Stephan Willems

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

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Publications (255)892.63 Total impact

  • [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 : official journal of the German Cardiac Society. 12/2014;
  • The American Journal of Cardiology. 10/2014;
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    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.
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    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.
    Deutsche medizinische Wochenschrift (1946). 09/2014; 139(39):1923-1928.
  • A Sultan, J Lüker, S Willems, D Steven
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    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.
    Deutsche medizinische Wochenschrift (1946). 09/2014; 139(39):1929-1931.
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    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; · 2.13 Impact Factor
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    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.
    IJC Heart & Vessels. 08/2014;
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    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;
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    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; · 4.56 Impact Factor
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    ABSTRACT: The 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 ICD in place or receive ICD implantation after LVAD implantation. However, limited data on feasibility and necessity of combined ICD and HVAD therapy is available. In this study we present our technical and clinical experience.
    Journal of Cardiovascular Electrophysiology 05/2014; · 3.48 Impact Factor
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    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; · 1.39 Impact Factor
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    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; · 3.41 Impact Factor
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    ABSTRACT: Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%). Between July 2003 and August 2011, 59 patients with severely reduced LVEF underwent concomitant surgical AF ablation, by either left atrial (LA) lesion set or bilateral pulmonary vein isolation in patients with paroxysmal AF, and biatrial lesion set in patients with persistent AF. Follow-up echocardiography (ECG) was conducted after 12 months; rhythm monitoring was accomplished by either 24-h Holter echocardiography or event recorder monitoring. The patients' mean age was 68 ± 9 years (male patients, 71%). Paroxysmal AF was present in 24 (41%) and persistent AF in 35 (59%) patients. No ablation-related adverse events occurred. The one-year survival rate was 95% without differences in patients with and without restoration of sinus rhythm (SR). The overall rate of SR was 54% after 1 year, showing a superior result in patients with preoperative paroxysmal AF compared with those with preoperative persistent AF (70 vs 41%, P < 0.001). LVEF improved from 29 ± 8% preoperatively to 39 ± 7% after 12 months of follow-up. The improvement in LVEF was significantly higher in patients with restored SR than in those with AF (16 vs 5%; P < 0.001). Only patients with restoration of SR showed a statistically significant reduction in New York Heart Association functional class at the 12-month follow-up (P = 0.0013). Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2014; · 2.40 Impact Factor
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    ABSTRACT: Der Einsatz von Elektrokautern kann bei Patienten mit Herzschrittmachern oder implantierten Kardiovertern/Defibrillatoren eine Vielzahl von Störungen bis hin zu Aggregatbeschädigungen zur Folge haben. Ihr Einsatz muss daher in jedem Fall kritisch hinterfragt werden. Sofern Elektrokauter bei diesen Patienten eingesetzt werden müssen, werden hier Empfehlungen für die prä- und postoperativen Maßnahmen bei beiden Aggregattypen gegeben. Diese betreffen sowohl die notwendigen Kontrollen als auch erforderliche Umprogrammierungen. Weiterhin werden intraoperative Maßnahmen empfohlen, um Interferenzen zwischen Elektrokauter und implantiertem Aggregat zu vermeiden. Grundsätzlich sollten bevorzugt bipolare Kauter eingesetzt werden, da diese ein geringeres Risiko für Störbeeinflussungen aufweisen. The use of electrocautery in patients with pacemakers or implantable cardioverter-defibrillators may cause a variety of interactions or even device damage. Its use must therefore be scrutinized in each case. This paper gives recommendations if electrocautery is necessary in those patients. These include pre- and postoperative procedures in patients with those devices. They apply to required additional device follow-ups, as well as to required changes of programmed parameters. Additionally, intraoperative measures are recommended to avoid interactions between the electrocautery and implanted devices. Generally, bipolar cauters should be preferred, as they have a lower potential for interference. SchlüsselwörterElektrokauter-Hochfrequenzstrom-Herzschrittmacher-Implantierbarer Kardioverter/Defibrillator-Störbeeinflussung KeywordsElectrocautery-High-frequency current-Pacemaker-Implantable cardioverter-defibrillator-Interference
