Hans Kottkamp

Klinik Hirslanden, Zürich, Zurich, Switzerland

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Publications (187)805.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Catheter ablation strategies beyond pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) are less well defined. Increasing clinical data indicate that atrial fibrosis is a critical common left atrial (LA) substrate in AF patients (pts). Objective: We applied a new substrate modification concept according to the individual fibrotic substrate as estimated from electroanatomic voltage mapping (EAVM) in 41 pts undergoing catheter ablation of AF. Results: First, EAVM during sinus rhythm was done in redo cases of 10 pts with paroxysmal AF despite durable PVI. Confluent low voltage areas (LVA) were found in all pts and were targeted with circumferential isolation, so-called box isolation of fibrotic areas (BIFA). This strategy led to stable sinus rhythm in 9/10 pts and was transferred prospectively to first procedures of 31 pts with non-paroxysmal AF. In 13 pts (42%), no LVA (<0.5mV) were identified, and only PVI was performed. In 18 pts (58%), additional BIFA strategies were applied (posterior box in 5, anterior box in 7, posterior plus anterior box in 5, no box in 1 due to diffuse fibrosis). Mean follow-up was 12.5±2.4months. Single-procedure freedom from AF/atrial tachycardia was achieved in 72.2 of pts and in 83.3 of pts with 1.17 procedures/patient. Conclusions: In approximately 40% of pts with non-paroxysmal AF, no substantial LVA were identified, and PVI alone showed high success rate. In pts with paroxysmal AF despite durable PVI and in approximately 60% of pts with non-paroxysmal AF, individually localized LVA were identified and could be targeted successfully with the BIFA strategy. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 10/2015; DOI:10.1111/jce.12870 · 2.96 Impact Factor
  • Hans Kottkamp · Roderich Bender · Jan Berg ·

    Journal of the American College of Cardiology 06/2015; 65(22):2465-2466. DOI:10.1016/j.jacc.2015.03.562 · 16.50 Impact Factor
  • Hans Kottkamp · Roderich Bender · Jan Berg ·
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    ABSTRACT: A frequent need for re-ablations and limited overall success rates are still major limitations of catheter ablation procedures for the treatment of atrial fibrillation (AF). These limitations include not only the durability of the pulmonary vein isolation (PVI) lines, but also the pathophysiological understanding of the arrhythmia's substrate. Long-term single procedure success rates in non-paroxysmal AF are disappointingly low for current stepwise ablation approaches adding the placement of linear lines and electrogram-based ablation after circumferential PVI isolation. In the future, substrate modification in AF ablation should move toward individualized patient-tailored ablation procedures. Magnetic resonance imaging could play a major role for noninvasively describing the localization and extent of fibrotic areas. Specific new strategies that could be used include precise localization and ablation of rotors that maintain the arrhythmia using multielectrode mapping during AF and box isolation of fibrotic areas guided by electroanatomic voltage mapping during sinus rhythm. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 01/2015; 65(2):196-206. DOI:10.1016/j.jacc.2014.10.034 · 16.50 Impact Factor
  • Hans Kottkamp ·

    Journal of the American College of Cardiology 11/2014; 64(21). DOI:10.1016/j.jacc.2014.09.033 · 16.50 Impact Factor
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    ABSTRACT: Background: Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal end points for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of noninducibility of postinfarction VT for long-term outcomes after VT ablation. Methods and results: We performed a systematic review of MEDLINE (1950-2013), EMBASE (1988-2013), the Cochrane Controlled Trials Register (Fourth Quarter, 2012), and reports presented at scientific meetings (1994-2013). Randomized controlled trials, case-control, and cohort studies of VT ablation were included. Outcomes reported in eligible studies were freedom from VT/ventricular fibrillation and all-cause mortality. Of the 3895 studies evaluated, we identified 8 cohort studies enrolling 928 patients for the meta-analysis. Noninducibility after VT ablation was associated with a significant increase in arrhythmia-free survival compared with partial success (odds ratio, 0.49; 95% confidence interval, 0.29-0.84; P=0.009) or failed ablation procedure (odds ratio, 0.10; 95% confidence interval, 0.06-0.18; P<0.001). There was also a significant reduction in all-cause mortality if patients were noninducible after VT ablation compared with patients with partial success (odds ratio, 0.59; 95% confidence interval, 0.36-0.98; P=0.04) or failed ablation (odds ratio, 0.32; 95% confidence interval, 0.10-0.99; P=0.049). Conclusions: Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality.
    Circulation Arrhythmia and Electrophysiology 05/2014; 7(4). DOI:10.1161/CIRCEP.113.001404 · 4.51 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; 25(9). DOI:10.1111/jce.12440 · 2.96 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; 35(2). DOI:10.1093/eurheartj/eht207 · 15.20 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; 34(35). DOI:10.1093/eurheartj/eht194 · 15.20 Impact Factor
  • Hans Kottkamp ·

