Gerhard Hindricks

University of Leipzig , Leipzig, Saxony, Germany

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Publications (364)1577.03 Total impact

  • European Heart Journal 04/2014; · 14.10 Impact Factor
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    ABSTRACT: -Recurrences of atrial fibrillation (AF) occur in up to 30% within one year after catheter ablation. This study evaluated the value of CHADS2, R2CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcomes of AF catheter ablation. -Using the Leipzig Heart Center AF Ablation Registry, we documented rhythm outcomes within the first 12 months in 2,069 patients (67% male, 60 ± 10 years, 35% persistent AF) undergoing AF catheter ablation. AF recurrences were defined as any atrial arrhythmia occurring within the first week (early recurrences, ERAF) and between 3 and 12 months (late recurrences, LRAF) after ablation. ERAF and LRAF occurred in 36% and 33%, respectively. On multivariable analysis, R2CHADS2 (OR 1.11, 95% CI 1.02-1.21, p=0.016) and CHA2DS2-VASc (OR 1.09, 95% CI 1.017-1.17, p=0.015) scores as well as persistent AF and left atrial (LA) diameter were significant predictors for ERAF. Similar, the same clinical variables remained significant predictors for LRAF even after adjustment for ERAF, which was the strongest predictor for LRAF (OR 3.12, 95% CI 2.62-3.71, p<0.001). However, using ROC curve analyses both scores demonstrated relatively low predictive value for ERAF (AUC 0.536 [0.510-0.563], p=0.007 and 0.547 [0.521-0.573], p<0.001 for R2CHADS2 and CHA2DS2-VASc respectively) and LRAF (AUC 0.548 [0.518-0.578], p=0.002 and 0.550 [0.520-0.580], p=0.001). -R2CHADS2 and CHA2DS2-VASc were associated with rhythm outcomes after catheter ablation. However, AF type, LA diameter and especially ERAF are also significant predictors for LRAF that should be included into new clinical scores for prediction of rhythm outcomes after catheter ablation.
    Circulation Arrhythmia and Electrophysiology 03/2014; · 5.95 Impact Factor
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    ABSTRACT: Background Intraoperative atrial fibrillation (AF) ablation during cardiac surgery is a well-established treatment. However, tachycardia mechanisms, ablation strategies and long-term follow-up of atrial arrhythmias (AA) following intraoperative AF ablation (AFA) have not been previously studied in a large cohort of patients. Objective Eighty-two patients (48 male, median age of 65 years) with symptomatic recurrence of AA following intraoperative AFA underwent radiofrequency catheter ablation. Methods Regular atrial tachycardias (AT) were mapped using three-dimensional color-coded entrainment/activation mapping and eliminated by linear ablation. Pulmonary Vein (PV)-isolation was achieved in patients with LA-PV conduction after AT elimination. ResultsIn 85 (83%) out of a total of 103 regular ATs, the entire reentrant circuits were localized perimitrally (n = 27), around PVs (LPV or RPV, n = 9), around left atrial appendage (LAA) (n = 1), on left-sided atrial septum (n = 8), on atrioventricular nodal area (n = 1), on the posterior wall of LA (n = 1), along roof-septum-inferoposterior wall (n = 8), at coronary sinus ostium (n = 2), upper loop in RA (n = 1) and as cavotricuspid isthmus-dependent reentrant ATs (n = 27). Sixty-five (79%) patients received PV-isolation. Non-inducibility of any AT was reached at the end of all procedures. During a median follow-up time of 18 months, 69 patients (87%) were free of AA. Conclusion Reentrant AT appears in the majority of patients with recurrence of AA following intraoperative AFA. Detailed three-dimensional color-coded entrainment mapping was successfully obtained in the majority of patients suffering from reentrant AT after intraoperative AFA, facilitated the accurate identification of the entire reentrant circuit, and selection of optimal ablation lines.This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 03/2014; · 3.48 Impact Factor
