-
Hans-Ruprecht Neuberger,
Roland Richard Tilz,
Hendrik Bonnemeier,
Thomas Deneke,
Heidi L Estner,
Charalampos Kriatselis,
Malte Kuniss, Armin Luik,
Philipp Sommer,
Daniel Steven,
Christian von Bary,
Frederik Voss,
Lars Eckardt
[show abstract]
[hide abstract]
ABSTRACT: AIMS: To provide a nationwide survey (and reference for the future) on cardiac electrophysiologists, types and numbers of invasive electrophysiological procedures, and training opportunities in 2010.METHODS AND RESULTS: German cardiology centres performing invasive electrophysiology were identified from quality reports and contacted to fill a questionnaire. A majority of 122 centres (65%) responded. Electrophysiology (ablation procedures and device therapy) was mainly part of a cardiology department (82%), and only in 9% independent (own budget). In only 58% of the centres, (at least) two physicians were present during catheter ablations. Although in 2010, women represented 59.4% of physicians <35 years old, only 26% of physicians in electrophysiology training were female. In total, 33 420 catheter ablations were performed with a median number of 180 per centre. Atrial fibrillation (AF) was the most common arrhythmia invasively treated (35%). At least 50 AF ablations were performed in 53% of the centres. Of the centres performing AF ablations, consecutive left atrial arrhythmias were treated by catheter ablation only in 75%, and only 44% had in-house surgical backup. Only one-fourth of the 122 centres fulfilled all requirements for training centre accreditation according to the European Heart Rhythm Association and the German Cardiac Society.CONCLUSION: The results indicate a high number of electrophysiology centres and procedures in Germany. Atrial fibrillation was the most common arrhythmia invasively treated. An increasing demand for catheter ablation is likely, but training opportunities are limited. Women are clearly underrepresented. A co-operation of higher and lower volume electrophysiology centres may be necessary for training purposes.
Europace 06/2013; · 1.98 Impact Factor
-
Michael Burdumy, Armin Luik,
Peter Neher,
Raghed Hanna,
Martin W Krueger,
Christopher Schilling,
Hans Barschdorf,
Cristian Lorenz,
Gunnar Seemann,
Claus Schmitt,
Olaf Doessel,
Frank M Weber
[show abstract]
[hide abstract]
ABSTRACT: Atrial arrhythmias are frequently treated using catheter ablation during electrophysiological (EP) studies. However, success rates are only moderate and could be improved with the help of personalized simulation models of the atria. In this work, we present a workflow to generate and validate personalized EP simulation models based on routine clinical computed tomography (CT) scans and intracardiac electrograms. From four patient data sets, we created anatomical models from angiographic CT data with an automatic segmentation algorithm. From clinical intracardiac catheter recordings, individual conduction velocities were calculated. In these subject-specific EP models, we simulated different pacing maneuvers and measurements with circular mapping catheters that were applied in the respective patients. This way, normal sinus rhythm and pacing from a coronary sinus catheter were simulated. Wave directions and conduction velocities were quantitatively analyzed in both clinical measurements and simulated data and were compared. On average, the overall difference of wave directions was 15° (8%), and the difference of conduction velocities was 16 cm/s (17%). The method is based on routine clinical measurements and is thus easy to integrate into clinical practice. In the long run, such personalized simulations could therefore assist treatment planning and increase success rates for atrial arrhythmias.
Biomedizinische Technik/Biomedical Engineering 01/2012; 57(2):79-87. · 0.53 Impact Factor
-
Isabel Deisenhofer,
Bernhard Zrenner,
Yue-Hui Yin,
Heinz-Friedrich Pitschner,
Malte Kuniss,
Georg Grossmann,
Sascha Stiller, Armin Luik,
Christian Veltmann,
Julia Frank, [......],
Stephanie Fichtner,
Susanne Kathan,
Martin R Karch,
Clemens Jilek,
Sonia Ammar,
Christof Kolb,
Zeng-Chang Liu,
Bernhard Haller,
Claus Schmitt,
Gabriele Hessling
[show abstract]
[hide abstract]
ABSTRACT: Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block.
