elderly shows favourable acute success and low complication rates. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Wahedi
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - S Willems
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - M Jularic
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - J Hartmann
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - B Schaeffer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | | | - C Eickholt
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - O Anwar
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - T Maurer
- Asklepios St. Georg Clinic , Hamburg , Germany
| | - K Hedenus
- Asklepios St. Georg Clinic , Hamburg , Germany
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9
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Dinter R, Willems S, Hachem M, Mittelstädt M, Brunschweiger A, Kockmann N. Two‐Phase Flow Reaction System for Amide Coupling Towards Automated DNA‐Encoded Chemistry. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255228] [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: 11/10/2022]
Affiliation(s)
- R. Dinter
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - S. Willems
- TU Dortmund University Department of Chemistry and Chemical Biology, Medicinal Chemistry Otto-Hahn-Str. 6 44227 Dortmund Germany
| | - M. Hachem
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - M. Mittelstädt
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
| | - A. Brunschweiger
- TU Dortmund University Department of Chemistry and Chemical Biology, Medicinal Chemistry Otto-Hahn-Str. 6 44227 Dortmund Germany
| | - N. Kockmann
- TU Dortmund University Department of Chemical and Biochemical Engineering, Laboratory of Equipment Design Emil-Figge-Str. 68 44227 Dortmund Germany
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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11
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Obergassel J, Taraba S, Nies M, Atzor C, Lemoine MD, Rottner L, Schleberger R, Dinshaw LWH, Meyer C, Willems S, Reissmann B, Ouyang F, Metzner A, Kirchhof P, Rillig A. Why are redo AF ablations required and what does it take? Type of index PVI predicts pattern of redo ablations. Europace 2022. [DOI: 10.1093/europace/euac053.228] [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
Catheter ablation targeting isolation of the pulmonary veins (PVI) is the most effective treatment for atrial fibrillation (AF). Despite its high overall effectiveness, repeat AF ablations (re-do procedures, RDP) are often required to maintain sinus rhythm.
Purpose
Determine predictors for multiple and/or complex RDP, evaluate reference values for procedure duration and radiation exposure during index PVI (iPVI) and nth RDP in a large cohort.
Methods and Results
Data mining identified 934 (mean age 62.6 ± 12.3 years, 346 females) out of 6848 total AF ablation patients from a large German AF ablation center between 09/2008 and 09/2021 with an index PVI and at least one RDP. Analysis included 2152 procedures (out of 8750 total AF-related ablations). At iPVI, AF pattern was classified as paroxysmal AF (PAF) in 387 patients (41%). All others (59%) were classified as non-paroxysmal AF (Non-PAF). Non-PAF was significantly more frequent in males (64% vs. 49%, p<0.01). Median period between first PVI and RDP was 558 days (25th/75th percentiles 244.0/1175.5 days). Non-PAF patients had a significantly higher probability of multiple RDP compared to patients with PAF at iPVI (p<0.01, Figure 1A). 18% (8%) of patients with non-PAF had 2 (3) or more RDP while only 13% (3%) of pat. with PAF had 2 (3) or more RDP.
iPVI was classified as PVI-only or PVI with additional substrate modification (SM). 724/934 patients (78%) received PVI-only as initial procedure. Of these, 572 (79%) had only 1 RDP, 116 (16%) had 2 RDP and 36 (5%) had 3 or more RDP. This distribution was 77%, 15% and 8% for 1, 2 and 3 or more RDP for patients with complex PVI as iPVI.
An algorithm based on regular expressions classified all RDP as repeat PVI (Re-PVI) due to reconduction (PV reconduction), ablation of atrial tachycardia (AT) or SM, e. g. defragmentation of fractionated signals, or combinations. The results were manually quality-controlled. 798/934 (85%) patients required PV re-isolation due to PV reconduction, 298/934 (32%) required ablation for atrial tachycardia (AT) at least once during FU (Figure 1B). Comparing PVI-only iPVI patients with patients who received substrate modification during iPVI, significantly less patients with PVI-only iPVI had RDP for AT compared to those with SM during iPVI (27% vs. 50%, p<0.01). More PVI-only iPVI patients required PV-reisolation at any time during FU (87% vs 79%, p<0.01). Considering PVI-only (+/- CTI) iPVIs only, dose-area product decreased in RDP compared to first PVI, while procedure duration slightly increased (Figure 1C). Data on periprocedural complications will be reported.
Conclusion
Redo AF ablations procedures are mainly required due to reconnected pulmonary veins or AT. Patients with PAF at iPVI are less likely to require more than one RDP which provides indirect support for early rhythm control in treatment of AF. SM at iPVI might be a predictor for occurrence of AT in the further course.
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Affiliation(s)
- J Obergassel
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Taraba
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Nies
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Atzor
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - MD Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - LWH Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Meyer
- Evangelical Hospital, Cardiology, Duesseldorf, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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12
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Kaiser L, Hochadel M, Senges J, Kleemann T, Szendey I, Voss F, Steinbeck G, Leschke M, Butter C, Becker R, Willems S, Hakmi S. Procedure related complications following implantation of cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices - Insights from the German DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.465] [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: Foundation. Main funding source(s): Stiftung Institut für Herzinfarktforschung
Background
The number of patients receiving cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices has been increasing in the last decades. Both CRT and ICD play an essential role in modern heart failure therapy. However, the implantation procedure might be ensued by serious complications. Therefore, knowledge about the prevalence of complications and identification of risk factors are key to improve patient care.
Methods
Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD or CRT implantation. Patient characteristics, data on procedural outcome, adverse events and mortality during index hospitalization and follow-up at 1 year from discharge, were recorded. Patients who suffered from perioperative complications during or shortly after device implantation were identified for comparative analysis with patients without complications.