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    ABSTRACT: Recurrence of atrial fibrillation (AF) is frequently observed after AF catheter ablation. However, the predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction (LVDD) has not been well studied.METHODS AND RESULTS: In 124 consecutive patients (mean age 61 ± 10 years, 60% male) with paroxysmal (n = 70) or persistent AF (n = 54) undergoing AF catheter ablation, mitral early diastolic peak (E-wave) and late peak (A-wave) velocities, E/A ratio, deceleration time (DT) of mitral early velocity, early diastolic mitral annulus peak velocity (e'), and E/e' ratio were determined by transthoracic echocardiography. Early (ERAF) and late AF recurrence (LRAF) were monitored with 7-day Holter electrocardiograms directly after catheter ablation and after 6 and 12 months. Early AF recurrence occurred in 34% of the patients, while LRAF was observed in 27% of the patients. Patients with ERAF had higher E-wave (0.9 ± 0.2 vs. 0.8 ± 0.2 m/s, P = 0.035) and lower A-wave velocity (0.5 ± 0.2 vs. 0.6 ± 0.2 m/s, P = 0.038), higher E/A ratio (1.8 ± 0.9 vs. 1.5 ± 0.9, P = 0.089), and slower DT (214 ± 67 vs. 243 ± 68 ms, P = 0.073), while E/e', left atrial diameter, and left ventricular ejection fraction were similar. In multivariable regression analysis, the E/A ratio was the only independent predictor of ERAF (odds ratio 2.905, 95% confidence interval 1.072-7.870, P = 0.036). None of the echocardiographic parameters influenced the late therapy outcome.CONCLUSION: Early results of the catheter ablation, but not the late rhythm outcome, are influenced by an impaired mitral inflow pattern, which is associated with LVDD.
    Europace 02/2014; · 2.77 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is associated with frequent appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapies. Catheter ablation of AF has been shown to reduce AF burden and improve left ventricular function in heart failure patients but the impact on ICD therapies has not yet been studied. The aim of this study was to test the hypothesis that AF ablation reduces ICD therapies in patients with cardiomyopathies.METHODS AND RESULTS: In 73 consecutive patients (mean age 59 ± 10 years, 85% male) with previously implanted ICD due to ischaemic (n = 30) or dilated cardiomyopathy (n = 43) undergoing AF ablation, the prevalence and frequency of ICD therapies before and after AF ablation were compared. During the total follow-up of 3.3 ± 3 years prior to AF ablation, 5.1 ± 14.7 therapies per patient-year were delivered as opposed to 1.8 ± 10.9 in a period of 1.1 ± 0.9 years after ablation (P = 0.002). Prior to AF ablation, 39 patients (53%) received at least one ICD therapy when compared with 15 patients (21%) after ablation. Atrial fibrillation ablation was associated with freedom from any therapy regardless of appropriateness (odds ratio, OR, 0.366, CI 0.164-0.816, P = 0.014, adjusted for follow-up). Appropriate shocks significantly decreased from 0.3 ± 1.3 to 0.1 ± 0.5 per patient-year (P = 0.030). While heart failure medication and use of antiarrhythmic drugs were comparable during the entire follow-up, a statistically significant improvement of left ventricular ejection fraction (LVEF) from 36.9 ± 12.3% to 40.7 ± 6.7% (P = 0.008) was observed after AF ablation.CONCLUSIONS: In patients with ischaemic or dilated cardiomyopathy, catheter ablation of AF is associated with the reduction of inappropriate and appropriate ICD therapies and improvement of LVEF.
    Europace 02/2014; · 2.77 Impact Factor
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    ABSTRACT: -Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. -A systematic Medline search was used to locate academic electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high volume centers. Three cases of tamponade (1%) culminated in death. -Tamponade during AF ablation procedures is relatively rare. Women have an almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.
