Hans Kottkamp

Klinik Hirslanden, Zürich, Zurich, Switzerland

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Publications (173)680.29 Total impact

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    ABSTRACT: -Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal endpoints for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of non-inducibility of post-infarction VT for long-term outcomes after VT ablation.
    Circulation Arrhythmia and Electrophysiology 05/2014; · 5.95 Impact Factor
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    ABSTRACT: IntroductionAlthough atrial arrhythmias may have genetic causes, very few data are available on evaluation of the arrhythmic substrate in genetic atrial diseases in humans. In the present study, we evaluate the nature and evolution of the atrial arrhythmic substrate in a genetic atrial cardiomyopathy.Methods and ResultsRepeated electroanatomic mapping and tomographic evaluations were used to investigate the evolving arrhythmic substrate in 5 patients with isolated arrhythmogenic atrial cardiomyopathy, caused by Natriuretic Peptide Precursor A (NPPA) gene mutation. Atrial fibrosis was assessed using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). The substrate of atrial tachycardia (AT) and atrial fibrillation (AF) was bi-atrial dilatation with patchy areas of low voltage and atrial wall scarring (in the right atrium: 68.5±6.0% and 22.2±10.2%, respectively). The evolution of the arrhythmic patterns to sinus node disease with atrial standstill (AS) was associated with giant atria with extensive low voltage and atrial scarring areas (in the right atrium: 99.5±0.7% and 57.5±33.2%, respectively). LGE-MRI-proven bi-atrial fibrosis (Utah stage IV) was associated with AS. Atrial conduction was slow and heterogeneous, with lines of conduction blocks. The progressive extension and spatial distribution of the scarring/fibrosis were strictly associated with the different types of arrhythmias.Conclusion The evolution of the amount and distribution of atrial scarring/fibrosis constitutes the structural substrate for the different types of atrial arrhythmias in a pure genetic model of arrhythmogenic atrial cardiomyopathy.This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 04/2014; · 3.48 Impact Factor
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    ABSTRACT: The rapidly increasing number of patients with implantable cardioverter-defibrillators (ICD) places a large burden on follow-up providers. This study investigated the possibility of longer in-office follow-up intervals in primary prevention ICD patients under remote monitoring with automatic daily data transmissions from the implant memory. Conducted in 155 ICD recipients with MADIT II indications, the study compared the burden of scheduled and unscheduled ICD follow-up visits, quality of life (SF-36), and clinical outcomes in patients randomized to either 3- or 12-month follow-up intervals in the period between 3 and 27 months after implantation. Remote monitoring (Biotronik Home Monitoring) was used equally in all patients. In contrast to previous clinical studies, no calendar-based remote data checks were performed between scheduled in-office visits. Compared with the 3-month follow-up interval, the 12-month interval resulted in a minor increase in the number of unscheduled follow-ups (0.64 vs. 0.27 per patient-year; P = 0.03) and in a major reduction in the total number of in-office ICD follow-ups (1.60 vs. 3.85 per patient-year; P < 0.001). No significant difference was found in mortality, hospitalization rate, or hospitalization length during the 2-year observation period, but more patients were lost to follow-up in the 12-month group (10 vs. 3; P = 0.04). The SF-36 scores favoured the 12-month intervals in the domains 'social functioning' and 'mental health'. In prophylactic ICD recipients under automatic daily remote monitoring, the extension of the 3-month in-office follow-up interval to 12 months appeared to safely reduce the ICD follow-up burden during 27 months after implantation. NCT00401466 (http://www.clinicaltrials.gov/ct2/show/NCT00401466).
