Publications (38) View all
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Article: [Non-fluoroscopic catheter tracking: the MediGuide(™) system.]
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ABSTRACT: Conventional fluoroscopy is the main technology for intracardiac device tracking in interventional cardiovascular procedures. For therapy delivery it carries the advantage of being able to instantaneously localize the device and its spatial relationship with respect to the moving target organ. However, besides the associated X-ray exposure, fluoroscopy only provides 2D orientation. For treatment of complex cardiac anatomies and substrates such as in interventional electrophysiology, 3-D mapping technologies have been introduced to facilitate spatial, anatomic, and electrical orientation. A new technological platform (MediGuide(™)) offers the option to continuously display the catheter tip on a prerecorded cine-loop allowing better anatomic understanding of the underlying substrate. We describe our initial experience using the system with diagnostic catheters only and the first procedures with the MediGuide(™) equipped ablation catheter (available since May 2012). We could show a significant decrease of fluoroscopy time in all types of procedures with comparable procedure times. No increase in complication rates was observed.Herzschrittmachertherapie & Elektrophysiologie 11/2012; -
Article: Diagnosis of atrial tachycardias originating from the lower right atrium: importance of P-wave morphology in the precordial leads V3-V6.
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ABSTRACT: AIMS: This study aimed to characterize P-wave morphology (PWM) in leads V3-V6 during focal atrial tachycardia (AT) originating from the lower right atrium (RA), and to investigate the role of interatrial conduction (IAC) pathways in the formation of PWM.METHODS AND RESULTS: Twenty-eight consecutive patients with tachycardia foci in the lower RA underwent detailed atrial endocardial activation mapping and radiofrequency catheter ablation. P-wave configuration was analysed using standard 12-lead electrocardiogram. Atrial tachycardia originated from lower non-septal tricuspid annulus (LTA) (n = 11), coronary sinus ostium (CSo) (n = 11), lower crista terminalis (LCT) (n = 4), or lower free wall (n = 2). In leads V3-V6, PWM showed a negative pattern in at least two consecutive leads during AT originating from CSo (11/11) and LTA (9/11), with an associated sensitivity of 91%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 75%. A positive PWM was observed in three of four ATs originating from LCT, with an associated sensitivity of 75%, specificity of 100%, PPV of 60%, and NPV of 96%. A negative PWM in V3-V6 was consistent with a preferential IAC through musculature in the vicinity of the CS and an activation of both atria in an antero-posterior direction. In contrast, a positive PWM was associated with the engagement of a posterior (non-CS-related) interatrial connection.CONCLUSION: Characteristic PWMs in V3-V6 may accurately differentiate the anatomic sites of AT from the low RA with high PPVs and NPVs. P-wave morphology in V3-V6 is likely to be influenced by the engagement of the preferential IAC.Europace 10/2012; · 1.98 Impact Factor -
Article: Enhancement of intracardiac navigation by new GPS-guided location system (MediGuide Technologies).
Europace 08/2012; 14 Suppl 2:ii24-ii25. · 1.98 Impact Factor -
Article: MediGuide in supraventricular tachycardia: initial experience from a multicentre registry.
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ABSTRACT: AIMS: Currently, fluoroscopy-based catheter visualization is the standard modality in invasive electrophysiological procedures. Recently a new technology for non-fluoroscopic visualization of diagnostic (since 2010) and ablation catheters (since May 2012) has been introduced. The MediGuide™-Technology (MediGuide) projects catheter tips on prerecorded cine loops in a high time resolution.METHODS AND RESULTS: We report on MediGuide-based supraventricular tachycardia (SVT) cases [atrioventricular nodal reentry tachycardia (AVNRT), atrioventricular reentry tachycardia (AVRT), Wolff-Parkinson-White syndrome (WPW), ectopic atrial tachycardia (EAT) and typical atrial flutter) from two European centres. In all patients, diagnostic and/or ablation catheters with a special sensor were used to perform the ablation procedures. All procedural data such as acute success, duration of the procedure, fluoroscopy time, and dose and patients' characteristics were analyzed and compared with conventionally ablated patients (n = 1865). Procedure-related complications during the hospital stay were recorded. A total of 24 consecutive patients were analyzed: no significant difference to the control group was seen in the baseline characteristics. The MediGuide patients were predominantly male (66%), aged 58 ± 14 years and were ablated for 6 AVNRT (25%), 4 AVRT/WPW (17%), 1 EAT (4%), and 13 typical atrial flutter (54%). The acute success rate was 100% (98% in the control group, n.s.). The median fluoroscopy time was 0.5 ± 1.4 min (10.2 ± 9.6 in the control group, P < 0.001), the median fluoroscopy dose was 187 ± 554 cGy cm(2) (996 ± 2593 cGy cm(2), P < 0.05). Mean procedure time was 70 ± 25 min (60 ± 36 min, n.s.). No complications during the hospital stay were recorded.CONCLUSION: In several different forms of supraventricular tachycardias the MediGuide-Technology contributed to a dramatic reduction in irradiation exposure. With a median fluoroscopy time of 30 s all SVT cases were effectively performed with no complications; the fluoroscopy burden can be significantly reduced not only for the patient but also for the nurses and the physicians performing the case. The overall procedure times are not prolonged due to the use of MediGuide Technology compared with a control group of >1800 patients undergoing conventional ablation procedures.Europace 04/2013; · 1.98 Impact Factor -
Article: Atrial fibrillation-induced cardiac troponin I release.
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ABSTRACT: BACKGROUND: Cardiac troponin I (cTnI) is highly specific for myocardial damage and for the diagnosis of acute coronary syndrome. We investigated cTnI utility and predictive value in patients with atrial fibrillation (AF) in the acute setting. METHOD: We studied 354 consecutive patients with the primary diagnosis of AF and clinical symptoms suggestive of myocardial ischemia presenting to our emergency department. cTnI was obtained on presentation. Patients with ST-segment elevation myocardial infarction were excluded. Coronary angiography was performed in 100 patients. RESULTS: cTnI was elevated (>0.09μg/L) in 51 of 354 (15%) patients. The mean cTnI in these patients was 0.37μg/L (0.09-3.14). In 23 of 100 patients undergoing coronary angiography, cTnI was elevated. Only 6 of these 23 patients (26%) had significant stenosis. In 77 of 100 patients undergoing coronary angiography, cTnI was normal, revealing significant stenosis in 25 patients (33%). The positive predictive value of elevated cTnI for a coronary intervention was 26% and the negative predictive value was 68%. Using multivariate logistic regression, we found that heart rate on presentation, the presence of angina pectoris, left ventricular ejection fraction, serum creatinine, and hemoglobin independently predicted elevated cTnI level. CONCLUSION: These data are the first to show that AF in the acute setting is frequently associated with cTnI elevations. AF patients with high heart rate and/or angina pectoris often show false elevated cTnI levels. These findings are relevant for clinicians evaluating patients with acute AF and myocardial ischemia symptoms. Appropriate clinical guidelines must be established that also consider AF-related elevations in cTnI.International journal of cardiology 04/2013; · 7.08 Impact Factor
