Stephan Willems

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

Are you Stephan Willems?

Claim your profile

Publications (276)997.59 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dual atrioventricular nodal non-re-entrant tachycardia (DAVNNT), also known as 'double fire', has recently received more attention since it was demonstrated to mimic more common arrhythmias such as atrial premature beats, atrial fibrillation, and ventricular tachycardia. This is important, since mistaken differential diagnoses and the resulting therapeutic decisions have severe consequences for affected patients. DAVNNT is characterized by conduction characteristics of the atrioventricular (AV) node that leads to a double antegrade conduction of one sinoatrial nodal activity via the slow and fast AV nodal pathways. As a result, the most significant hint from an electrocardiogram (ECG) is a P wave followed by two narrow QRS complexes. Although DAVNNT is rather a rare arrhythmia, it now appears to be more common than previously thought. To date, 68 cases including 3 small single-centre observational studies accumulated over the last 5 years have demonstrated the feasibility and safety of radiofrequency catheter ablation for DAVNNT. Catheter ablation treats this arrhythmia effectively by modifying or eliminating slow pathway function. Here, we review the current state of DAVNNT knowledge systematically and address current challenges presented by this 'ECG chameleon from the AV node'. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Europace 04/2015; DOI:10.1093/europace/euv056 · 3.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recently, a new image integration module (IIM, CartoUnivu™ Module) has been introduced to combine and merge fluoroscopy images with 3-dimensional-(3D)-electroanatomical maps (Carto® 3 System) into an accurate 3D view. The aim of the study was to investigate the influence of IIM on the fluoroscopy exposure during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. Between June and November 2014, a total of 60 patients with PAF (73.3% male, 64.0 ± 9.2 years), who underwent PVI with the endpoint of unexcitability of the ablation line, were randomized to either a conventional 3D mapping system (Carto® 3 System) or to an additional IIM on the basis of an assumed reduction of fluoroscopy exposure by the use of IIM. There were no significant differences in baseline characteristics. The median ablation procedure time was identical in both groups (140.7 ± 27.8 vs. 140.8 ± 39.5 minutes; P = 0.851). A significant decrease of mean fluoroscopy time from 11.9 ± 2.1 to 7.4 ± 2.6 minutes (P < 0.0006) and median fluoroscopy dose from 882.9 to 476.5 cGycm(2) (P < 0.001) was achieved. The main reduction of radiation could be realized during creation of the 3D-map. No major complications occurred during the procedures. After a median follow-up of 125.7 ± 45.6 days 80% of the patients were free from any atrial arrhythmias. CartoUnivu™ module easily integrates into the workflow of PVI with the endpoint of unexcitability of the ablation line without prolonging the procedure time. It is associated with a marked reduction in fluoroscopic dose when compared to a conventional 3D mapping system. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 03/2015; DOI:10.1111/jce.12673 · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: -In the meantime, catheter ablation (CA) is widely used for the treatment of persistent (pers) atrial fibrillation (AF). There is a paucity of data regarding long-term outcomes. This study evaluates (1) 5 year -single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after CA of persAF using the "stepwise approach" aiming at AF termination. -549 patients (pts) with persAF underwent de novo CA using the "stepwise approach" (2007-2009). 493 pts were included (holter-ecgs≥every 6 mo). Mean FU was 59±16 mo with 2.1±1.1 procedures/pt. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off AAD). AAD free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 pts (28%) and persAF/atrial tachycardia in 123 pts (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (HR: 1.279; 95%CI [1.093-1.497]; p=0.002), number of procedures (HR: 1.154; 95% CI [1.051-1.267]; p=0.003), female sex (HR: 1.263; 95% CI [1.027-1.553]; p=0.027) and presence of a structural heart disease (HR: 1.236; 95% CI [1.003-1.524]; p=0.047. AF termination, was correlated with a higher rate of consecutive procedures due to AT recurrences (p=0.003, HR 1.71 95% CI [1.20-2.43] CONCLUSIONS: -CA of persAF using the "stepwise approach" provides limited long term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, gender and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive AT procedures.