Results
Out of 4170 patients enrolled, 119 (2.9%) suffered from procedure related complications. The proportion of female patients suffering from perioperative complications was higher with 29.4%, compared to 18.5% of female patients without complications (p=0.003). There were neither any differences in age (66.3±13.6 vs. 65.4±12.5 years; p=0.13), nor in cardiac or non-cardiac comorbidities and in the indications for device implantation between groups. There was a trend towards a higher rate of complications with procedures on pre-existing devices (24,8 vs. 18.1%; p=0.064), than observed with de-novo implantations (75.2 vs. 81.9%; p=0.064). CRT implantations were more frequent among patients who suffered from complications (46.2 vs. 28.9%; p<0.001), compared to the group without complications, in which the proportion of ICD implantations was much more frequent (53.8 vs. 71.1%; p<0.001). The most frequent complication overall was pocket hematoma (55.1%), followed by pneumothorax (30.3%), pericardial effusion/tamponade (12.7%) and haemothorax (4.2%). The median hospital stay was significantly longer for patients with complications (7 [5; 11] vs. 3 [2; 5] days; p<0.001)). There was no difference in all-cause in-hospital mortality between respective groups. Median follow-up was 455 [398; 551] vs. 462 [391; 569] days (p=0.82) with no differences in all-cause mortality (6.5 vs. 6.9%; p=0.88), device-associated complications (12.6 vs. 8.5%; p=0.18) or rehospitalizations (37.9 vs. 32.2%; p=0.26) after 1-year follow-up.
Conclusion
The overall procedure-related complication rate following CRT or ICD implantation is low (2.9%). Among patients with complications female gender and patients receiving CRT devices were more prevalent. Perioperative device complications neither seem to translate into increased in-hospital mortality, nor in increased rates of further device-associated complications, rehospitalizations or death after 1-year follow-up.
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Affiliation(s)
- L Kaiser
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - I Szendey
- Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - F Voss
- Hospital Barmherzigen Bruder Trier, Trier, Germany
| | - G Steinbeck
- Klinikum Starnberg, Zentrum fuer Kardiologie, Starnberg, Germany
| | - M Leschke
- Clinic Esslingen, Esslingen, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - R Becker
- Clinic Wolfsburg, Wolfsburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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13
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Chung D, Burger H, Kaiser L, Osswald B, Baersch V, Naegele H, Knaut M, Reichenspurner H, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome and risk prediction in patients with implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction: a GALLERY subgroup analysis. Europace 2022. [DOI: 10.1093/europace/euac053.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD).
Objectives
Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE.
Methods
We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.
Results
A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p<0.001), less likely to be female (20.8 vs. 27.1%; p<0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p<0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p>0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p<0.001), followed by device-related infection (45.6 vs. 73.0%; p<0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p<0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p<0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p<0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p<0.001).
Conclusions
Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - H Burger
- Kerckhoff Clinic, Cardiac Surgery, Bad Nauheim, Germany
| | - L Kaiser
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - B Osswald
- Johanniter Hospital Duisburg Rheinhausen, Division of Electrophysiological Surgery, Duisburg, Germany
| | - V Baersch
- St. Marien-Hospital Siegen, Cardiology, Siegen, Germany
| | - H Naegele
- Albertinen Hospital, Cardiology, Hamburg, Germany
| | - M Knaut
- Dresden University Heart Center, Cardiology, Dresden, Germany
| | - H Reichenspurner
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - S Pecha
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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14
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Chung D, Hochadel M, Senges J, Kleemann T, Eckhardt L, Brachmann J, Steinbeck G, Larbig R, Butter C, Schulz E, Willems S, Hakmi S. Implantable cardioverter-defibrillator therapy in the very young - Patient characteristics procedural outcome and one-year follow-up - A subgroup analysis of the german DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are well-established and essential therapeutic pillars for patients with heart failure and survivors of sudden cardiac death. The number of young patients receiving ICD or CRT-D has been increasing in the last decades. Understanding the key differences between the typically older ICD population and younger patients is paramount to optimized patient care.
Methods
The DEVICE registry prospectively enrolled patients undergoing ICD/CRT implantation or revision from 50 German centers between 2007–2014. Data on patient characteristics, procedural outcome, adverse events and mortality during the initial stay and follow-up was collected. All patients under the age of 45 years were identified and included into a comparative analysis with the remaining population.
Results
A total number of 4181 patients were enrolled into the registry, of which 236 patients (5.6%) were under the age of 45 years. Median age was 38.0 [31.0; 42.0] vs. 69.0 [60.0; 75.0] years, p<0.001), compared to older patients. Young patients were more likely to receive an ICD (91.5 vs. 69.4%, p<0.001), than CRT device and were less likely to suffer from non-cardiac comorbidities (20.3 vs. 67.4%, p<0.001). Coronary artery disease was less common in young patients (15.7 vs. 63.6%, p<0.001), whereas hypertrophic cardiomyopathy (11.0 vs. 2.5%, p<0.001) and primary cardiac electrical diseases (14.0 vs. 1.6%, p< 0.001) were encountered more often. Mean left-ventricular ejection fractions were 42.4±18.5 vs. 31.5±11.8%, respectively (p<0.001) with less young patients in NYHA functional class III/IV (19.5 vs. 45.3%, p<0.001). Primary symptom at presentation was chronic heart failure for older patients (19.5 vs. 34.8%, p<0.001) and survived sudden cardiac death (30.9 vs. 15.6%, p<0.001) for young patients. Thus, ICD for secondary prevention was more common in young patients (53.8 vs. 43.2%, p<0.001). There were no detectable differences in postoperative complications (3.0 vs. 4.1%, p=0.500) or in-hospital mortality (0.0 vs. 0.3%, p=1.000). Median follow-up time was 514 [398; 669] vs. 458 [391; 563] days (p=0.006). Device-associated complications requiring revision were more common in young patients (16.3 vs. 8.2%, p<0.001) and all-cause 1-year-mortality after implantation was lower (3.1 vs. 7.3%, p=0.029; HR 0.42, 95%CI: 0.19-0.94). Even though there was no difference in rates of rehospitalization between groups (32.1 vs. 32.4%, p=0.93), young patients were re-admitted more often for "cardiac" reasons (82.7 vs. 58.9%, p<0.001).