A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001).
Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.
Circulation 11/2010; 122(22):2239-45. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Atrial arrhythmias, such as atrial flutter or fibrillation, are frequent indications for catheter ablation. Recorded intracardiac electrograms (EGMs) are, however, mostly evaluated subjectively by the physicians. In this paper, we present a method to quantitatively extract the wave direction and the local conduction velocity from one single beat in a circular mapping catheter signal. We simulated typical clinical EGMs to validate the method. We then showed that even with noise, the average directional error was below 10(°) and the average velocity error was below 5.4 cm/s. In a realistic atrial simulation, the method could clearly distinguish between stimuli from different pulmonary veins. We further analyzed eight clinical data segments from three patients in normal sinus rhythm and with stimulation. We obtained stable wave directions for each segment and conduction velocities between 70 and 115 cm/s. We conclude that the method allows for easy quantitative analysis of single macroscopic wavefronts in intracardiac EGMs, such as during atrial flutter or in typical clinical stimulation procedures after termination of atrial fibrillation. With corresponding simulated data, it can provide an interface to personalize electrophysiological (EP) models. Furthermore, it could be integrated into EP navigation systems to provide quantitative data of high diagnostic value to the physician.
IEEE transactions on bio-medical engineering 10/2010; 57(10):2394-401. · 2.15 Impact Factor
-
Stylianos Tzeis, Armin Luik,
Clemens Jilek,
Claus Schmitt,
Heidi L Estner,
Jinjin Wu,
Tilko Reents,
Stephanie Fichtner,
Christof Kolb,
Martin R Karch,
Gabriele Hessling,
Isabel Deisenhofer
[show abstract]
[hide abstract]
ABSTRACT: Ablation of left atrial flutter (LAF) is often limited by the need for technically demanding linear lesions. We evaluated the safety and efficacy of a new modified anterior line (MAL), connecting the anterior/anterolateral mitral annulus with the left superior pulmonary vein for ablation of perimitral flutter.
MAL was performed in 65 patients (15 females, age 63.6 +/- 9.8 years) with perimitral flutter using 3D mapping systems (70.8% Carto, 29.2% NavX). Perimitral flutter was either the presenting arrhythmia (73.8%) or an intermediate organized rhythm during atrial fibrillation ablation. Follow-up included repetitive 7-day Holter with 93.8% of patients off antiarrhythmics. MAL was acutely effective in 63/65 patients (96.9%). Termination to sinus rhythm occurred in 36 of 65 patients (55.4%), and in 27 of 65 patients (41.5%) there was a change to another LAF type. Bidirectional block across the MAL was achieved in 56 of 65 patients (86.1%). After 6 months of follow-up, 20 of 41 patients (48.8%) had a LAF recurrence, with 6 patients undergoing a reablation. In all redo patients the MAL was still complete and LAF mechanism was different to the initially targeted. No major complication occurred during the ablation procedures or in the postablation period.
The MAL is a safe and effective linear lesion for the treatment of perimitral LAF. Its value compared to more established linear lesions as the mitral isthmus line has to be evaluated in larger studies.
Journal of Cardiovascular Electrophysiology 06/2010; 21(6):665-70. · 3.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Atrial fibrillation is the most commonly encountered clinical arrhythmia, and there are an increasing number of patients with paroxysmal atrial fibrillation treated by catheter ablation. The criterion standard is the isolation of the pulmonary veins (PVs) using radiofrequency (RF) energy in combination with an open irrigated tip catheter. The procedure remains technically challenging with a significant number of complications. So far, no randomized comparisons between the outcome of cryoballoon versus RF ablation are available.