    European Heart Journal 07/2013; · 14.72 Impact Factor
  • Hans Kottkamp
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    ABSTRACT: The atrial structure/substrate of patients with atrial fibrillation (AF) and clinically similar characteristics can present very differently, and also the 'phenotype' (i.e. paroxysmal, persistent, and long standing persistent) of the arrhythmia cannot comprehensively explain these differences. It was unclear why some patients stay in paroxysmal AF for decades, whereas other patients with the same characteristics progress to persistent AF within a few months. In this review, evidence is described that AF patients without apparent structural heart disease have a chronic fibrotic bi-atrial substrate. There is also evidence from intraoperatively obtained specimen analysis, post-mortem autopsy findings, electroanatomic mapping studies, and delayed enhancement-MRI investigations that a higher mean value of fibrosis is detected in patients with persistent vs. paroxysmal AF but that the variability in the extend of fibrosis is always very high with part of paroxysmal AF patients having massive fibrosis and part of persistent AF patients showing mild fibrosis. In addition, patients undergoing ablation very early after the first AF episodes show already significant fibrosis. These data do not support a causal relationship that AF (significantly) produces fibrosis in the sense of 'AF begets AF' instead of being a consequence of the fibrotic process. In patients with mitral stenosis, evidence for reverse atrial remodelling after commissurotomy was reported, however, in patients with 'lone' AF, the atrial substrate progressed after successful AF elimination indicating towards the independent/progressive disease process of an underlying structural atrial disease called fibrotic atrial cardiomyopathy. Other 'conventional wisdoms' also need to be re-considered including the aetiological role of age and arterial hypertension for human structural atrial remodelling.
    European Heart Journal 06/2013; · 14.72 Impact Factor
  • Hans Kottkamp
    Journal of Cardiovascular Electrophysiology 05/2012; 23(7):797-9. · 3.48 Impact Factor
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    ABSTRACT: Hintergrund: Dem herkömmlichen 24-h-Langzeit-EKG sind bei selten auftretenden Symptomen Grenzen gesetzt. Bei Beschwerden wie Palpitationen, kurzen Phasen von Herzrasen oder zur Synkopendiagnostik kommen bei Erwachsenen patientenaktivierte Geräte zur EKG-Aufzeichnung (event-recorder) zum Einsatz. über Erfahrungen mit diesen Geräten bei Kindern gibt es bisher wenig Informationen. Patienten und Methode. Wir berichten über die Anwendung eines patientenaktivierten EKG-Geräts bei 27 Kindern (mittleres Alter 13,8 Jahre), bei denen rezidivierende Symptome bestanden und ein herkömmliches Langzeit-EKG ohne Ergebnis blieb. Ergebnisse. Nachdem wiederholt EKG und Langzeit-EKG ohne Ergebnis durchgeführt wurden, konnte in 9 Fällen (33,3%) mit Hilfe eines patientenaktivierten EKG-Geräts (Wrist-Rekorder) eine exakte Rhythmusdiagnose gestellt werden. Schlussfolgerung. Mit patientenaktivierten EKG-Geräten wird das Einsatzspektrum des Langzeit-EKG sinnvoll erweitert. Möglich ist der Einsatz in der Kinderheilkunde v. a. bei paroxysmalen Tachykardien und Palpitationen. Bei einer Monitoringperiode von 2–3 Wochen ist der Einsatz solcher Systeme effektiv. Die Geräte werden von Kindern und Jugendlichen akzeptiert, und die Anwendung gelingt mit guten Ergebnissen. Background: The usefulness of Holter monitoring to detect rarely occuring symptoms seems to be limited. In adults the event recorder has already been a precise diagnostic tool in evaluating palpitations and syncopes. There have been few reports of the implementation of cardiac monitoring with an event recorder in children. Patients and methods. We describe our experiences with event recorders in 27 children (mean age 13,8 years) with a history of palpitations or tachycardias. The event recorder was applied after failing to make the diagnosis by repeated 12-lead-ECG and Holter monitoring. Results. The event recorder revealed the underlying cardiac arrhythmia in 9 (33,3%) children. Conclusions. Thus, the ability to store patients events with an event recorder adds to the usual diagnostic capability with Holter monitoring. The main indication of event recorders in childhood are palpitations and paroxysmal tachycardias. A monitoring period of two weeks is reasonably effective for most children and should be the standard period. The devices provide a good quality of documentation and are well accepted by children.