Conclusion
Rates for procedural complications and in-hospital mortality were very low and without differences between both age groups. However younger patients experienced a higher rate of postoperative complications requiring revision and had higher readmission rates for cardiac reasons, potentially due to a more active lifestyle.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - M Hochadel
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - J Senges
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - L Eckhardt
- Muenster University Hospital, Cardiac Electrophysiology, Muenster, Germany
| | - J Brachmann
- Cardiac Center of Coburg, RegioMed Medical School, Coburg, Germany
| | | | - R Larbig
- Kliniken Maria Hilf Moenchengladbach, Cardiology, Moenchengladbach, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - E Schulz
- General Hospital of Celle, Cardiology, Celle, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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Kahle AK, Klatt N, Jungen C, Dietenberger A, Kuklik P, Muenkler P, Willems S, Nikolaev V, Scherschel K, Meyer C. Selective intracardiac sympathetic denervation acutely modulates left ventricular control. Europace 2022. [DOI: 10.1093/europace/euac053.612] [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: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research (DZHK)
Background
The sympathetic nervous system plays an integral role in cardiac physiology. Neuromodulation is emerging as a treatment option for ventricular arrhythmias, but selective intracardiac approaches are rare. Sympathetic nerve fibers innervating the left ventricle have been demonstrated to be amenable to transvenous catheter stimulation along the coronary sinus (CS).
Purpose
The aim of the present study was to modulate left ventricular control by selective sympathetic denervation using epicardial or standard catheter ablation for intracardiac axotomy at the level of the CS.
Methods
First, the impact of epicardial CS ablation on cardiac electrophysiology was studied in a Langendorff model of murine hearts (n=10 each, ablation and control). Second, the impact of transvenous, anatomically-driven axotomy by catheter-based radiofrequency ablation along the CS was evaluated in a healthy ovine in vivo model (n=8) before and during left stellate ganglion stimulation (LSGS).
Results
CS ablation for intracardiac sympathetic axotomy prolonged epicardial ventricular refractory period (VRP) without (41.8±8.4 ms vs. 53.0±13.5 ms; P=0.0487) and with beta1-2-adrenergic receptor blockade (47.8±2.8 ms vs. 73.1±5.0 ms; P=0.0009) and enhanced the increasing effect of beta1-2-adrenergic receptor blockade on epicardial VRP (∆VRP 6.3±7.0 ms vs. 20.0±7.5 ms; P=0.0045) in mice (Figure, A). Mean epicardial wave propagation velocity in the left ventricle was faster in ablated hearts than in controls (1.13±0.05 m/s vs. 1.00±0.02 m/s; P=0.0463), but did not differ in the right ventricle (1.15±0.05 m/s vs. 1.20±0.08 m/s; P=0.7938). Transvenous catheter ablation of the CS reduced systolic (SBP, 57.7±5.0 mmHg vs. 46.9±3.6 mmHg; P=0.0428) and diastolic blood pressure (DBP, 35.5±3.0 mmHg vs. 26.7±1.8 mmHg; P=0.0106) and diminished the blood pressure increase during LSGS in sheep (∆SBP 21.9±3.8 mmHg vs. 10.5±4.2 mmHg; P=0.0234; ∆DBP 9.0±1.9 mmHg vs. 3.0±1.2 mmHg; P=0.0391) (Figure, B, C). Cycle length remained unchanged by LSGS, both before (baseline 653.2±20.6 ms vs. LSGS 627.8±27.5 ms; P=0.2309) and after CS ablation (baseline 734.8±24.2 ms vs. LSGS 746.2±37.3 ms; P=0.7145).
Conclusions
Anatomically-driven axotomy targeting nerve fibers along the CS enables selective intracardiac sympathetic denervation resulting in acute modulation of left ventricular control.
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Affiliation(s)
- AK Kahle
- Evangelical Hospital, Duesseldorf, Germany
| | - N Klatt
- Schoen Clinic Neustadt, Neustadt in Holstein, Germany
| | - C Jungen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Dietenberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kuklik
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - P Muenkler
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - V Nikolaev
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - C Meyer
- Evangelical Hospital, Duesseldorf, Germany
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16
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Bollen H, Nuyts S, Willems S, Maes F. MO-0886 Automatic delineation of head and neck gross tumor volume using multimodal information. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02452-5] [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: 11/26/2022]
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17
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Van Poel E, Vanden Bussche P, Klemenc-Ketis Z, Willems S. How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC Prim Care 2022; 23:11. [PMID: 35172744 PMCID: PMC8760114 DOI: 10.1186/s12875-021-01587-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND General practitioners (GPs) play a crucial role in the fight against the COVID-19 pandemic as the first point of contact for possibly infected patients and are responsible for short and long-term follow-up care of the majority of COVID-19 patients. Nonetheless, they experience many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in 38 countries are organized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks and the wellbeing of staff members is researched. Finally, PRICOV-19 aims to study the association with practice- and health care system characteristics. It is expected that both characteristics of the GP practice and health care system features are associated with how GP practices can cope with these challenges. This paper describes the protocol of the study. METHODS Using a cross-sectional design, data are collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The questionnaire is developed in multiple phases, including a pilot study in Belgium. The final version includes 53 items divided into six sections: patient flow (including appointments, triage, and management for routine care); infection prevention; information processing; communication; collaboration and self-care; and practice and participant characteristics. In the countries where data collection is already finished, between 13 and 636 GP practices per country participated in the study. Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level. DISCUSSION To the best of our knowledge, the PRICOV-19 study is the largest and most comprehensive study that examines how GP practices function during the COVID-19 pandemic. Its results can significantly contribute to better preparedness of primary health care systems across Europe for future major outbreaks of infectious diseases.