The object of this randomized clinical trial is to compare the efficacy of isolating the PVs with either the cryoballoon or the open irrigated tip RF catheter. Two hundred forty-four patients with paroxysmal atrial fibrillation will be randomized for either RF or cryoballoon. With both techniques, PV isolation will be performed. Primary end point of the study is freedom from atrial fibrillation without antiarrhythmic drugs and without persistent complications at 6 and 12 months. Clinical success will be evaluated using Holter electrocardiogram and event recordings for at least 7 days. Within 6 months, no redo procedure is performed; and a redo after 6 months is performed with the previously used energy source. Secondary end points include the mid- and long-term clinical success, procedural data, and cost-effectiveness.
The FreezeAF trial will examine for the first time in a randomized trial whether PV isolation with the cryoballoon is not relevantly inferior to open irrigated RF ablation in patients with paroxysmal atrial fibrillation during follow-up. It will additionally directly compare acute procedural success and safety of the procedures.
American heart journal 04/2010; 159(4):555-560.e1. · 4.65 Impact Factor
-
Kardiologie up2date 01/2010; 6(02):96-99.
-
[show abstract]
[hide abstract]
ABSTRACT: Catheter ablation of persistent and long-standing persistent atrial fibrillation (AF) is still challenging. So far different ablation techniques have been reported, including pulmonary vein isolation, additional linear lesions, ablation of complex fractionated atrial electrograms (CFAE), and combinations of these techniques. During ablation of CFAE, the occurrence of left atrial (LA) tachycardia is well known. The occurrence of right atrial flutter on the other hand is less well described.
Here, we report three patients who had been ablated because of symptomatic persistent atrial fibrillation.
In all patients, AF changed into a cavotricuspid isthmus = dependent right atrial flutter during ablation of CFAE in the LA.
Pacing and Clinical Electrophysiology 12/2009; 33(3):304-8. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Complex fractionated atrial electrograms (CFAE) are a possible target for atrial fibrillation (AF) ablation and can be visualized in three-dimensional (3D) mapping systems with specialized software.
To use the new CFAE software of CartoXP (Biosense Webster, Diamond Bar, CA, USA) for analysis of spatial distribution of CFAE in paroxysmal and persistent AF.
We included 16 consecutive patients (6 females; mean 59.3 years) with AF (6 paroxysmal and 10 persistent) undergoing AF ablation. Carto maps of left atrium (LA) were reconstructed. Using the new CFAE software, the degree of local electrogram fractionation was displayed color-coded on the map surface. LA was divided into four regions: anterior wall, inferior wall, septum, and pulmonary veins (PV). The relationship among regions with CFAE visualized and CFAE ablation regions (persistent AF only) was analyzed retrospectively.
In paroxysmal and persistent AF, CFAE were observed in all four LA regions. In paroxysmal AF, the density of CFAE around the PV was significantly higher than in other regions (P < 0.05) and higher than in persistent AF (P < 0.05). In persistent AF, CFAE were evenly distributed all over the LA. Of 40 effective ablation sites with significant AF cycle length prolongation, 33 (82.5%) were judged retrospectively by CFAE map as CFAE sites.
CFAE software can visualize the spatial distribution of CFAE in AF. CFAE in persistent AF were observed in more regions of LA compared to paroxysmal AF in which CFAE concentrated on the PV. Automatically detected CFAE match well with ablation sites targeted by operators.