    Monatsschrift Kinderheilkunde 04/2012; 148(9):829-831. · 0.19 Impact Factor
  • Hans Kottkamp
    Journal of Cardiovascular Electrophysiology 04/2012; 23(9):1001-2. · 3.48 Impact Factor
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    ABSTRACT: This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
    Europace 03/2012; 14(4):528-606. · 2.77 Impact Factor
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    ABSTRACT: This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
    Journal of Interventional Cardiac Electrophysiology 03/2012; 33(2):171-257. · 1.39 Impact Factor
  • Heart rhythm: the official journal of the Heart Rhythm Society 03/2012; 9(4):632-696.e21. · 4.56 Impact Factor
  • Hans Kottkamp
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2012; 9(4):481-2. · 4.56 Impact Factor
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    ABSTRACT: Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long-lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients. Sedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist. The mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation-related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation. Deep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient.
    Journal of Cardiovascular Electrophysiology 06/2011; 22(12):1339-43. · 3.48 Impact Factor
  • Journal of Cardiovascular Electrophysiology 06/2011; 22(6):717. · 3.48 Impact Factor
  • Doreen Schreiber, Hans Kottkamp
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    ABSTRACT: Idiopathic ventricular arrhythmias occur in patients without structural heart disease. They can arise from a variety of specific areas within both ventricles and in the supravalvular regions of the great arteries. Two main groups need to be differentiated: arrhythmias from the outflow tract (OT) region and idiopathic left ventricular, so-called fascicular, tachycardias (ILVTs). OT tachycardia typically originates in the right ventricular OT, but may also occur in the left ventricular OT, particularly in the sinuses of Valsalva or the anterior epicardium or the great cardiac vein. Activation mapping or pace mapping for the OT regions and mapping of diastolic potentials in ILVTs are the mapping techniques that are typically used. The ablation of idiopathic ventricular arrhythmias is highly successful, associated with only rare complications. Newly recognized entities of idiopathic ventricular tachycardias are those originating in the papillary muscles and in the atrioventricular annular regions.
    Current Cardiology Reports 09/2010; 12(5):382-8.
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    ABSTRACT: Electrical storm due to recurrent ventricular tachycardia (VT) in patients with implantable cardioverter defibrillator (ICD) can adversely affect their long-term survival. This study evaluates the efficiency of the radiofrequency catheter ablation of electrical storm due to monomorphic VT in patients with idiopathic dilated cardiomyopathy (DCM) and assesses its long-term effects on survival. Between April 2004 and October 2008, 13 consecutive patients (nine men, mean age 56.8 ± 17.8 years) with DCM and electrical storm due to monomorphic VT who had ICD underwent 17 catheter ablation procedures, including four epicardial, at our center. Acute complete success was defined as the lack of inducibility of any VT at the end of procedure during programmed right ventricular stimulation and was achieved in eight patients (61.5%). During a median follow-up of 23 months (range 3-63 months) nine patients (69%) were alive and eight patients (61.5%) were free from VT recurrence. Among those with acute complete (n = 8) and partial (n = 5) success, seven patients (87.5%) and one patient (20%) were free from any VT recurrence and ICD therapy, respectively (P = 0.025). Among those with acute complete and partial success, seven patients (87.5%) and two patients (40%) were alive, respectively (Mantel-Cox test P = 0.082). Among those who had an initially failed endocardial ablation (n = 8), four underwent further epicardial ablation that was completely successful in three patients (75%). Catheter ablation in patients with DCM and electrical storm due to monomorphic VT who had an ICD prevents further VT recurrence in 61.5% of the patients. Complete successful catheter ablation may play a protective role and was associated with reduced mortality during the follow-up period. More aggressive ablation strategies in patients with initially failed endocardial ablation might improve the long-term survival of these patients; however, further studies are needed to clarify this issue.