    Circulation Arrhythmia and Electrophysiology 02/2014; · 5.95 Impact Factor
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    ABSTRACT: Left atrial fibrosis is prominent in patients with atrial fibrillation (AF). Extensive atrial tissue fibrosis identified by delayed enhancement magnetic resonance imaging (MRI) has been associated with poor outcomes of AF catheter ablation. To characterize the feasibility of atrial tissue fibrosis estimation by delayed enhancement MRI and its association with subsequent AF ablation outcome. Multicenter, prospective, observational cohort study of patients diagnosed with paroxysmal and persistent AF (undergoing their first catheter ablation) conducted between August 2010 and August 2011 at 15 centers in the United States, Europe, and Australia. Delayed enhancement MRI images were obtained up to 30 days before ablation. Fibrosis quantification was performed at a core laboratory blinded to the participating center, ablation approach, and procedure outcome. Fibrosis blinded to the treating physicians was categorized as stage 1 (<10% of the atrial wall), 2 (≥10%-<20%), 3 (≥20%-<30%), and 4 (≥30%). Patients were followed up for recurrent arrhythmia per current guidelines using electrocardiography or ambulatory monitor recording and results were analyzed at a core laboratory. Cumulative incidence of recurrence was estimated by stage at days 325 and 475 after a 90-day blanking period (standard time allowed for arrhythmias related to ablation-induced inflammation to subside) and the risk of recurrence was estimated (adjusting for 10 demographic and clinical covariates). Atrial tissue fibrosis estimation by delayed enhancement MRI was successfully quantified in 272 of 329 enrolled patients (57 patients [17%] were excluded due to poor MRI quality). There were 260 patients who were followed up after the blanking period (mean [SD] age of 59.1 [10.7] years, 31.5% female, 64.6% with paroxysmal AF). For recurrent arrhythmia, the unadjusted overall hazard ratio per 1% increase in left atrial fibrosis was 1.06 (95% CI, 1.03-1.08; P < .001). Estimated unadjusted cumulative incidence of recurrent arrhythmia by day 325 for stage 1 fibrosis was 15.3% (95% CI, 7.6%-29.6%); stage 2, 32.6% (95% CI, 24.3%-42.9%); stage 3, 45.9% (95% CI, 35.5%-57.5%); and stage 4, 51.1% (95% CI, 32.8%-72.2%) and by day 475 was 15.3% (95% CI, 7.6%-29.6%), 35.8% (95% CI, 26.2%-47.6%), 45.9% (95% CI, 35.6%-57.5%), and 69.4% (95% CI, 48.6%-87.7%), respectively. Similar results were obtained after covariate adjustment. The addition of fibrosis to a recurrence prediction model that includes traditional clinical covariates resulted in an improved predictive accuracy with the C statistic increasing from 0.65 to 0.69 (risk difference of 0.05; 95% CI, 0.01-0.09). Among patients with AF undergoing catheter ablation, atrial tissue fibrosis estimated by delayed enhancement MRI was independently associated with likelihood of recurrent arrhythmia. The clinical implications of this association warrant further investigation.
    JAMA The Journal of the American Medical Association 02/2014; 311(5):498-506. · 29.98 Impact Factor
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    ABSTRACT: The safety and efficacy of novel oral anticoagulants in patients with atrial fibrillation undergoing pacemaker or implantable cardioverter-defibrillator interventions have not been clearly defined. Therefore, we compared the incidence of bleeding and thrombo-embolic complications following cardiac rhythm device (CRD) implantations under dabigatran vs. rivaroxaban in a real-world cohort.METHODS AND RESULTS: We analysed 176 consecutive procedures performed in 93 patients treated peri-interventionally with dabigatran and 83 patients with rivaroxaban, respectively. Post-operative bleeding complications and thrombo-embolic events occurring within 30 days were compared. There were no significant differences in baseline characteristics between patients in the dabigatran and the rivaroxaban group. Most of the patients in both the groups received dual chamber or cardiac resynchronization devices (71 vs. 78%) as opposed to single-chamber systems (29 vs. 22%). In the dabigatran group, two (2%) bleeding complications (two pocket haematomas) were observed in comparison with four (5%, three pocket haematomas and one pericardial effusion) in the rivaroxaban group (P = 0.330). Three complications in the rivaroxaban group necessitated surgical intervention as opposed to none in the dabigatran group (P = 0.064). One case of a transient ischaemic attack occurred in the dabigatran group (P = 0.343).CONCLUSION: Bleeding and thrombo-embolic complications in patients treated with dabigatran or rivaroxban are rare. Further and larger studies are warranted to define the optimal anticoagulation management in patients with a need for oral anticoagulation and CRD interventions.