    Circulation Arrhythmia and Electrophysiology 03/2015; 8(2). DOI:10.1161/CIRCEP.114.001672 · 5.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Catheter ablation (CA) of ventricular tachycardia (VT) is an important treatment option in patients with structural heart disease (SHD) and implantable cardioverter defibrillator (ICD). A subset of patients requires epicardial CA for VT.
    International Journal of Cardiology 03/2015; 182. DOI:10.1016/j.ijcard.2014.12.003 · 6.18 Impact Factor
  • M Antz, S Willems, B A Hoffmann
    [Show abstract] [Hide abstract]
    ABSTRACT: In addition to treatment with drugs to control the rate and rhythm, the method of catheter ablation is a cornerstone in the treatment of atrial fibrillation. Another crucial part in treating patients with atrial fibrillation is an adequate oral anticoagulation. Apart from the vitamin K antagonists (VKA) phenprocoumon and warfarin, the direct oral anticoagulants (DOAC) apixaban, dabigatran and rivaroxaban have been approved for oral anticoagulation of patients with atrial fibrillation. As a result there are different potential treatment possibilities for pre-interventional, peri-interventional and post-interventional anticoagulation in the setting of catheter ablation for atrial fibrillation. Due to increasing clinical experience with DOAC and the increasing number of atrial fibrillation ablations worldwide, peri-interventional treatment strategies are continuously changing. Therefore, the current article discusses current standards and gives practical guidance.
    Herz 02/2015; DOI:10.1007/s00059-014-4196-9 · 0.91 Impact Factor
  • The Thoracic and Cardiovascular Surgeon 01/2015; 63(S 01). DOI:10.1055/s-0035-1544273 · 1.08 Impact Factor
  • Source
    The Thoracic and Cardiovascular Surgeon 01/2015; 63(S 01). DOI:10.1055/s-0035-1544301 · 1.08 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial fibrillation (AF) is the most common cause of ischemic stroke. Recent data suggest that AF patients after successful ablation have the same risk for thromboembolic events (TE) as patients without AF. Despite current guideline recommendations it is still under debate if oral anticoagulation (OAC) can be safely discontinued after ablation. We analyzed follow-up (FU) after ablation of paroxysmal AF (PAF) in a high- (previous stroke; group 1) and a low-risk group (no previous stroke; group 2) based on data from the German Ablation Registry to reveal real-life prescription behavior. Overall 29 centers in Germany participated by performing AF-ablation. Between April 2008 and April 2011, 83 patients in group 1 and 377 patients in group 2 with a first ablation of PAF were included in the registry. Mean CHA2DS2-VASc-Score was 4.2 ± 1.4 (group 1) vs. 1.6 ± 1.2 (group 2) (p < 0.0001). No peri-interventional TE was observed. Arrhythmia recurrence was seen in 47.4 vs. 48.4 % (p = 0.79) during a median FU of 489 (453-782) days, resulting in a repeat procedure in 20.0 vs. 20.7 % (p = 0.88), respectively. OAC was discontinued in 38.6 % in group 1 vs. 66.3 % in group 2 (p < 0.0001) during FU. TE during FU occurred more often in group 1 than in group 2 (4.3 vs. 0.3 %, p < 0.05). Even in patients with previous stroke, OAC was frequently discontinued during FU after PAF ablation in this observational study. However, TE occurred significantly more frequent in these high-risk patients. These data argue against OAC discontinuation after ablation in patients with previous stroke.