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Affiliation(s)
- E Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - P Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Z Klemenc-Ketis
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - S Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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18
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Schleberger R, Metzner A, Kuck KH, Andresen D, Willems S, Hoffmann E, Deneke T, Eckardt L, Brachmann J, Hochadel M, Senges J, Rillig A. Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0357] [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
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden.
Methods
Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome.
Results
In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]).
Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]).
The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD.
Conclusion
The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - T Deneke
- Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - L Eckardt
- Muenster University Hospital, Muenster, Germany
| | | | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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19
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Vandewinckele L, Willems S, Lambrecht M, Maes F, Crijns W. PD-0819 Dose mimicking by deep learning based fluence prediction: one model for different class solutions. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07098-5] [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: 11/25/2022]
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20
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van der Veen J, Gulyban A, Willems S, Maes F, Nuyts S. Interobserver variability in organ at risk delineation in head and neck cancer. Radiat Oncol 2021; 16:120. [PMID: 34183040 PMCID: PMC8240214 DOI: 10.1186/s13014-020-01677-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background In radiotherapy inaccuracy in organ at risk (OAR) delineation can impact treatment plan optimisation and treatment plan evaluation. Brouwer et al. showed significant interobserver variability (IOV) in OAR delineation in head and neck cancer (HNC) and published international consensus guidelines (ICG) for OAR delineation in 2015. The aim of our study was to evaluate IOV in the presence of these guidelines. Methods HNC radiation oncologists (RO) from each Belgian radiotherapy centre were invited to complete a survey and submit contours for 5 HNC cases. Reference contours (OARref) were obtained by a clinically validated artificial intelligence-tool trained using ICG. Dice similarity coefficients (DSC), mean surface distance (MSD) and 95% Hausdorff distances (HD95) were used for comparison. Results Fourteen of twenty-two RO (64%) completed the survey and submitted delineations. Thirteen (93%) confirmed the use of delineation guidelines, of which six (43%) used the ICG. The OARs whose delineations agreed best with the OARref were mandible [median DSC 0.9, range (0.8–0.9); median MSD 1.1 mm, range (0.8–8.3), median HD95 3.4 mm, range (1.5–38.7)], brainstem [median DSC 0.9 (0.6–0.9); median MSD 1.5 mm (1.1–4.0), median HD95 4.0 mm (2.3–15.0)], submandibular glands [median DSC 0.8 (0.5–0.9); median MSD 1.2 mm (0.9–2.5), median HD95 3.1 mm (1.8–12.2)] and parotids [median DSC 0.9 (0.6–0.9); median MSD 1.9 mm (1.2–4.2), median HD95 5.1 mm (3.1–19.2)]. Oral cavity, cochleas, PCMs, supraglottic larynx and glottic area showed more variation. RO who used the consensus guidelines showed significantly less IOV (p = 0.008). Conclusions Although ICG for delineation of OARs in HNC exist, they are only implemented by about half of RO participating in this study, which partly explains the delineation variability. However, this study highlights that guidelines alone do not suffice to eliminate IOV and that more effort needs to be done to accomplish further treatment standardisation, for example with artificial intelligence.
Supplementary information Supplementary information accompanies this paper at 10.1186/s13014-020-01677-2.
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Affiliation(s)
- J van der Veen
- Department of Oncology, Radiation-Oncology, University of Leuven, University Hospitals Leuven, 3000, Leuven, KU, Belgium
| | - A Gulyban
- Department of Medical Physics, Jules Bordet Institute, Brussels, Belgium.
| | - S Willems
- Department ESAT, Processing Speech and Images (PSI), Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, 3000, Leuven, Belgium
| | - F Maes
- Department ESAT, Processing Speech and Images (PSI), Medical Imaging Research Center, KU Leuven, University Hospitals Leuven, 3000, Leuven, Belgium
| | - S Nuyts
- Department of Oncology, Radiation-Oncology, University of Leuven, University Hospitals Leuven, 3000, Leuven, KU, Belgium.
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21
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Pecha S, Ziegelhoeffer T, Yildirim Y, Choi YH, Willems S, Reichenspurner H, Burger H, Hakmi S. Safety and Efficacy of Transvenous Lead Extraction of Very Old Leads. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725710] [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: 10/21/2022]
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22
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Jungen C, Akbulak R, Kahle A, Eickholt C, Schaeffer B, Dinshaw L, Schleberger R, Nies M, Gunawardene M, Muenkler P, Klatt N, Hartmann J, Jularic M, Willems S, Meyer C. Outcome after practical isthmus ablation of scar-related atrial tachycardia guided by high-density mapping. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High-density mapping (HDM) has been found to precisely identify the practical isthmus of scar-related atrial tachycardia (AT) circuits. Since practical isthmuses have been found to be shorter than the usual anatomical isthmuses targeted ablation has been proposed. However, outcome data are sparse. Here we describe HDM-guided catheter ablation by targeting the practical isthmus in patients with scar-related ATs.
