Publications (17)85.4 Total impact
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Article: Hypertrophic cardiomyopathy.
The Lancet 04/2013; 381(9876):1456. · 38.28 Impact Factor -
Article: Alcohol septal ablation for recurrent left ventricular outflow tract obstruction after combined myectomy and mitral valve repair in hypertrophic cardiomyopathy.
International journal of cardiology 04/2013; · 7.08 Impact Factor -
Article: A decade of percutaneous septal ablation in hypertrophic cardiomyopathy.
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ABSTRACT: Percutaneous septal ablation has emerged as a less invasive treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). In the past decade, the availability of this sophisticated technique has revived the interest of cardiologists in left ventricular outflow tract obstruction, which led to the recognition that most patients with HCM have the obstructive type. Follow-up studies have already shown the safety and efficacy of the procedure, which offers symptomatic relief in most patients. Long-term survival is comparable to historical reports after surgical myectomy. Complications are rare and can be further reduced with increased experience of the operators, and the theoretical concern for possible ventricular arrhythmogenicity of the myocardial scar has not been documented by the existing data. Although there are still no randomized trials, percutaneous septal ablation is undeniably a viable alternative for patients with HOCM.Circulation Journal 12/2010; 75(1):28-37. · 3.77 Impact Factor -
Article: Optimal branch selection in alcohol septal ablation.
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ABSTRACT: Alcohol septal ablation is an emerging technique for the reduction of the subaortic gradient in hypertrophic obstructive cardiomyopathy. The selection of the branch to be ablated is not always obvious, however, and the use of Myocardial Contrast Echocardiography assists in the proper localization of the perfusion area of each branch. We present a case of alcohol septal ablation in a 78-year old woman, in whom the choice of the optimal branch for septal ablation was performed after careful evaluation of the echocardiographic images, in accordance with the angiographic appearance. Alcohol septal ablation was performed without complications and resulted in reduction of the subaortic gradient and improvement of the patient's functional capacity.International journal of cardiology 11/2009; 147(1):143-4. · 7.08 Impact Factor -
Article: Hypertrophic cardiomyopathy as a cause of sudden death.
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ABSTRACT: Hypertrophic cardiomyopathy (HCM) is the main cause of sudden unexpected death in the young and especially in young athletes with an incidence up to 2.3 per 100,000 athletes and year. Risk stratification models including patient history (syncope, familial risk of sudden death) and findings in noninvasive tests (nonsustained ventricular tachycardia, abnormal blood pressure response during exercise, maximum left ventricular wall thickness > or = 30 mm) have been developed in order to estimate the risk of individual patients. Echocardiographic parameters are helpful in distinguishing HCM from athlete's heart. Definitive diagnosis of HCM implicates disqualification from competitive sports resulting in a significant reduction of sudden cardiac death due to HCM during sports competition. This positive development should lead to a widespread preparticipation screening of athletes including historical, clinical, and electrocardiographic examination. At least in borderline findings and symptomatic athletes, an additional echocardiogram should be performed in order to minimize or better exclude the risk of sudden cardiac death.Herz 07/2009; 34(4):305-14. · 0.92 Impact Factor -
Article: Percutaneous septal ablation after unsuccessful surgical myectomy for patients with hypertrophic obstructive cardiomyopathy.
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ABSTRACT: To evaluate the long-term outcome of percutaneous septal ablation (PTSMA) after a previous myectomy. Myectomy usually results in symptomatic improvement and reduction of dynamic obstruction in hypertrophic obstructive cardiomyopathy patients (HOCM-pts.). However, a few pts. remain with severe symptoms and obstruction, and need additional interventions. We reviewed our database of 450 pts. who underwent PTSMA in our institution, and identified 11 (7 women, 4 men, mean age: 50 +/- 14 years) with residual or recurrent NYHA class symptoms > or =III and significant left ventricular outflow obstruction (LVOTO) despite a previous myectomy 4 +/- 5 years ago. In-hospital and follow-up data covering 6 +/- 4 years, focusing on mortality and morbidity, symptoms, exercise capacity, and echocardiographic measures were collected. PTSMA was performed by injection of 3.6 +/- 2.9 ml of alcohol. There was no peri-procedural or late death in this cohort. CK peaked at 614 +/- 434 U/l. In addition to two pts. who already had a pacemaker implanted, two more (18%) who both had pre-existing left bundle branch block were pacemaker-dependent after PTSMA. During follow-up, 9 pts. (81%) reported significant and stable improvement. Two pts. (18%) developed progressive class III symptoms until their last follow-up, one of these together with persistent AF and a non-fatal stroke, the other received an ICD for primary prophylaxis and entered our pre-transplant program. Echo-Doppler showed sustained LVOTO elimination without global LV dilatation in all cases. PTSMA is an effective non-surgical option for treating symptoms and residual or recurrent LVOTO after a previous surgical myectomy. The high rate of conduction disturbances in this post-surgical cohort translated into a higher rate of pacemaker dependency after PTSMA.Clinical Research in Cardiology 09/2008; 97(12):899-904. · 2.95 Impact Factor -
Chapter: Alcohol Septal Ablation
10/2007: pages 259 - 278; , ISBN: 9780470987469 -
Article: Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: managing the risk of procedure-related AV conduction disturbances.