    Clinical Research in Cardiology 12/2014; DOI:10.1007/s00392-014-0804-1 · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial arrhythmias lower the biventricular pacing percentage in cardiac resynchronization therapy (CRT) treated patients (pts) and have a high prevalence in this population. External electrical cardioversion (ECV) is commonly performed to restore sinus rhythm. There is a paucity of data on the safety and efficacy of ECV in pts with CRT devices. Forty-three pts with CRT devices undergoing ECV at two centers were included prospectively. Devices were interrogated immediately prior to and after ECV, as well as after 4 weeks. Devices (CRT-D in 38 and CRT-P in 5) were all implanted in left pectoral position, with predominantly bipolar left ventricular (LV) leads. Sixty-one shocks were delivered, all biphasic. Arrhythmia had recurred in 36 % of pts at follow-up (FU). There was a significant increase in LV lead threshold voltage and drop in bipolar LV lead impedance after ECV, which returned to normal at FU. An at least twofold increase in pacing threshold voltage at FU was seen in 2 LV leads and a 0.5 V increase in threshold in 3 LV leads. Overall, biventricular pacing significantly increased during FU. ECV in CRT pts was safe and effective in this two-center study. A transient increase in LV lead pacing threshold was observed. Relevant changes in pacing threshold at FU occurred in five LV leads-identification and regular FU of these pts are necessary. Restoring SR through ECV significantly increased the biventricular pacing percentage but arrhythmia recurrence was frequent. CRT pts with atrial arrhythmias require close FU after ECV.
    Clinical Research in Cardiology 12/2014; 104(5). DOI:10.1007/s00392-014-0800-5 · 4.17 Impact Factor
  • The American Journal of Cardiology 10/2014; DOI:10.1016/j.amjcard.2014.10.002 · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: The FREEZE-cohort study (NCT 01360008) is a prospective observational, multicenter and multinational study to evaluate safety and effectiveness of cryoballoon ablation for pulmonary vein isolation as compared to radiofrequency ablation in patients with paroxysmal or persistent atrial fibrillation (lasting <one year) under the conditions of clinical routine. Methods and Results: The study started in 2011 and anticipates inclusion up to 2000 patients in each of the two treat-ment groups. A total of 37 centers from 8 countries worldwide, all experienced in at least one of the two ablation techniques, participate in the study. The primary outcome parameter of the study is defined as atrial fibrillation recurrence rate during twelve months of follow-up. Secondary out-come parameters include primary success rates, complication rates in general, specific complica-tions with respect to phrenic nerve palsy and pulmonary vein stenosis, radiation exposure, clinical course including death and repeat ablation. Finally specific procedural aspects will be evaluated in a descriptive manner. Preliminary data of the first 1882 patients show that in clinical practice cryoablation is preferentially performed in patients with paroxysmal atrial fibrillation, whereas application of radiofrequency ablation is equally distributed between patients with persistent and paroxysmal atrial fibrillation. Conclusion: Based on multi-center and multi-national data the FREEZE-cohort study will provide important information on long-term efficacy, clinical effective-ness, complication rates and procedural differences between atrial fibrillation patients treated with either cryoablation or radiofrequency ablation.
    International Journal of Clinical Medicine 10/2014; 5(19):1161-1172. DOI:10.4236/ijcm.2014.519149
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Catheter ablation (CA) for atrial fibrillation (AF) is an effective therapeutic option for the treatment of symptomatic drug-refractory AF. According to current guidelines, the prevention of stroke and embolism is the most important therapeutic goal in AF and the recommendations for anticoagulation (OAC) after successful CA are based upon the CHA2DS2-VASc-Score 3. The aim of this study was to evaluate the use of OAC in patients with a high risk for thromboembolic events 1 year after CA and to identify predictor variables for discontinuation of OAC. Methods: Between January 2007 and January 2010 13092 patients were enrolled in the study. A total of 52 German electrophysiological centers agreed to participate in this prospective multicenter registry. 41 centers included patients undergoing CA for AF. Analysis included patients who were discharged with OAC after CA and had a CHA2DS2-VASc-Score ≥ 2. A centralized 1 year follow-up (FU) was conducted via telephone. Results: 1300 patients fulfilled the inclusion criteria. One year after CA 51.8 % of these patients were on OAC. Factors significantly associated with discontinuation of OAC included no AF recurrence in FU (adjusted odds ratio (OR): 2.14, [95 % confidence interval (CI): 1.73-2.66], P < 0.001) and paroxysmal AF (OR: 1.53 [95 % CI: 1.29-1.81], P < 0.001). Factors associated with continuation of OAK were patient age (OR per 10 years: 0.79 [95 % CI: 0.68-0.91], P = 0.002), valvular heart disease (OR: 0.67 [95 % CI: 0.48-0.92], P = 0.013), an implanted pacemaker, defibrillator or a cardiac resynchronization therapy system (OR: 0.55 [95 % CI: 0.41-0.74], P < 0.001) and neurological events in hospital or during FU (OR: 0.40 [95 % CI: 0.18-0.88], P < 0.022). Conclusion: Almost half of the patients with an indication for OAC are not adequately anticoagulated one year after CA for AF. Paroxysmal AF or freedom from AF is significantly associated with discontinuation of OAC.