Methods and results
In 250 consecutive patients with scar-related ATs HDM-guided catheter ablation with the support of a 64-electrode mini-basket catheter has been performed. Most patients underwent a prior catheter ablation (98%) while 13% had a prior cardiac valve surgery and 6% an underlying congenital heart disease. A total of 355 ATs occurred in the index procedure, of which 64% had a macro-, 26% a micro-reentry and 10% a focal mechanism. The ATs had a mean cycle length of 304±4.3 ms and in 237 patients (95%) an acute termination into sinus rhythm was achieved. They were mainly located in the left atrium (72%) but also in the right atrium (25%), bi-atrially (5%) or in the CS (3%) (see figure). Targeting the practical isthmus revealed arrhythmia freedom in 53% of patients after a single procedure during a mid-term follow-up (median 489 days, range 95–1407 days). Freedom from any arrhythmia could be achieved in 74% of patients after multiple procedures and in 93% of patients after multiple procedures and optimal clinical therapy, including pharmaceutical or electrical cardioversion.
Conclusions
HDM-guided catheter ablation of the practical isthmus in patients with scar-related ATs leads to a high acute success rate. Nevertheless, multiple procedures are necessary in a relevant number of patients resulting in a low recurrence rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Akbulak
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Kahle
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - C Eickholt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - L Dinshaw
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - R Schleberger
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Nies
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - M Gunawardene
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
| | - J Hartmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - M Jularic
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Interventional and General Cardiology, Hamburg, Germany
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23
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Grégoire C, Faymonville ME, Vanhaudenhuyse A, Jerusalem G, Willems S, Bragard I. Randomized controlled trial of a group intervention combining self-hypnosis and self-care: secondary results on self-esteem, emotional distress and regulation, and mindfulness in post-treatment cancer patients. Qual Life Res 2020; 30:425-436. [PMID: 33025372 PMCID: PMC7886776 DOI: 10.1007/s11136-020-02655-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Accepted: 09/24/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Cancer patients often report low self-esteem and high emotional distress. Two factors seem particularly linked to these symptoms: emotion regulation strategies and mindfulness. The interest of hypnosis and self-care to relieve these symptoms is not well documented. Our randomized controlled trial aimed at assessing the effect of a group intervention combining self-hypnosis and self-care on self-esteem, emotional distress, emotion regulation, and mindfulness abilities of post-treatment cancer patients, as well as investigating the links between these variables. METHODS One hundred and four patients who had suffered from cancer were randomized into the intervention group (N = 52) and the wait-list control group (N = 52). They had to answer questionnaires before (T1) and after the intervention (T2). Nine men were excluded from the analyses, leading to a final sample of 95 women with cancer. Group-by-time changes were assessed with MANOVA, and associations with self-esteem and emotional distress were investigated with hierarchical linear regression models. RESULTS Participants in the intervention group (mean age = 51.65; SD = 12.54) reported better self-esteem, lower emotional distress, a decreased use of maladaptive emotion regulation strategies, and more mindfulness abilities after the intervention, compared to the WLCG. This increase in mindfulness explained 33% of the improvement of self-esteem and 41.6% of the decrease of emotional distress in the intervention group. Self-esteem and emotional distress also predicted each other. CONCLUSION Our study showed the efficacy of our hypnosis-based intervention to improve all the investigated variables. Mindfulness predicted the improvement of self-esteem and emotional distress. The primary impact of our intervention on mindfulness abilities seems to explain, at least in part, its efficacy. Registration: ClinicalTrials.gov (NCT03144154). Retrospectively registered on the 1st of May, 2017.
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Affiliation(s)
- C Grégoire
- Faculty of Psychology, Speech Therapy and Educational Sciences, and Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.
| | - M-E Faymonville
- Interdisciplinary Algology Centre, CHU Liège, and Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - A Vanhaudenhuyse
- Interdisciplinary Algology Centre, CHU Liège, and Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - G Jerusalem
- Medical Oncology Department, CHU Liège and University of Liège, Liège, Belgium
| | - S Willems
- Faculty of Psychology, Speech Therapy and Educational Sciences, University of Liège, Liège, Belgium
| | - I Bragard
- Haute Ecole Libre Mosane (HELMo), Liège, Belgium
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24
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Chung D, Pecha S, Burger H, Moeller V, Madej T, Osswald B, Ghaffari N, Baersch V, Naegele H, Gosau N, Knaut M, Butter C, Willems S, Hakmi S. 1255Comprehensive analysis of pacemaker patients with and without abandoned leads undergoing transvenous lead extraction: A GALLERY subgroup analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.261] [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
OnBehalf
GALLERY investigators
Background
The number of cardiac implantable electronic device (CIED)-associated complications such as infection, lead dysfunction or thrombotic events is continuously rising and thus making transvenous lead extraction (TLE) an ever more needed procedure in clinical practice today. Patients with abandoned leads represent a special cohort with a potentially higher susceptibility to CIED-related infections and vascular complications. Moreover, according to literature abandoned leads seem to be associated with more procedural complications and mortality during TLE.
Aim
The aim of this study was to provide an insight on safety, procedural outcome and risk prediction on pacemaker patients with abandoned leads undergoing TLE from the largest national laser-sheath registry to date.