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ABSTRACT: To provide tools for predicting the course of AV conduction disturbances after ethanol-induced septal ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM). Based on a scoring system developed 1996-1998 and including parameters from baseline ECG, heart rate profile, severity of outflow obstruction (LVOTO), peri-interventional enzyme kinetics, and peri-interventional conduction problems, the risk of permanent AV block following PTSMA was assessed in 155 consecutive HOCM patients (pts.; mean age: 53+/-13 years) between 1999 and 2004. During PTSMA with 2.1+/-0.5 ml of ethanol, transient complete AV block occurred in 71 pts. (46%). Pts. were grouped into a low, intermediate, and high risk group for permanent conduction damage, and treated accordingly (early discharge from monitoring, prolonged monitoring, early DDD-PM implantation). Permanent pacing was necessary in 11 cases (7%), 0/116 of these (0%) in the low, 4/31 (13%) in the intermediate, and 7/8 (87%) in the high-risk group. While a new right bundle branch block was the most frequent ECG finding after PTSMA, a left bundle branch block at baseline was associated with 4 of the 11 DDD-PM implantations (p<0.0001). In-hospital mortality was 0%, short-term (3-months) follow up was complete. During follow-up, AV conduction recovered in 4 pts. (46%) with a DDD-PM. New onset AV blocks did not occur. Significant improvement of symptoms was reported by 141 pts. (91%). Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. The proposed scoring system appears to reliably discriminate pts. with a high risk for permanent PM dependency from those with stable AV conduction after PTSMA. Pts. with left bundle branch block at baseline should undergo DDD-PM implantation prior to ablation.International journal of cardiology 08/2007; 119(2):163-7. · 7.08 Impact Factor -
Article: Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: collateral vessel communication between septal branches.
International journal of cardiology 12/2006; 113(2):e67-9. · 7.08 Impact Factor -
Article: Echo-guided percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: 7 years of experience.
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ABSTRACT: To analyze the impact of intra-procedural echocardiographic imaging on the interventional strategy in ethanol-induced septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM), based on a single-center experience of 7 years. PTSMA was intended for refractory symptoms in 337 patients (pts.) with HOCM (mean age: 54 +/- 15 years), with 312 procedures completed by injection of 2.8 +/- 1.2 ml ethanol. In 25 pts. (8%) the intervention was aborted without ethanol injection, mostly because of echocardiographic findings (n = 18/6%). An echocardiography-driven target vessel change was necessary in 33 pts. (11%). In the 312 pts. who received ethanol, permanent pacing was necessary in 22 cases (7%). In-hospital mortality was 1.3% (4 pts.). After 3 months, mean NYHA functional class was reduced from 2.9 +/- 0.5 to 1.5 +/- 0.6 (p < 0.0001) along with a gradient reduction from 60 +/- 33 to 13 +/- 18 mmHg at rest, and from 120 +/- 43 to 38 +/- 35 mmHg with provocation (p < 0.0001 each). Exercise capacity improved from 94 +/- 51 to 115 +/- 43 W, peak oxygen consumption from 18 +/- 4 to 21 +/- 6 ml/kg/min (p < 0.01 each). There was no significant difference regarding residual gradients in pts. with different levels of immediate gradient reduction during probatory balloon occlusion. Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. Intra-procedural echocardiographic guidance has a cumulative impact on the interventional strategy in about 15-20%, and clearly identifies pts. who should not receive ethanol but undergo a surgical myectomy.European Heart Journal – Cardiovascular Imaging 11/2004; 5(5):347-55. · 2.32 Impact Factor -
Article: [Septal ablation in hypertrophic cardiomyopathy: current status].
Revista Espa de Cardiologia 01/2004; 56(12):1153-9. · 2.53 Impact Factor -
Article: Management of hypertrophic cardiomyopathy in children.