Journal of Cardiovascular Electrophysiology 04/2008; 19(9):897-903. · 3.06 Impact Factor
-
Heidi L Estner,
Gabriele Hessling,
Gjin Ndrepepa, Armin Luik,
Claus Schmitt,
Agathe Konietzko,
Ekrem Ucer,
JinJin Wu,
Christof Kolb,
Andreas Pflaumer,
Bernhard Zrenner,
Isabel Deisenhofer
[show abstract]
[hide abstract]
ABSTRACT: Complex fractionated atrial electrographic (CFAE) catheter ablation is a new approach for the treatment of atrial fibrillation (AF). It is unclear if acute results of this approach correspond to long-term outcome. The purpose of this study was to prospectively assess acute and long-term successes of an ablation approach combining pulmonary vein isolation (PVI) and ablation of CFAE areas for treatment of persistent AF. PVI and ablation of CFAE areas were performed in 35 patients with persistent AF (30 men, 57+/-9 years of age). At the end of the ablation procedure AF had terminated in 23 of 35 patients (66%) by conversion to sinus rhythm (8 of 23 patients, 35%) or organization to atrial tachycardia (15 of 23 patients, 65%). AF persisted in 12 of 35 patients (34%). At the end of the follow-up period (19+/-12 months), sinus rhythm was present in 26 of 35 patients (74%), including 9 patients with a repeat procedure. This group of 26 patients consisted of 7 of 8 patients (88%) with acute sinus rhythm after the first ablation, 11 of 15 patients (73%) with organization, and 8 of 12 patients (66%) with ongoing AF (p=0.32). In conclusion, a combined approach of PVI and CFAE ablation in persistent AF leads to acute AF termination in 66% and long-term maintenance of sinus rhythm in 74% of cases. However, long-term outcome was not predictable by acute results of the ablation procedure.
The American Journal of Cardiology 03/2008; 101(3):332-7. · 3.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Complex fractionated atrial electrograms (CFAE) have been described as a new target for ablation of atrial fibrillation (AF). This prospective study evaluates the acute effects of CFAE ablation in patients with paroxysmal or persistent AF and analyzes the preferential anatomic sites where these effects occur.
Ablation of CFAE was performed in 66 symptomatic patients (mean age of 58 +/- 12 years) with paroxysmal (n = 36) or persistent AF (n = 30). Termination or regularization of AF during ablation of CFAE was achieved in 56 of 66 patients (84%), with termination in 28 of 66 patients (42%) and regularization of AF in 28 of 66 patients (42%). Ablation of CFAE showed no effect in 10 of 66 patients (16%). Termination of AF occurred at 53 sites and AF regularization at 81 sites. The preferential sites of AF termination or regularization were found around the pulmonary veins (termination n = 15; regularization n = 22), at the anterior wall (termination n = 14; regularization n = 19) and at the interatrial septum (termination n = 8; regularization n = 17).
Termination or regularization of AF was achieved acutely in 84% of patients by ablation of CFAE. The preferential sites of AF termination or regularization were found around the pulmonary veins, at the anterior wall of the LA and at the interatrial septum. These findings may have implications for future ablation concepts.
Journal of Cardiovascular Electrophysiology 10/2007; 18(10):1039-46. · 3.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Mapping and catheter ablation of permanent junctional reciprocating tachycardia (PJRT) in children can be challenging. Remote magnetic navigation may improve precise mapping and catheter stability during ablation, as well as reduce fluoroscopy time, especially in conjunction with a non-fluoroscopic mapping system.
We report a case of PJRT ablation in a 7-year-old child using remote magnetic navigation.
Mapping of the right atrium (RA) and the coronary sinus (CS) and catheter ablation were performed using remote magnetic navigation in conjunction with a non-fluoroscopic mapping system (NavX). We observed excellent catheter steering abilities and constant wall contact during ablation, allowing a short and safe procedure.
Remote magnetic navigation may be used for mapping and ablation of PJRT in children.
Journal of Cardiovascular Electrophysiology 09/2007; 18(8):882-5. · 3.06 Impact Factor
-
Journal of Cardiovascular Electrophysiology 09/2007; 18(8):892-3. · 3.06 Impact Factor
-
08/2006: pages 1-33;
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to investigate the feasibility of performing segmental pulmonary vein (PV) isolation guided by the NavX (Endocardial Solutions, St Jude Medical, Inc., St Paul, MN, USA) system without the three-dimensional (3D) geometric reconstruction option and whether the use of NavX system will reduce the radiation exposure and procedure duration.