Methods + Results:
We conducted a retrospective analysis of the GALLERY database, which collected 2533 patients undergoing TLE in Germany between 2013 and 2017. Out of 903 pacemaker patients, who underwent TLE, 226 patients (25.0%) with abandoned leads were identified. Those patients had a higher number of leads per patient (3.2 ± 0.8 vs. 1.9 ± 0.3; ns) and longer lead dwell-times (168.0 ± 89.7 vs. 123.0 ± 69.2 months; p < 0.0001) compared to pacemaker patients without abandoned leads. There were no differences in age (71.5 vs. 72.3 years; ns), body mass index (26.5 ± 4.5 vs. 26.78 ± 4.8 kg/m2; ns) or gender distribution (69.0 vs. 66.5% male; ns). Leading indication for TLE was device infection with no difference between groups (79.7 vs 77.8 %; ns). There were no differences in terms of pacemaker dependency, length of hospitalization or comorbidities. Patients with abandoned leads had longer procedure times (112.0 ± 69.0 vs. 86.4 ± 53.0 minutes; p < 0.0001) and a higher incidence of procedural complications (6.6 vs. 3.1%; p = 0.03), but there were no differences in neither procedural and clinical success rates (96.5 vs. 97.3%; ns), nor all-cause mortality (1.33 vs. 2.66%; ns). Multivariate logistic regression revealed abandoned leads (OR 2.1, CI 1.0-4.4, p = 0.04) and female gender (OR 2.4, CI 1.2-4.9, p = 0.02) as independent predictors for procedural complications. Systemic infection (OR 5.4, CI 2.0-14.8, p = 0.001) and chronic kidney disease (OR 4.0, CI 1.5-10.7, p = 0.007) were strong predictors for all-cause mortality in patients with indwelling pacemaker. Patient age > 75 years (OR 3.9, CI 2.7-5.6, p < 0.0001) and a lead dwell-time > 10 years (OR 1.6, CI 1.1-2.2, p = 0.01) were identified as risk factors for an infectious cause for TLE.
Conclusion
Abandoned leads are frequently encountered in pacemaker patients undergoing TLE and pose an important risk factor for procedural complications. Systemic CIED-related infections are the strongest driver of mortality in this patient cohort and urgently call for further improvements in early diagnosis and prevention.
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Affiliation(s)
- D Chung
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Pecha
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - H Burger
- Kerckhoff Clinic, Cardiac Surgery, Bad Nauheim, Germany
| | - V Moeller
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - T Madej
- Heart Center - University Hospital Dresden, Cardiac Surgery, Dresden, Germany
| | - B Osswald
- Heart Center Duisburg, Cardiac Surgery, Duisburg, Germany
| | - N Ghaffari
- Helios Heart Surgery Clinic Karlsruhe, Karlsruhe, Germany
| | - V Baersch
- St. Marien-Hospital Siegen, Cardiology, Siegen, Germany
| | - H Naegele
- Albertinen Hospital, Cardiology, Hamburg, Germany
| | - N Gosau
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Knaut
- Heart Center - University Hospital Dresden, Cardiac Surgery, Dresden, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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25
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Schenker N, van der Schalk H, Bohné M, Hahn J, Waddell D, Moschner A, Alexy H, Willems S, Kivelitz D, Bahlmann E. Hirninfarkt als Erstsymptom – seltene kardiogene Ursache. Med Klin Intensivmed Notfmed 2020; 115:343-347. [DOI: 10.1007/s00063-020-00666-3] [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] [Received: 10/01/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/24/2022]
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26
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Kuijpers C, Van Den Heuvel M, Van Lindert A, Damhuis R, Willems S. P1.09-06 Evaluation of Molecular Testing in a Dutch Cohort of Metastatic Non-Small Cell Lung Cancer Patients from 2017. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Dinshaw L, Lemoine M, Hartmann J, Schaeffer B, Klatt N, Jularic M, Gunarwadene M, Muenkler P, Tam A, Eickholt C, Willems S, Patten M, Meyer C. P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain.
Purpose
The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems.
Methods
A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices.
Results
Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003).
Conclusion
Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.
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Affiliation(s)
- L Dinshaw
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Lemoine
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Gunarwadene
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - A Tam
- University Heart Center Hamburg, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Patten
- University Heart Center Hamburg, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
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28
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Kuijpers C, Van Den Heuvel M, Van Lindert A, Damhuis R, Willems S. EP1.09-14 Best Practice Session on Lung Cancer Molecular Diagnostics in the Netherlands to Enhance Testing Proportions Nationwide. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2210] [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: 11/28/2022]
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29
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Kuijpers C, Van den Heuvel M, Overbeek L, Van Lindert A, Damhuis R, Willems S. Notable variation of molecular testing in metastatic lung cancer in the Netherlands. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz072.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Boeve K, Den Toom I, Van Weert S, Bloemena E, Brouwers A, Hoekstra O, De Keizer B, Van der Vegt B, Willems S, Leemans C, Witjes M, De Bree R. OC-022 Unexpected drainage patterns and high accuracy of SLNB in OSCC after previous neck treatment. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30188-4] [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: 10/27/2022]
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31
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Pecha S, Petersen J, Alassar Y, Hakmi S, Meyer C, Willems S, Reichenspurner H. Outcome Predictors for Surgical Atrial Fibrillation Ablation Concomitant to Mitral Valve Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678770] [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: 10/27/2022]
Affiliation(s)
- S. Pecha
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - J. Petersen
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - Y. Alassar
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - S. Hakmi
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - C. Meyer
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
| | - S. Willems
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
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32
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Castro L, Pecha S, Amin S, Linder M, Gosau N, Willems S, Reichenspurner H, Hakmi S. Up to 5-Year Follow-up after Transvenous Lead Extraction Procedures. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678947] [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: 10/27/2022]
Affiliation(s)
- L. Castro
- Klinik für Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Pecha
- Klinik für Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Amin
- Klinik für Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Linder
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Gosau
- Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Klinik für Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Klinik für Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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33
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Demal J, Pecha S, Castro L, Vogler J, Gosau N, Linder M, Willems S, Reichenspurner H, Hakmi S. In-Hospital Mortality after Transvenous Lead Extraction. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678795] [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: 10/27/2022]
Affiliation(s)
- J.T. Demal
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
| | - S. Pecha
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
| | - L. Castro
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
| | - J. Vogler