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ABSTRACT: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease characterized by unexplained left ventricular hypertrophy, typically involving the interventricular septum. Hypertrophy may be present in infants, but commonly develops during childhood and adolescence. Management of children with HCM aims to provide symptomatic relief and prevention of sudden death, which is the primary cause of death. Unfortunately, no randomized comparative trials to date have assessed different treatment options in HCM. Medical treatment with negative inotropic agents (beta-adrenoceptor antagonists [beta-blockers], verapamil) is the first therapeutic choice in all symptomatic patients. Beta-blockers also appear to have prognostic merit in children. Surgical myectomy is effective in reducing symptoms in children with left ventricular (LV) obstruction who are unresponsive to medical treatment, although a repeat operation may be needed in a substantial proportion of patients due to relapse of LV obstruction. The recently introduced percutaneous septal ablation can also be regarded as a feasible alternative in this cohort. Technical limitations of both invasive therapeutic options should be carefully considered, preferably in experienced centers. Results of recent randomized trials indicate that dual chamber pacing, once considered a therapeutic option for patients with HCM, should only be used as treatment for conduction abnormalities. Regular clinical risk stratification for sudden death is of vital importance for the prevention of sudden death in young patients. Familial history of sudden death at a young age, LV hypertrophy >3 cm, unexplained syncope, nonsustained ventricular tachycardia in Holter monitoring, and abnormal blood pressure response during exercise are currently considered clinical risk factors for sudden death. Each factor has a low positive predictive accuracy, but patients having two or more of these risk factors are deemed as high risk. Secondary prevention of sudden death in patients successfully resuscitated from cardiac arrest and/or sustained ventricular tachycardia warrants treatment with an implantable cardioverter defibrillator (ICD). Primary prevention of sudden death in patients considered to be at high risk should aim at the management of obvious arrhythmogenic mechanisms (paroxysmal atrial fibrillation, sustained monomorphic ventricular tachycardia, conduction system disease, accessory pathway, myocardial ischemia), and the prevention and/or management of ventricular tachyarrhythmias with amiodarone and/or ICD implantation, respectively. The choice of treatment in children is greatly influenced by technical aspects, such as adverse effects of amiodarone, and ICD implantation difficulties or complications. Amiodarone could also be used as a bridge in children at high risk, until they reach adulthood, possibly achieving a lower risk status, or until their physical growth permits ICD implantation as long-term therapy.Paediatric Drugs 01/2003; 5(10):663-72. · 1.79 Impact Factor -
Article: Echocardiography-Guided Percutaneous Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: One Year Follow-Up
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ABSTRACT: Introduction: Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion has been introduced as a new treatment option in symptomatic patients with hyper-trophic obstructive cardiomyopathy. Echocardiographic monitoring of the procedure with injection of echo-contrast agent in the balloon-occluded target septal branch through the central lumen of the balloon catheter has resulted in improvement of acute results. We report on the late results after 1-year follow-up. Methods: One hundred consecutive symptomatic (NYHA class 2.8±0.6) patients underwent percuta-neous septal ablation with echocardiographic monitoring. Two of the patients had prior surgical myecto-my, 5 had prior DDD pacemaker implantation and 2 had non-echo-guided septal ablation, all of which were haemodynamically and clinically unsuccessful. Three patients with LAD lesions underwent PTSMA and PTCA in one session. An additional 3 patients underwent PTCA of an RCA lesion and PTSMA after 6 months due to ongoing symptoms, despite a good angioplasty follow-up result. All patients had clinical and non-invasive (echocardiography, exercise stress test) follow-up after 3 months and 1 year. Results: The intervention was performed in 1 septal branch in each of the 100 patients by injection of 3.2±0.7 ml alcohol. In 3 patients we had to change the branch after echocardiography had shown mis-placement of echo-contrast. In an additional 5 patients, septal branches originating atypically from a diago-nal branch could be identified as target vessels. Acute reduction of the left ventricular outflow tract