The study included 64 patients with symptomatic paroxysmal or permanent atrial fibrillation, in whom PV isolation was performed using fluoroscopic guidance (n=32) or the NavX system (n=32). Pulmonary vein mapping with a circular mapping catheter allowed the identification and localization of myocardial connections between the PV and the left atrium. PV isolation was performed by radiofrequency ablation of these connections at the atrial aspect of the PV ostium. Primary success rate for isolated PVs did not differ significantly in patients ablated under fluoroscopic guidance vs. those ablated under guidance of NavX system [100/107 PVs (93.5%) vs. 120/124 PV (96.8%; P=n.s.)]. Compared with fluoroscopy guided procedures, NavX-guided procedures showed a significant reduction in the fluoroscopy time (75.8+/-24.5 vs. 38.9+/-19.3 min, P<0.05), total X-ray exposure (93.2+/-51.6 vs. 56.6+/-37.9 Gy cm(2), P=0.03), and total procedural time (237.7+/-65.4 vs. 188.6+/-62.7 min, P=0.01). The mean follow-up was 9.5+/-3.0 months. One patient in each group was lost to follow-up. Seven-day Holter monitoring showed that 23 of 31 patients (74.2%) in the NavX-guided group and 21 of 31 patients (67.7%) in the fluoroscopy-guided group were in sinus rhythm (P=0.57).
The 3D visualization of the catheters by NavX system allows a rapid and precise visualization of the mapping and ablation catheters at the PV ostia and markedly reduces fluoroscopy time, total X-ray exposure, and procedural duration during PV isolation compared with ablation performed under fluoroscopy guidance.
Europace 08/2006; 8(8):583-7. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Atresia of the coronary sinus (CS) ostium with retrograde drainage of the cardiac veins via the persistent left superior vena cava (PLSVC) is a rare abnormality and only a few case reports in association with electrophysiological studies have been reported.
During standard electrophysiological study in three patients with a focal left atrial tachycardia, atrial fibrillation and common type right atrial flutter, the CS could not be cannulated despite several attempts. Assuming an occluded CS ostium we advanced a multipurpose catheter via the right atrium and the right superior vena cava in a PLSVC and performed CS angiography.
CS angiography showed that the CS was occluded in all 3 patients and the PLSVC was used as a drainage route to the superior vena cava. After retrograde placement of a 2.5 Fr nonsteerable diagnostic catheter via the PLSVC in the CS, the intracardiac CS electrogram was recorded. Successful ablation could be performed in all three cases.
The cases highlight the possibility that failure to access the CS during electrophysiological studies may be related to this anomaly and that retrograde cannulation via PLSVC enables the CS access and acquisition of its electrograms.
Pacing and Clinical Electrophysiology 03/2006; 29(2):171-4. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Interferon-alpha2 (IFN-alpha2) is used as standard treatment of patients with chronic hepatitis C (cHCV), but little is known about the immunomodulatory effects of this cytokine in vivo. We have studied immunologic parameters in freshly isolated peripheral blood mononuclear cells (PBMC) of 26 patients with cHCV 12 h before and 12 h after the first s.c. injection of 5-6 MU IFN-alpha2. In PBMC obtained after IFN injection, a substantial increase in IL-10 production after antigen-specific and nonspecific stimulation was observed, whereas IFN-gamma production and proliferation were significantly diminished compared with PBMC obtained before IFN injection. Patients were stratified according to single nucleotide polymorphisms (SNPs) in the interleukin-10 (IL-10) promoter, which have been associated with the response to IFN therapy. Induction of IL-10 and suppression of IFN-gamma levels were more prominent in patients with genotype CC at position -592 (n = 15) compared with patients with genotype AA/AC (n = 11). In conclusion, our data indicate that IFN-alpha2 therapy can potently enhance IL-10 and suppress IFN-gamma production of PBMC, which is, at least partially, dependent on an SNP in the IL-10 promoter. This suggests an autoregulatory role of IL-10 in IFN therapy.
Journal of Interferon & Cytokine Research 11/2004; 24(10):585-93. · 3.06 Impact Factor
-
Journal of Interferon and Cytokine Research - J INTERFERON CYTOKINE RES. 01/2004; 24(10):585-593.