    DMW - Deutsche Medizinische Wochenschrift 09/2014; 139(39):1923-1928. DOI:10.1055/s-0034-1387316 · 0.55 Impact Factor
  • A Sultan, J Lüker, S Willems, D Steven
    [Show abstract] [Hide abstract]
    ABSTRACT: History and admission findings: A 62-year-old woman presented with history of repeat syncope and palpitations. She experienced aggravation of symptoms within the last few months. At referring hospital a ventricular tachycardia was already inducible during electrophysiological study. The patient was transferred to our hospital for VT ablation vs. ICD implantation. Investigation: No evidence for structural heart disease was revealed during TTE nor was a coronary heart disease detectable during coronary angiography, only hypertension was verifiable. No ICD implantation so far. Treatment and course: The patient underwent repeat EP study at our facility with induction of VT. Pace-mapping and mapping for earliest ventricular activation was performed. The middle-cardiac vein was revealed as site of earliest ventricular activation (50 ms) and good pace-map. Therefore, radiofrequency ablation at this site terminated successfully VT into sinus rhythm. Conclusion: Ablation of epicardial VT foci is successfully feasible via coronary sinus. With regard to typical ECG parameters an epicardial foci may be assumed precociously. The great cardiac vein is one of the most common sites of origin for epicardial foci, however, VT partially may originate from the crux cordis which is accessible for ablation via the middle cardiac vein with good ablation results.
    DMW - Deutsche Medizinische Wochenschrift 09/2014; 139(39):1929-1931. DOI:10.1055/s-0034-1387311 · 0.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Vascular reflex mechanisms contribute to vasovagal syncope. However, the alterations in central haemodynamics in patients with vasovagal syncope are unknown. 30 consecutive patients (36.5 ± 15 years, 14 females) with recurrent vasovagal syncope (VVS) and a positive tilt table test were compared to 39 age- and sex-matched controls (36.9 ± 16 years, 15 females) with a negative tilt table result and no history of syncope. Central aortic pressure parameters including augmentation index and central pulse pressure as markers of aortic stiffness were generated non-invasively by applanation tonometry of the radial artery and use of a validated mathematical transfer function. No difference in aortic augmentation index was observed between groups. (VVS 9 ± 2.6 vs. Control 11 ± 2.4, p = 0.8). However, in patients with vasovagal syncope the aortic pressure waveform significantly differed from healthy controls. A prolonged time to the peak of aortic pressure wave (aortic T2) was observed in patients with vasovagal syncope (226 ± 24 vs. 208 ± 21 ms, p = 0.001). Furthermore time to the first shoulder of the aortic pressure wave (aortic T1) was slightly shorter compared to healthy controls, but did not reach statistical significance (106 ± 22 vs. 110 ± 12 ms, p = 0.33). Patients with vasovagal syncope have an altered aortic pressure waveform at rest, but no signs of elevated aortic stiffness. The underlying mechanisms for these findings may potentially result from a complex imbalance of the autonomic nervous system with a continuous deregulation of the sympathetic and parasympathetic reflex arcs.
    Heart and Vessels 08/2014; DOI:10.1007/s00380-014-0576-6 · 2.11 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Ablation of premature ventricular contractions (PVC) can be challenging due to infrequent spontaneous ectopy and the limitations subjective pacemapping (PM). Activation mapping (AM) provides an objective parameter, but relies on spontaneous ectopic activity. Objectives The objective of the study was to evaluate the correlation of automated template matching (TM) with activation timing and to investigate potential implications towards ablation success. Methods Forty Patients undergoing catheter ablation of idiopathic outflow tract VT or PVC in 47 procedures were included. PVC/VT origin was determined by PM and AM. A percentage value for PM was calculated using TM software and correlated with corresponding activation timing. Overall, 126 TM and corresponding AM values were analysed. All patients were followed (313 ± 158 days after ablation) including a 24-hour Holter ECG. Results A correlation between TM and activation timing (r = 0.66, p < 0.0001) could be shown. Success rate at follow up was 77%. No statistically significant coherence of TM percentage and relapse was observed. Conclusions Template matching correlates with activation timing in the process of mapping idiopathic focal PVC/VT. TM helps to objectify the process of PM and may therefore be helpful to guide successful ablation in the absence of spontaneous ectopy.