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II/Kardiologie, Angiologie, Intensivmedizin, Lübeck, Germany
| | - N. Gosau
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie - Schwerpunkt Elektrophysiologie, Hamburg, Germany
| | - M. Linder
- Universitäres Herzzentrum Hamburg, Klinik für Allgemeine und Interventionelle Kardiologie, Hamburg, Germany
| | - S. Willems
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie - Schwerpunkt Elektrophysiologie, Hamburg, Germany
| | - H. Reichenspurner
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
| | - S. Hakmi
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Hamburg, Germany
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34
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Sill B, Vogler J, Gosau N, Bernhard A, Willems S, Blankenberg S, Barten M, Rybczynski M, Reichenspurner H, Knappe D. Is There a Need for an Implantable Cardioverter Defibrillator in Patients with Left Ventricular Assist Devices? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678949] [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: 10/27/2022]
Affiliation(s)
- B. Sill
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Vogler
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Gosau
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Bernhard
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | - M. Barten
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | - D. Knappe
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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35
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Petersen J, Hakmi S, Alassar Y, Subbotina I, Wagner M, Meyer C, Willems S, Reichenspurner H, Pecha S. Which Energy Source Is Superior? Bipolar Radiofrequency versus Cryoablation in Concomitant Atrial Fibrillation Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678774] [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: 10/27/2022]
Affiliation(s)
- J. Petersen
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Y. Alassar
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - I. Subbotina
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Wagner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Meyer
- Department of Cardiology - Electrophysiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Department of Cardiology - Electrophysiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Pecha
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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36
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Pecha S, Castro L, Gosau N, Willems S, Reichenspurner H, Hakmi S. Heparin Bridging or Continuation of Oral Anticoagulation for Transvenous Lead Extraction? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678772] [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: 10/27/2022]
Affiliation(s)
- S. Pecha
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - L. Castro
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - N. Gosau
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
| | - S. Willems
- Universitäres Herzzentrum Hamburg, Elektrophysiologie, Hamburg, Germany
| | | | - S. Hakmi
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
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37
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Driehuis E, Kolders S, Devriese L, Willems S, Clevers H, de Bree R, de Ruiter E. Head and neck squamous cell carcinoma organoids as a platform for personalized medicine. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy318.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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38
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Jungen C, Kuklik P, Eickholt C, Akbulak R, Klatt N, Hartmann J, Gunawardene M, Geisler A, Jularic M, Klene C, Klutmann S, Willems S, Mester J, Meyer C. 3012Ventricular arrhythmia ablation in areas of mismatch between sympathetic innervation and electroanatomical voltage. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3012] [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: 11/14/2022] Open
Affiliation(s)
- C Jungen
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - P Kuklik
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - R Akbulak
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Gunawardene
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - A Geisler
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - C Klene
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Klutmann
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
| | - J Mester
- University Medical Center Hamburg Eppendorf, Department of Nuclear Medicine, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Department of Cardiology - Electrophysiology, University Medical Centre Hamburg-Eppendorf, Germany, Hamburg, Germany
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39
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De Maesschalck S, Willems S, Hanssens L. 7.10-P4Analysing the Belgian HIS data on diversity and health. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.237] [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: 11/14/2022] Open
Affiliation(s)
- S De Maesschalck
- Ghent University, Dep. of Family Medicine and Primary Healthcare, Belgium
| | - S Willems
- Ghent University, Dep. of Family Medicine and Primary Healthcare, Belgium
| | - L Hanssens
- Ghent University, Dep. of Family Medicine and Primary Healthcare, Belgium
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40
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Castro L, Pecha S, Vogler J, Gosau N, Willems S, Reichenspurner H, Hakmi S. The Dilemma After CRT Device Removal: A Bi-ventricular Bridging Solution is Needed. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.813] [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: 10/17/2022] Open
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41
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Bernhardt A, Klatt N, Jungen C, Scherschel K, Willems S, Reichenspurner H, Meyer C. A New Ex-Vivo Working Heart Model without Ischemia-Reperfusion Damage to Analyze Electrophysiological Properties of a Denervated Heart. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.561] [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: 11/28/2022] Open
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42
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Hindricks G, Weiner S, Jais P, Wong T, Maddox W, Garcia-Bolao IJ, Ji SY, Sacher F, Willems S, Mounsey JP, Maury P, Bollmann A, Tung R, Raciti G, Mcelderry T. 527Safety and acute effectiveness of the 3D RHYTHMIA mapping system for ablation of arrhythmias: results of the TRUE-HD study. Europace 2018. [DOI: 10.1093/europace/euy015.294] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - S Weiner
- Trinity Monther Frances, Tyler, TX, United States of America
| | - P Jais
- University Hospital of Bordeaux, Bordeaux, France
| | - T Wong
- Royal Brompton and Harefield foundation Trust and Imperial College, London, United Kingdom
| | - W Maddox
- University of Alabama Birmingham, Birmingham, United States of America
| | | | - S Y Ji
- Torrance Memorial Medical Center, Torrance, United States of America
| | - F Sacher
- University Hospital of Bordeaux, Bordeaux, France
| | - S Willems
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J P Mounsey
- University of North Carolina Hospitals, Chapel Hill, United States of America
| | - P Maury
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - A Bollmann
- Heart Center of Leipzig, Leipzig, Germany
| | - R Tung
- University of Chicago Medicine, Chicago, United States of America
| | - G Raciti
- Boston Scientific Corporation, St Paul, MN, United States of America
| | - T Mcelderry
- University of Alabama Birmingham, Birmingham, United States of America
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43
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Jilek C, Brachmann J, Lewalter T, Kuck KH, Andresen D, Willems S, Spitzer SG, Straube F, Schumacher B, Eckardt L, Danilovic D, Thomas D, Hochadel M, Senges J. 1012No support for additional left atrial substrate modification among patients with persistent atrial fibrillation at first PVI procedure- Results from German Ablation registry. Europace 2018. [DOI: 10.1093/europace/euy015.561] [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: 11/14/2022] Open