    Pacing and Clinical Electrophysiology 07/2010; 33(12):1504-9. · 1.75 Impact Factor
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    ABSTRACT: The objective of this study was to compare results between the magnetic navigation system (MNS) and conventional catheter ablation of cavo-tricuspid isthmus (CTI)-dependent right atrial flutter (AFL) in a case control study. A remote MNS has been used for ablation of various arrhythmias including CTI-dependent AFL but comparative results between MNS and conventional ablation are not available. Between May and September 2007, a total of 51 consecutive patients (45 men, mean age 65.4 +/- 9.4 years) had undergone catheter ablation for CTI-dependent AFL. The catheter ablation (70 degrees C, 70 W, 90 s) was performed with either an 8-mm-tip magnetic catheter using MNS (case group, n = 26, 23 men, mean age 64.6 +/- 9.6 y) or a conventional 8-mm catheter (case group, n = 25, 22 men, mean age 65.4 +/- 9.1 y). Acute procedural success was defined as complete bidirectional isthmus block and success at six months was defined as absence of AFL during the six months follow-up. With respect to baseline characteristics there were no differences between the two groups. The procedure time in MNS and conventional group was [median (range)] 53 (30-130) min and 45 (30-100) min, respectively (P = 0.12). Acute success was achieved by MNS and conventional ablation in 25/26 (96.2%) and 25/25 (100%) of patients, respectively (P = 0.53). During the six months of follow-up 4 patients, 2 in each group, experienced recurrence (P = 0.90). No major complication occurred during the procedure. Charring on the catheter tip occurred in 5 patients (19.2%) in MNS and none of the patients in the control group (P <0.05). This case-control study demonstrated the acute and mid-term efficacy and safety of catheter ablation by MNS for CTI-dependent AFL, similar to rates achieved by conventional radiofrequency catheter ablation.
    Acta cardiologica 06/2010; 65(3):279-83. · 0.61 Impact Factor
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    ABSTRACT: Identifying suitable candidates for circumferential left atrial pulmonary vein ablation (CPVA). CPVA is widely used as an ablation strategy in patients with atrial fibrillation (AF). Understanding the predictors of long-term success of single catheter ablation procedure of AF based on CPVA can help to identify those patients who have a high risk of recurrence based on this approach. In this retrospective analysis 674 consecutive patients (464 male, mean age 57.3 +/- 10.8 years) with AF (84.8%, paroxysmal) treated with CPVA ablation between May 2005 and August 2007 using a manually controlled steerable sheath (Agilis((R)) St. Jude Medical Inc., St. Paul, MN, USA), were included. The endpoint of the ablation was the completion of predefined lesions (CPVA for paroxysmal, and CPVA+mitral isthmus and roof line ablation for persistent AF). Seven day Holter recordings were done immediately, 3, 6, and 12 month after ablation. AF longer than 30 s was considered as recurrence. The success was defined as lack of recurrence during 7-day Holter recordings done 3, 6, and 12 months after ablation. Early recurrence was defined as recurrence during the first 7-day Holter recording immediately after ablation. Forty-five and 20.8% of the patients received antiarrhythmic medications for the first 3 and 6 months after ablation procedure, respectively. After 6 months all antiarrhythmics were discontinued. About 51.5% experienced early recurrence. Twelve months success rate was 75.7% (paroxysmal: 75.7%, persistent: 75.0%, P = 1.0). Using multivariate analysis left atrial (LA) diameter > or =50 mm was the predictor of early recurrence {Hazard Ratio (HR) [95% confidence interval (CI)] = 5.1 (2.0-12.9)}. LA Diameter > or =50 mm [HR (95% CI) = 4.6 (2.6-9.1)]; early recurrence [HR (95% CI) = 4.3 (2.0-9.1)]; and arterial hypertension [HR (95% CI) = 4.6 (2.6-9.1)] were predictors of late recurrence. In our patients' cohort, a single catheter ablation procedure based on CPVA using steerable sheath for catheter navigation resulted in a 1 year success rate of 75.7% [without (91.0%) and with (58.6%) early recurrence, respectively, P = 0.0001]. Among those patients who are at high risk for recurrence after CPVA other ablation endpoints rather than completion of predefined lesions might be necessary to increase the success rate.