    Der Kardiologe 01/2014; 4(5):383-388.
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    ABSTRACT: Background 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. Objective We hypothesized that PAF-patients with sustained AF acutely after PVI might also benefit from additional CFAE-ablation. Methods Overall 1134 consecutive patients received a first catheter-ablation of PAF between 06/2008-12/2012. In most patients AF was either not inducible or terminated during PVI. In 68 patients (6%) AF sustained after successful PVI. These patients were randomized to either cardioversion (PVI-alone, n=33) or additional CFAE-ablation (PVI+CFAE, n=35) and followed every 1-3 months including serial Holter recordings. Primary endpoint was recurrence of AF/atrial tachycardia (AT) after a blanking period of 3 months. Results Procedure-duration (127±6 vs 174±10 min), radiofrequency-application- (44±3 vs 74±5 min) and fluoroscopy-time (26±2 vs 41±3 min) were longer in PVI+CFAE (all p<0.001). In PVI+CFAE in 30/35 (86%) patients ablation terminated AF. There was no significant group difference with respect to freedom from AF/AT (22/33 (67%) vs 22/35 (63%) p=0.66). Subsequently, 10/11 (91%) patients in PVI-alone and 11/13 (85%) in PVI+CFAE underwent repeat ablation (p=1.00). Overall, 29/33, 88%, vs 30/35, 86%, (p=1.00) were free from AF/AT after 1.4±0.1 vs 1.4±0.2, (p=0.87) procedures. Conclusion Patients with sustained AF after PVI in a PAF-cohort are rare. Regarding AF/AT-recurrence, these patients did not benefit from further CFAE- ablation compared to PVI-alone, but are exposed to longer procedure-, fluoroscopy- and radiofrequency-duration.
    Heart Rhythm. 01/2014;
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    ABSTRACT: Recent observational clinical and ex-vivo studies suggest that inflammation and in particular leukocyte activation predisposes to atrial fibrillation (AF). However, whether local binding and extravasation of leukocytes into atrial myocardium is an essential prerequisite for the initiation and propagation of AF remains elusive. Here we investigated the role of atrial CD11b/CD18 mediated infiltration of polymorphonuclear neutrophils (PMN) for the susceptibility to AF. C57bl/6J wildtype (WT) and CD11b/CD18 knock-out (CD11b(-/-)) mice were treated for 14 days with subcutaneous infusion of angiotensin II (Ang II), a known stimulus for PMN activation. Atria of Ang II-treated WT mice were characterized by increased PMN infiltration assessed in immunohistochemically stained sections. In contrast, atrial sections of CD11b(-/-) mice lacked a significant increase in PMN infiltration upon Ang II infusion. PMN infiltration was accompanied by profoundly enhanced atrial fibrosis in Ang II treated WT as compared to CD11b(-/-) mice. Upon in-vivo electrophysiological investigation, Ang II treatment significantly elevated the susceptibility for AF in WT mice if compared to vehicle treated animals given an increased number and increased duration of AF episodes. In contrast, animals deficient of CD11b/CD18 were entirely protected from AF induction. Likewise, epicardial activation mapping revealed decreased electrical conduction velocity in atria of Ang II treated WT mice, which was preserved in CD11b(-/-) mice. In addition, atrial PMN infiltration was enhanced in atrial appendage sections of patients with persistent AF as compared to patients without AF. The current data critically link CD11b-integrin mediated atrial PMN infiltration to the formation of fibrosis, which promotes the initiation and propagation of AF. These findings not only reveal a mechanistic role of leukocytes in AF but also point towards a potential novel avenue of treatment in AF.
    PLoS ONE 01/2014; 9(2):e89307. · 3.53 Impact Factor
  • Der Kardiologe 01/2014; 8(1).
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    ABSTRACT: CA has emerged as a widespread therapeutic option in the treatment of AF. Currently, no safety data with regard to the impact of the underlying SHD is available. We sought to assess the risk for acute and long-term complications during catheter ablation (CA) of atrial fibrillation (AF) in relation to underlying structural heart diseases (SHD). We included 6211 patients in a prospective registry undergoing CA of AF in 41 nationwide centers. All patients were divided into four groups according to the underlying heart disease: No SHD (69.4%), hypertensive heart disease (HHD) (12.0%), coronary artery disease (CAD) (15.1%) and cardiomyopathy (CM) (3.6%). In univariate analysis patients with HHD had an overall complication rate of 7.28%, whereas patients without a SHD had a significantly lower rate of 6.01% (P <0.01). Multivariate