    Europace 01/2014; · 2.77 Impact Factor
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    ABSTRACT: Purpose To assess if real-time magnetic resonance (MR) imaging-guided radiofrequency (RF) ablation for atrial flutter is feasible in patients. Materials and Methods The study complied with the Declaration of Helsinki and was approved by the local ethics committee. All patients were informed about the investigational nature of the procedures and provided written informed consent. Ten patients (six men; mean age ± standard deviation, 68 years ± 10) with symptomatic atrial flutter underwent isthmus ablation. In all patients, two MR imaging conditional steerable diagnostic and ablation catheters were inserted into the coronary sinus via femoral sheaths and into the right atrium with fluoroscopic guidance. The patients were then transferred to a 1.5-T whole-body MR imager for an ablation procedure, in which the catheters were manipulated by an electrophysiologist by using a commercially available interactive real-time steady-state free precession MR imaging sequence. Results All catheters were placed in standard positions successfully. Furthermore, simple programmed stimulation maneuvers were performed. In one of 10 patients, a complete conduction block was performed with MR imaging guidance. In nine of 10 patients, creating only a small number of additional touch-up lesions was necessary to complete the isthmus block with conventional fluoroscopy (median, three lesions; interquartile range, two to four lesions). Conclusion Real-time MR imaging-guided placement of multiple catheters is feasible in patients, with subsequent performance of stimulation maneuvers and occasional complete isthmus ablation. © RSNA, 2014 Online supplemental material is available for this article.
    Radiology 01/2014; · 6.34 Impact Factor
  • P Sommer, S Richter, G Hindricks, S Rolf
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    ABSTRACT: A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today's electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution.After reviewing the currently available publications in the field of MG-supported EP procedures, we describe the workflows for (1) ablation of supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia using MG-enabled diagnostic and ablation catheters, as well as (2) implant of cardiac resynchronization therapy (CRT) devices using sensor-equipped delivery tools including sheaths, sub-selectors, and guidewires.As shown in several studies [5-9], MG procedures resulted in similar efficacy as conventional cases but with a significant reduction in fluoroscopy time and dose. In particular, for SVT ablations, the median fluoroscopy time using the MG technology was 0.5 ± 1.4 min compared to 10.2 ± 9.6 min in conventional fluoroscopic settings. Similar reductions were demonstrated for AF ablation procedures from 25 min in conventional settings with electroanatomical mapping systems and live x-ray to 4.6 min with the addition of the MG technology. Recently, it was demonstrated that the application of MG for CRT device implants could successfully result in a median fluoroscopy time of 2.6 min for LV lead deployment.In summary, the first measurable clinical impact of the MG technology on a daily clinical routine is the reduction of fluoroscopy time and radiation exposure for various EP indications. These beneficial effects were achieved without negative consequences on procedural efficacy, complications, or time in more than 600 EP procedures.
    Journal of Interventional Cardiac Electrophysiology 01/2014; · 1.39 Impact Factor
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    ABSTRACT: Although rare, atrioesophageal fistula is a serious and often lethal complication of radiofrequency catheter ablation in patients with atrial fibrillation (AF). Consequently, esophagogastroduodenoscopy (EGD) after AF catheter ablation has been suggested to detect thermal esophageal lesions. To report the incidence of thermal lesions and other incidental gastrointestinal (GI) pathologies in AF patients after radiofrequency catheter ablation. 425 (mean age 59±10 years, 64 % male) consecutive patients with symptomatic AF who underwent left atrial radiofrequency catheter ablation were scheduled for upper GI endoscopy 1 - 3 days after the procedure. Patients were asymptomatic for gastrointestinal diseases, i.e. exhibiting no dysphagia, heart burn, or abdominal pain. Pathological gastrointestinal findings were observed in 328 patients (77%) and included: gastral erosions (22 %), esophageal erythema (21 %), gastroparesis (17 %), hiatal hernia (16 %), reflux esophagitis (12 %), thermal esophageal lesion (11 %) and suspected Barrett's esophagus (5 %). Biopsies were extracted in 70 patients, showing gastritis (84 %), Helicobacter pylori colonization (17 %) and mucosa-associated lymphoid tissue (17 %), esophagitis (9%), and Barrett's esophagus (4%). Further diagnostic work-up or treatment was initiated in 105 (25%) patients. Upper GI pathologies are frequently observed in asymptomatic patients. Half of all patients have a requirement for treatment. Among the findings, thermal esophageal lesions and gastroparesis can be attributed to AF catheter ablation. The high incidence of gastroparesis is a novel finding that deserves further investigation.