    Europace 11/2009; 12(2):173-80. · 2.77 Impact Factor
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    ABSTRACT: Catheter ablation provides curative treatment for atrial fibrillation (AF). Data on anticoagulation after the procedure are sparse. We investigated real-life antithrombotic treatment after AF ablation and examined its adherence to current recommendations. Eight hundred forty-four patients (age 58 + or - 10 years) underwent AF ablation. Most patients had a CHADS(2) score of 0 (46%) or 1 (45%). Seven-day Holter was performed at three, six and 12 months after ablation. Decision on anticoagulation treatment was made by general practitioners and referring cardiologists in consultation with the patients. At discharge, anticoagulants were prescribed for the vast majority (94-96%) of patients. This percentage remained high at three and six months (80-90%) without differences between stroke risk groups. At 12 months, the use of anticoagulants was mainly influenced by the detection of recurrence; usage exceeded 90% in all stroke risk groups in patients with recurrences. In patients without recurrences, differences between risk groups were significant but small, ranging from 42% (CHADS(2)=0) to 62% (CHADS(2) > or = 2) (p=0.033). In multivariate analysis, the only factor independently associated with oral anticoagulation at 12 months was the detection of recurrences (odds ratio=16.2, p<0.001), whereas the effect of the CHADS(2) score was not significant (p=0.080). The effect of all other examined factors was also not significant. Contrary to current recommendations, anticoagulation after AF ablation is hardly guided by the stroke risk profile and remains high even in low-risk patients. The most important factor influencing the use of anticoagulants is the detection of recurrences during follow-up. This results in possible overtreatment of low-risk patients.
    Thrombosis and Haemostasis 10/2009; 102(4):754-8. · 5.76 Impact Factor
  • Hans Kottkamp, Gerhard Hindricks
    Journal of Cardiovascular Electrophysiology 10/2009; 20(12):1388-90. · 3.48 Impact Factor
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    ABSTRACT: Catheter ablation is potentially curative treatment for atrial fibrillation (AF). However, complications are more frequent and more severe compared with other ablation procedures. We investigated the complication rate in 1,000 AF ablation procedures in a high-volume center and examined possible risk factors. One thousand consecutive circumferential pulmonary vein radiofrequency ablations were performed for symptomatic, drug-refractory AF. Major complications were defined as the ones that were life threatening, caused permanent harm, and required intervention or prolonged hospitalization. Thirty-nine (3.9%) major periprocedural complications were observed. There was no death immediately associated with the procedure. However, there were 2 deaths (0.2%) of unclear cause, 14 days and 4 weeks after ablation. The most common complications were tamponade (1.3%), treated mainly by percutaneous drainage, and vascular complications (1.1%). There were also 4 thromboembolic events (0.4%): 3 nonfatal strokes and one transient ischemic attack. Importantly, 2 cases (0.2%) of atrial-esophageal fistula and 2 cases (0.2%) of endocarditis were observed. Factors associated with an increased complication risk were age > or = 75 years (hazard ratio 3.977, P = 0.022) and congestive heart failure (hazard ratio 5.174, P = 0.001). AF ablation still has a considerable number of major complications that may be life threatening or may lead to severe residues. Atrial-esophageal fistula is still observed despite continuous systematic methods to prevent it. Stroke, tamponade, and vascular complications are the most frequent major complications. However, in most patients treatment can be conservative and results in complete recovery. Advanced age and congestive heart failure seem to be associated with an increased risk of complications.
    Journal of Cardiovascular Electrophysiology 05/2009; 20(9):1014-9. · 3.48 Impact Factor

Publication Stats

4k Citations
680.29 Total Impact Points

Institutions

  • 2007–2014
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • Pacific Rim Electrophysiology Research Institute
      Los Angeles, California, United States
  • 1999–2013
    • University of Leipzig
      • • Klinik und Poliklinik für Kinderchirurgie
      • • Department of Cardiac Surgery
      Leipzig, Saxony, Germany
  • 2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 2006–2009
    • Attikon University Hospital
      • Department of Cardiology
      Athens, Attiki, Greece
    • Handelshochschule Leipzig
      Leipzig, Saxony, Germany
  • 2003
    • Universitätsklinikum Dresden
      • Klinik und Poliklinik für Kinder- und Jugendmedizin
      Dresden, Saxony, Germany
    • Kunststoff-Zentrum in Leipzig
      Leipzig, Saxony, Germany
  • 1992–2001
    • University of Münster
      • Department of Cardiology
      Münster, North Rhine-Westphalia, Germany