    08/2014; 4. DOI:10.1016/j.ijchv.2014.08.006
  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial fibrillation is the most common form of arrhythmia worldwide and is associated with potentially severe complications. Apart from antiarrhythmic drug therapy, interventional treatment by catheter ablation has emerged as an effective and safe alternative notably for the paroxysmal form. The pulmonary veins (PV) have been identified as a major source in the setting of paroxysmal atrial fibrillation. Circumferential wide area PV isolation, optimization of procedural techniques and the positioning of an ablation line deep in the left atrium have contributed to the increased success rates; however, the procedure is still associated with potentially severe complications and should therefore be carried out in centers with sufficient case numbers and operators with corresponding training and experience.
    Herzschrittmachertherapie & Elektrophysiologie 07/2014; DOI:10.1007/s00399-014-0332-8
  • [Show abstract] [Hide abstract]
    ABSTRACT: Single procedure success rates of pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are still unsatisfactory. In patients with persistent atrial fibrillation (AF) ablation of complex fractionated atrial electrograms (CFAE) beyond PVI results in improved outcomes.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; 11(9). DOI:10.1016/j.hrthm.2014.06.002 · 4.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: HeartWare Ventricular Assist Device and Implantable Cardioverter Defibrillator IntroductionThe HeartWare continuous flow ventricular assist device (HVAD) is used in an increasing number of heart failure patients. In those patients, ventricular arrhythmias (VAs) are common and, consequently, many patients already have an implanted implantable cardioverter defibrillator (ICD) in place or receive ICD implantation after left ventricular assist device implantation. However, limited data on feasibility and necessity of combined ICD and HVAD therapy are available. In this study we present our technical and clinical experience. Methods and ResultsBetween 01/2010 and 06/2013, 41 patients received HVAD implantation. Twenty-six HVAD patients who already had an ICD device placed prior to HVAD implantation or received ICD implantation afterwards were enrolled in this study. Peri- and postoperative complications as well as ICD interrogations were documented and analyzed retrospectively. Mean patients age was 58.4 12.6 years; 88.5% of patients were male. During mean follow-up of 12.2 +/- 8.9 months, appropriate ICD interventions occurred in 9 patients (34.6%) due to ventricular tachyarrhythmia (n = 7) or ventricular fibrillation (n = 2). An inappropriate ICD intervention was seen in 1 patient (3.9%) due to tachycardic atrial fibrillation. Patients on HVAD with a history of VAs (n = 13) had a significantly higher incidence of ICD interventions compared to patients with primary prophylactic indication for ICD (n = 13; 53.8% vs. 7.7%; P = 0.015). No disturbance of ICD function was seen after HVAD implantation. Conclusion Combined ICD and HVAD therapy was safe and feasible, without electromagnetic interference between ICD and ventricular assist device. The incidence of ICD interventions was high in patients with a history of VAs, but low in patients with ICD implantation for primary prevention.