gradient was achieved in 99 patients from 76±37 to 19±21 mm Hg at rest, from 104±34 to 43±31 mm Hg during Valsalva manoeuvre, and from 146±45 to 59±42 mm Hg post extrasystole (p<0.0001 for each). Mean CK increase was 570±236 U/l. One patient died at day 2 due to massive pulmonary embolism following deep venous thrombosis. Permanent DDD pacing due to post-interventional complete atrioventricular block was required in 8 patients. No other patient died during follow-up. All 99 living patients showed clinical im-provement in NYHA class: 1.4±0.6 after 3 months and 1.5±0.6 after 1 year (p<0.0001, each versus baseline). Exercise capacity also improved from 90±49 W before the procedure to 114±42 W at 3 months and 121±37 W at 1 year (p<0.0001, each versus baseline). Twenty-two out of 23 patients with an abnor-mal exercise blood pressure response before PTSMA showed normalisation of this finding after 1 year, while only 1 of 31 patients with exercise-induced syncope before PTSMA reported this symptom during the one-year follow-up period. Echocardiography revealed thinning of the ablated septal area, similar to the post myectomy result. No septal perforations were observed. Significant reduction of the left ventricular posterior wall thickness was also identified after 3 months (from 13.9±2.5mm to 12.8±2.0mm, p<0.0001) with ongoing significant decrease after 1 year (12.0±1.8mm, p<0.0001 versus baseline and 3 months). Left ventricular end-diastolic dimensions showed only a slight increase from 45.6±5.5mm to 46.6±5.5mm at 3 months (p<0.05) with no further significant increase at 1 year, whereas left atrial dimension decreased significantly. Furthermore, Doppler-estimated mitral regurgitation as well as the grade of SAM significantly decreased (p<0.0001 versus baseline, at both 3 months and 1 year). Conclusion: Percutaneous septal ablation is an effective treatment of symptomatic patients with hyper-trophic obstructive cardiomyopathy. Left ventricular remodelling after the alcohol induced therapeutic sep-tal infarction resulted in improvement of acute gradient, reduction during one-year follow-up with ongoing symptomatic and objective improvement and without significant complications and side effects. H ypertrophic obstructive cardiomyopathy (HOCM) is defined as a primary, frequently familial and genetically determined condi-tion characterized by myocardial hypertrophy and dynamic left ventricular outflow tract obstruction 1-3 . It is also accompanied by diastolic dysfunction of varying degree. In addition to hypertrophy of the ventricular myocardium, primarily the interventricu-lar septum, morphologic changes of the papillary muscles and mitral valve leaflets may also be ob-served, imposing different treatment options 2-4 . Surgical myotomy/myectomy has traditionally been the treatment of choice for drug-refractory sy-mptomatic patients with outflow tract obstruction 5-8 . The high postoperative mortality of up to 10% has been reduced to <1-2% in experienced centres. Re-cently, the potential therapeutic options for sympto-matic patients have been dramatically changed by the introduction of dual-chamber pacemaker im-plantation 9-11 and percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion 12-18 . We report on the acute and 1 year follow-up results of echocardiography-guided septal ablation 19 , which has been established as the standard technique of PTSMA.Hellenic Journal of Cardiology Hellenic J Cardiol. 01/2003; 44:171-179. -
Article: Vorhersage des Risikos permanenter atrioventrikulärer Überleitungsstörungen nach perkutaner Septumablation bei Patienten mit hypertropher obstruktiver Kardiomyopathie
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ABSTRACT: Summary. Background and introduction: Damage to the AV conduction system is a frequent complication of percutaneous septal ablation (PTSMA) that needs early and reliable identification of those patients (pts.) at risk for complete heart block (CHB) and subsequent pacemaker implantation. Methods and results: In the first 39 pts. who underwent PTSMA in 1996, AV conduction recovery needed up to 11 days. One pt. suffered from unexpected CHB after 9 days. Seven pts. who needed a DDD pacemaker (DDD-PM) were compared to those without conduction disturbances. A score was established which identified all DDD-PM candidates retrospectively if they presented with >12 score points. In the following 137 consecutive pts. treated in 1997 and 1998, this score was applied prospectively, and again correctly identified all candidates for a DDD-PM. In addition, a low risk group was identified with <8 score points. From 1999 on, the score was applied in routine clinical decision-making in 120 consecutive pts. with respect to DDD-PM implantation. All low risk pts. (<8 points) remained free from bradycardias, while 2/54 pts. (4%) of the