    Journal of Cardiovascular Electrophysiology 05/2012; 23(7):797-9. DOI:10.1111/j.1540-8167.2012.02341.x · 2.96 Impact Factor
  • B. Hennig · F. Heinke · P. Kinzel · H. Kottkamp · P. Schneider · H.-J. Häusler ·
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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. DOI:10.1007/s001120050650 · 0.23 Impact Factor
  • Hans Kottkamp ·

    Journal of Cardiovascular Electrophysiology 04/2012; 23(9):1001-2. DOI:10.1111/j.1540-8167.2012.02358.x · 2.96 Impact Factor

  • Europace 04/2012; 14(4-4):528-606. DOI:10.1093/europace/eus027 · 3.67 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. · 3.67 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. DOI:10.1007/s10840-012-9672-7 · 1.58 Impact Factor

  • Heart rhythm: the official journal of the Heart Rhythm Society 03/2012; 9(4):632-696.e21. DOI:10.1016/j.hrthm.2011.12.016 · 5.08 Impact Factor
  • Hans Kottkamp ·
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    ABSTRACT: We need to differentiate whether AF is (1) the only driver of the disease in a self-perpetuating process ("AF begets AF"), (2) a consequence of an underlying structural heart disease (eg, hypertrophic cardiomyopathy), or (3) an arrhythmic manifestation of an independent FACM or of the aging atria. The potentiality of the reversal of structural atrial remodeling may be high in the first group, intermediate in the second group, but low in the third group. In addition, the initial phase of the atrial disease process in FACM or in the elderly is difficult to detect with conventional diagnostic means but may explain why some patients stay in paroxysmal AF for decades and others progress to persistent AF.
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2012; 9(4):481-2. DOI:10.1016/j.hrthm.2012.01.008 · 5.08 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. DOI:10.1111/j.1540-8167.2011.02120.x · 2.96 Impact Factor
  • Doreen Schreiber · Kristin Müller · Hans Kottkamp ·

    Journal of Cardiovascular Electrophysiology 06/2011; 22(6):717. DOI:10.1111/j.1540-8167.2010.01970.x · 2.96 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. DOI:10.1007/s11886-010-0121-x · 1.93 Impact Factor
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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. DOI:10.1111/j.1540-8159.2010.02835.x · 1.13 Impact Factor

Publication Stats

6k Citations
805.26 Total Impact Points


  • 2007-2014
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • Pacific Rim Electrophysiology Research Institute
      Los Angeles, California, United States
  • 2013
    • ETH Zurich
      Zürich, Zurich, Switzerland
  • 2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 1999-2012
    • University of Leipzig
      • • Klinik und Poliklinik für Kinderchirurgie
      • • Department of Cardiac Surgery
      Leipzig, Saxony, Germany
  • 2009
    • Attikon University Hospital
      • Department of Cardiology
      Athens, Attiki, Greece
    • Swiss Epilepsy Centre in Zurich
      Zürich, Zurich, Switzerland
  • 1994-2007
    • University of Münster
      • Department of Cardiology and Angiology
      Muenster, North Rhine-Westphalia, Germany
  • 2003
    • Universitätsklinikum Dresden
      • Klinik und Poliklinik für Kinder- und Jugendmedizin
      Dresden, Saxony, Germany
    • Kunststoff-Zentrum in Leipzig
      Leipzig, Saxony, Germany
    • INSEAD The Business School for the World
      Fontainebleau, Île-de-France, France