    Journal of Cardiovascular Electrophysiology 05/2014; 25(10). DOI:10.1111/jce.12455 · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The involvement of the Purkinje system in a subset of patients with idiopathic ventricular fibrillation or polymorphic VT/VF related to structural heart disease was first demonstrated in the pioneering work of Michel Haissaguerre and co-workers (Circulation 106:962-967, 2002 and Lancet 359:677-678, 2002). It is very important to identify these patients with recurrent episodes of ventricular fibrillation and/or ICD shocks with regard to the presence of triggering premature ventricular contractions (PVC), which may be amenable to mapping and catheter ablation by screening Holter and ICD recordings. The practical problem, which is frequently encountered, is the absence of these PVCs when the patients are brought to the EP lab. However, catheter ablation is an important adjunctive tool to antiarrhythmic drug treatment, beta blocker therapy, and general anesthesia in this setting. Local electrogram criteria related to this phenomenon have been identified guiding mapping and ablation (e.g., low amplitude, high-frequency Purkinje potentials preceding a closely coupled ventricular signal (Fig. 1a)). The favorable long-term follow-up after catheter ablation has been demonstrated in the setting of right and left ventricular Purkinje-related PVCs leading to polymorphic VT/VF (Leenhardt et al., Circulation 89:206-215, 1994) and also following myocardial infarction (Baensch et al., Circulation 108:3011-3016, 2003) and right ventricular outflow tract-associated VF (Noda et al., Journal of the American College of Cardiology 46:1288-1294, 2005). Most recently, epicardial ablation strategies leading to suppression of polymorphic VT/VF episodes related to the Brugada syndrome have been described irrespective to the presence of premature ventricular beats (Nademanee et al., Circulation 123:1270-1279, 2011).
    Journal of Interventional Cardiac Electrophysiology 03/2014; 40(3). DOI:10.1007/s10840-014-9886-y · 1.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Various lesion sets and subsequent success rates have been reported in patients receiving concomitant surgical ablation for atrial fibrillation. However, most of these results have been obtained by discontinuous monitoring. We report results using continuous event recorder rhythm monitoring to compare more accurately the efficacy of a left versus biatrial lesion set to treat patients with persistent atrial fibrillation. Between July 2008 and December 2011, 66 patients with persistent or long-standing persistent atrial fibrillation underwent concomitant surgical atrial fibrillation ablation with a biatrial lesion set and subcutaneous event recorder implantation. The results and outcomes were compared with a propensity score-matched cohort of 66 patients with a left atrial lesion set and event recorder implantation. Event recorder interrogation was performed at 3, 6, and 12 months follow-up. The mean patient age was 70.2 ± 7.4 years, and 70.3% were male. No major ablation-related complications occurred. One-year survival was 94.8% with no statistically significant differences between the 2 groups. The overall rate of freedom from atrial fibrillation was 57.3% and 64.4% after 3 and 12 months follow-up, respectively. Three months postoperatively, patients in the biatrial group had a slightly higher rate of freedom from atrial fibrillation (63.6% vs 52.3% P = .22), but it did not reach statistical significance. At 12 months follow-up, a statistically significant higher rate of freedom from atrial fibrillation was observed in patients with a biatrial lesion set (74.4% vs 55.8%; P = .026). The mean atrial fibrillation burden in all patients was 15.1% ± 12.5% in the biatrial group and 21.2% ± 14.4% in the left atrial group 12 months postoperatively (P = .03). Continuous rhythm monitoring by subcutaneous event recorder implantation was safe and feasible. In patients undergoing biatrial ablation, a statistically significant higher rate of freedom from atrial fibrillation was observed at 12 months follow-up.
    The Journal of thoracic and cardiovascular surgery 02/2014; 148(5). DOI:10.1016/j.jtcvs.2014.02.061 · 3.99 Impact Factor

Publication Stats

3k Citations
997.59 Total Impact Points

Institutions

  • 1997–2015
    • University Medical Center Hamburg - Eppendorf
      • • Department of Cardiology, Electrophysiology
      • • Department of Cardiovascular Surgery
      Hamburg, Hamburg, Germany
  • 2007–2014
    • University of Hamburg
      • • Department of Cardiology, Electrophysiology
      • • University Heart Center
      Hamburg, Hamburg, Germany
  • 2011
    • CHU de Québec
      Quebec City, Quebec, Canada
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 2009–2011
    • Universitätsklinikum Münster
      • Department für Kardiologie und Angiologie
      Muenster, North Rhine-Westphalia, Germany
  • 2010
    • Ludwig-Maximilian-University of Munich
      • Department of Internal Medicine I
      München, Bavaria, Germany
  • 1994–2009
    • University of Münster
      • Department of Cardiology and Angiology
      Muenster, North Rhine-Westphalia, Germany