Affiliation(s)
- C Jilek
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - J Brachmann
- Coburg Hospital, Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg, Germany
| | - T Lewalter
- Peter-Osypka-Heart Centre, Hospital for Internal Medicine Munich South, Munich, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Andresen
- Vivantes Klinikum Am Urban, Department of Cardiology and Internal Medicine, Berlin, Germany
| | - S Willems
- University Heart Center Hamburg, Department of Electrophysiology, Hamburg, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | - F Straube
- Munich Municipal Hospital Group, Heart Center Munich- Bogenhausen, Munich, Germany
| | - B Schumacher
- Westpfalz Hospital, Department of Cardiology, Pneumology, Angiology and Intensive Care, Kaiserslautern, Germany
| | - L Eckardt
- University Medical Center, Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | - D Danilovic
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - D Thomas
- University of Heidelberg, Department of Cardiology, Heidelberg, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
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44
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Dinshaw L, Akbulak Ö, Schaeffer B, Jularic M, Gunawardene M, Muench J, Klatt N, Hartmann J, Eickholt C, Gosau N, Patten M, Willems S, Meyer C. P844Long-term outcome of ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.447] [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: 11/14/2022] Open
Affiliation(s)
- L Dinshaw
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - Ö Akbulak
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - B Schaeffer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Jularic
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Gunawardene
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Muench
- University Heart Center Hamburg, Hamburg, Germany
| | - N Klatt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - J Hartmann
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - C Eickholt
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - N Gosau
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - M Patten
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - S Willems
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
| | - C Meyer
- University Heart Center Hamburg, Cardiology Electrophysiology, Hamburg, Germany
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45
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Garcia-Bolao JI, Mcelderry T, Weiner S, Jais P, Wong T, Maddox W, Ji SY, Sacher F, Willems S, Mounsey J, Maury P, Bollmann A, Tung R, Raciti G, Hindricks G. P1173Repeated ablation of atrial fibrillation with ultra-high density mapping: workflow and validation in clinical practice. Insights from the TRUE HD study. Europace 2018. [DOI: 10.1093/europace/euy015.658] [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: 11/14/2022] Open
Affiliation(s)
| | - T Mcelderry
- University of Alabama Birmingham, Birmingham, United States of America
| | - S Weiner
- Trinity Mother Frances Health System, Tyler, TX, United States of America
| | - P Jais
- University Hospital of Bordeaux, Bordeaux, France
| | - T Wong
- Royal Brompton and Harefield foundation Trust and Imperial College, London, United Kingdom
| | - W Maddox
- University of Alabama Birmingham, Birmingham, United States of America
| | - S Y Ji
- Torrance Memorial Medical Center, Torrance, United States of America
| | - F Sacher
- University Hospital of Bordeaux, Bordeaux, France
| | - S Willems
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - J Mounsey
- University of North Carolina Hospitals, Chapel Hill, United States of America
| | - P Maury
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - A Bollmann
- Heart Center of Leipzig, Leipzig, Germany
| | - R Tung
- University of Chicago Medicine, Chicago, United States of America
| | - G Raciti
- Boston Scientific Corporation, St Paul, MN, United States of America
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46
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Pecha S, Castro L, Vogler J, Gosau N, Willems S, Reichenspurner H, Hakmi S. The Bridge Occlusion Balloon as a Safety Net in High-Risk Transvenous Lead Extraction Procedures: A Novel Approach. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628094] [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: 10/28/2022]
Affiliation(s)
- S. Pecha
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - L. Castro
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Vogler
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Gosau
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | - S. Hakmi
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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47
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Castro L, Pecha S, Linder M, Vogler J, Gosau N, Willems S, Reichenspurner H, Hakmi S. Laser Lead Extraction in Patients with Venous Stenosis or Occlusion: System Upgrade or Revision Is Needed. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628085] [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: 10/28/2022]
Affiliation(s)
- L. Castro
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - S. Pecha
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - M. Linder
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - J. Vogler
- Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany
| | - N. Gosau
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - S. Willems
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - S. Hakmi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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48
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Bernhardt A, Hakmi S, Lietz P, Klatt N, Pamirsad M, Jungen C, Reitmeier A, Willems S, Reichenspurner H, Scherschel K, Meyer C. A New Ex-Vivo Working Heart Model without Ischemia-Reperfusion Damage. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628029] [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: 10/28/2022]
Affiliation(s)
- A. Bernhardt
- Herz- und Gefäßchirurgie, Hamburg, Universitäres Herzzentrum Hamburg, Germany
| | - S. Hakmi
- Herz- und Gefäßchirurgie, Hamburg, Universitäres Herzzentrum Hamburg, Germany
| | - P. Lietz
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Klatt
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Pamirsad
- Herz- und Gefäßchirurgie, Hamburg, Universitäres Herzzentrum Hamburg, Germany
| | - C. Jungen
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Reitmeier
- Versuchstierhaltung, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - S. Willems
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Herz- und Gefäßchirurgie, Hamburg, Universitäres Herzzentrum Hamburg, Germany
| | - K. Scherschel
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Meyer
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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49
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Hakmi S, Pecha S, Castro L, Vogler J, Gosau N, Willems S, Reichenspurner H. The Benefits of Femoral Access in Patients Undergoing Transvenous Lead Extraction via Subclavian Route. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627990] [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: 10/28/2022]
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50
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Pecha S, Hakmi S, Petersen J, Wagner F, Willems S, Reichenspurner H. Do We Need to Open the Left Atrium for Surgical AF Ablation in Paroxysmal AF Concomitant to CABG or AVR? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628030] [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: 10/28/2022]
Affiliation(s)
- S. Pecha
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Hakmi
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Petersen
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Wagner
- Herzchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Willems
- Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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