analysis revealed that HHD (adjusted odds ratio (OR): 1.97 [95% confidence interval (CI): 1.02 to 3.83], P = 0.0442) and age (years) (OR: 1.04 [95% CI: 1.01 to 1.07], P = 0.0155) were independent predictors of severe, non-fatal complications and death. Other SHD including CAD (OR: 1.48 (0.73-3.00), P = 0.2797) and CM (OR: 2.37 (0.70-7.99), P = 0.1630) failed to reach statistical significance. Male sex was protective (OR: 0.47 [95% CI: 0.27 to 0.81], P = 0.0062). In general, CA of AF has a low number of severe complications. In our prospective registry HHD emerged as an independent predictor of severe, non-fatal complications during AF ablation but other structural heart diseases including CAD and CM did not. The influence of HHD on the complication rate should be considered in patient selection. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 11/2013; · 3.48 Impact Factor
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    ABSTRACT: -The role of subsequent atrial tachycardias (AT) in the context of persistent atrial fibrillation (AF) remains undetermined. This study evaluated the prognostic role of subsequent ATs for arrhythmia recurrences following catheter ablation of persistent AF. -A total of 110 patients with persistent AF (63±9 y, 22 female, 61 long-lasting persistent AF) underwent pulmonary vein isolation followed by electrogram-guided ablation. After AF terminated to AT, patients were separated by the randomization protocol to receive either direct cardioversion (group A) or further ablation of subsequent ATs to sinus rhythm (SR) (group B). After a mean follow-up (FU) of 20.1±13.3 months after the first procedure, significantly more group B patients were in SR as compared to patients in group A (30 (57%) vs. 18 (34%), p=0.02). Moreover, recurrences of AF were significantly less frequent of group B than in group A patients (10 (19%) vs. 26 (49%), p=0.001). After the last procedure (FU 34.0±6.4 months), significantly more group B patients were free of AF as compared to patients of group A (49 (92%) vs. 39 (74%), p=0.01). The proportion of AT recurrences did not differ between the two groups after the first and final procedure. The strongest predictor for an arrhythmia free survival after a single procedure was randomization to the procedural endpoint of termination to SR by elimination of subsequent ATs (p=0.004). -Catheter ablation of subsequent ATs increases freedom from AF but not AT, suggesting a contributing role of subsequent ATs in the mechanisms of persistent AF. Clinical Trial Registration-URL: http://www.clinicaltrials.gov; Unique identifier: NCT01896570.
    Circulation Arrhythmia and Electrophysiology 10/2013; · 5.95 Impact Factor
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    ABSTRACT: Catheter ablation for idiopathic ventricular arrhythmia is well established but epicardial origin, proximity to coronary arteries, and limited accessibility may complicate ablation from the venous system in particular from the great cardiac vein (GCV). Between April 2009 and October 2010 14 patients (56±15years; 9 male) out of a total group of 117 patients with idiopathic outflow tract tachycardias were included undergoing ablation for idiopathic VT or premature ventricular contractions (PVC) originating from GCV. All patients in whom the PVC arose from the GCV were subject to the study. In these patients angiography of the left coronary system was performed with the ablation catheter at the site of earliest activation. Successful ablation was performed in 6/14 (43%) and long-term success was achieved in 5/14 (36%) patients. In 4/14 patients (28.6%) ablation was not performed. In another 4 patients (26.7%), ablation did not abolish the PVC/VT. In the majority, the anatomical proximity to the left coronary system prohibited effective RF application. In 3 patients RF application resulted in a coronary spasm with complete regression as revealed in repeat coronary angiography. A relevant proportion idiopathic VT/PVC can safely be ablated from the GCV without significant permanent coronary artery stenosis after RF application. Our data furthermore demonstrate that damage to the coronary artery system is likely to be transient.
    International journal of cardiology 10/2013; · 6.18 Impact Factor

Publication Stats

2k Citations
892.63 Total Impact Points

Institutions

  • 1998–2014
    • University Medical Center Hamburg - Eppendorf
      • • Department of Cardiology, Electrophysiology
      • • Department of Cardiovascular Surgery
      Hamburg, Hamburg, Germany
  • 2011–2013
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 1997–2013
    • University of Hamburg
      • • University Heart Center
      • • Department of Cardiovascular Surgery
      • • Department of Internal Medicine II and Clinic (Oncology Center)
      Hamburg, Hamburg, 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
  • 1992–2007
    • University of Münster
      • • Department of Cardiology
      • • Faculty of Medicine
      Münster, North Rhine-Westphalia, Germany