intermediate risk group, and 20/23 pts. (87%) of the high risk group had to undergo DDD-PM implantation. Pts. with a first-degree AV block or those with a right bundle branch block at baseline had no excess risk, while 50% of the pts. with a left bundle branch block (LBBB) needed a DDD-PM. Conclusions: Based on pre-interventional data and careful monitoring of the first 48 hours after PTSMA, identification of pts. at risk for CHB and subsequent DDD-PM implantation seems to be possible. Pts. with a score <8 seem to be at low, those with >12 points at high risk. In the remaining cases watchful waiting with prolonged monitoring may allow AV conduction to recover, thus, reducing the number of unnecessary DDD-PM implantations. In cases with LBBB at baseline, however, implantation of a DDD-PM should be considered first-line therapy. Zusammenfassung. Einleitung: Hhergradige AV-berleitungsstrungen (AVB) stellen eine hufige Komplikation der perkutanen Septumablation (PTSMA) dar und erfordern eine frhzeitige und verlssliche Identifikation derjenigen Patienten (Pat.), die einen permanenten DDD-Schrittmacher (DDD-SM) bentigen. Methoden und Ergebnisse: Wir beobachteten den Spontanverlauf des AVB bei den ersten 39 im Jahr 1996 mittels PTSMA behandelten Pat., ausgenommen 6 Pat. mit bereits implantiertem DDD-SM bzw. vorbestehenden Erregungsleitungsstrungen, wobei die stabile Erholung einer gestrten berleitung maximal 11 Tage bentigte. Sieben der verbleibenden 33 Pat. erhielten einen DDD-SM. Der Vergleich dieser Pat. mit denen ohne AVB resultierte in einem Scoresystem, welches mit >12 Punkten retrospektiv alle DDD-SM-Kandidaten identifizierte. Bei den 137 nachfolgenden Pat. der Jahrgnge 1997 und 1998 wurde dieser Score prospektiv angewendet und klassifizierte ebenfalls alle weiteren DDD-SM-Kandidaten korrekt. Darber hinaus konnte eine Gruppe niedrigen Risikos mit <8 Score-Punkten ermittelt werden. Ab dem Jahr 1999 an erfolgte die Anwendung des Score-Systems bei 120 konsekutiven Pat. in der klinischen Routine. In der Niedrig-Risikogruppe (<8 Punkte) blieben smtliche Pat. ereignisfrei. Ein DDD-SM war bei 2/52 (4%) der Gruppe mit mittlerem Risiko, und bei 20/23 (87%) der Hochrisikogruppe erforderlich. Ein AV-Block Grad I oder ein Rechtsschenkelblock im Ausgangs-EKG vor PTSMA erhhte die Wahrscheinlichkeit einer DDD-SM-Implantation nicht, whrend Pat. mit Linksschenkelblock (LSB) eine Schrittmacher-Quote von 50% aufwiesen. Schlussfolgerung: Basierend auf der Kombination printerventioneller Daten mit einer sorgfltigen berwachung der ersten 48 h nach PTSMA erscheint die zuverlssige Identifikation von DDD-SM-Kandidaten mglich. Patienten mit <8 Punkten des vorgestellten Score haben ein uerst geringes, solche mit >12 Punkten ein sehr hohes Risiko fr einen permanenten AVB. In den verbleibenden Fllen kann unter prolongiertem Monitoring die Erholung der AV-berleitung abgewartet und so die Zahl langfristig unntiger DDD-SM-Implantationen verringert werden. Bei Pat. mit LSB erscheint die primre Versorgung mit einem DDD-SM sinnvoll.Zeitschrift für Kardiologie 12/2002; 92(1):39-47. · 0.97 Impact Factor -
Article: Medical therapy versus interventional therapy in hypertropic obstructive cardiomyopathy.
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ABSTRACT: Medical treatment in symptomatic patients with hypertrophic obstructive cardiomyopathy aims to reduce the outflow tract gradients, and to improve diastolic dysfunction and rhythm disorders. Surgical myectomy is the standard treatment in patients with drug refractory symptoms. Since the early 1990s, dual-chamber (DDD)-pacemaker implantation and percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion have widened treatment options in this subgroup of patients. An overview of medical and interventional treatment is presented.Current controlled trials in cardiovascular medicine 02/2000; 1(2):115-119. · 2.33 Impact Factor -
Article: Alcohol septal ablation in hypertrophic obstructive cardiomyopathy.
Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 50(6):511-22. · 1.23 Impact Factor -
Article: Ablación septal en la miocardiopatía hipertrófica: situación actual
Revista española de cardiología, ISSN 0300-8932, Vol. 56, Nº. 12, 2003, pags. 1153-1159.
Top co-authors
Top Journals
Institutions
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2009
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Hippokration General Hospital, Athens
Athens, Attiki, Greece
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2003–2008
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Ruhr-Universität Bochum
Bochum, North Rhine-Westphalia, Germany
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2007
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Minneapolis Heart Institute
Minneapolis, MN, USA
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