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2014; · 4.56 Impact Factor
  • Karl Heinz Kuck, Gerhard Hindricks
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    ABSTRACT: The Year in Cardiology 'arrhythmias' presents an update on the latest studies and innovations published in the field within the last 12 months. Recent advances in the management of atrial fibrillation and novel treatment strategies and technologies are presented. New consensus documents to improve the diagnosis and treatment of patients with inherited cardiac arrhythmias and for paediatric patients with cardiac arrhythmias are summarized. Great progress has also been made in the field of cardiac implantable electronic devices: improvements in implantation techniques and novel technologies have been introduced and successfully applied. In addition, novel data on prevention of implantable cardioverter defibrillator-shocks and cardiac resynchronization therapy will certainly help to improve the quality of care for patients with cardiac arrhythmias and heart failure.
    European Heart Journal 01/2014; · 14.10 Impact Factor
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    ABSTRACT: Background It is suggested that adenosine resistance of retrograde fast pathway in slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) confirms the participation of a concealed retrograde atriohisian pathway, rather than conventional fast pathway in the arrhythmia circuit of slow-fast AVNRT. Objective We prospectively assessed the retrograde fast pathway response to the intravenous administration of adenosine in patients with typical AVNRT and the control group. Methods Electrophysiologic parameters and adenosine sensitivity of retrograde fast pathway were studied in 21 consecutive patients (18 women, age 57±10 years) with slow–fast AVNRT and 24 patients (11 women; age 46±16 years) as control group. Results Fifteen patients (71%) with AVNRT and 18 patients in control group (75%) developed transient VA block after intravenous administration of adenosine (P=0.79). Among patients with slow-fast AVNRT female gender (P=0.003), longer VA interval during right ventricular pacing (P<0.001), and longer tachycardia’s cycle length (P<0.001) predicted transient VA block after intravenous administration of adenosine. Among patients in control group shorter VA interval during fixed rate right ventricular apical pacing (P=0.009) and presence of dual AV nodal physiology (P=0.002) were associated with adenosine resistance of retrograde fast pathway. Conclusion The prevalence of adenosine resistance of retrograde fast pathway’s conduction is comparable between patients with and without slow-fast AVNRT. This finding can be explained better by the existence of an insulated intra nodal tract with Purkinje-like properties or a superior atrionodal connection to the nodo-hisian region of the AV node, rather than presence of an atriohisian pathway.
    Heart rhythm: the official journal of the Heart Rhythm Society 01/2014; · 4.56 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LV-EF), but long-term outcomes are still unknown. We aimed to assess the long-term effects of AF ablation in patients with systolic heart failure according to rhythm outcome. We included 69 patients with LV-EF≤40%, referred for circumferential pulmonary vein isolation with or without additional substrate modification to our institution in 2006-2010. Follow-up included 7-day Holter-ECG and echocardiography at baseline and at 6, 12 and 24 months after ablation. A matched control group (n=69) post-AF ablation without heart failure was used for comparison. After 28±11 months and 1.6±0.7 ablation procedures, 45(65%) patients were still in stable sinus rhythm (SSR group). EF increased from 33±6% to 53±11% (p<0.001) in the SSR group, and from 33±5% to 38±12% (p=0.03) in patients with recurrences (ATF group). While LV-EF increase was similar in the two groups at 6 months (15±12% vs. 8±11%, p=0.2), further LV-EF improvements were observed in the SSR group only. Adjustments for baseline characteristics revealed that the increase in LV-EF at 6 months was associated with higher baseline heart rate and not with rhythm outcome. Heart rate did not change in either group after 6 months of follow-up. Complications and procedural data of the study group were similar to the control group. In heart failure patients undergoing AF ablation, there is an initial short-term LV-EF improvement related to baseline heart rate. However, long-term LV-EF improvement is associated with rhythm outcome.
    Heart rhythm: the official journal of the Heart Rhythm Society 12/2013; · 4.56 Impact Factor
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    Gerhard Hindricks, Douglas L Packer
    European Heart Journal 12/2013; · 14.10 Impact Factor
  • European Heart Journal 11/2013; · 14.10 Impact Factor
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    ABSTRACT: Data on the outcomes of ventricular tachycardia (VT) ablation in non-ischemic dilated cardiomyopathy (NIDCM) are insufficient. The HEART CENTRE OF LEIPZIG VT (HELP-VT) STUDY WAS PROSPECTIVELY CONDUCTED TO COMPARE OUTCOMES AFTER RADIOFREQUENCY CATHETER ABLATION (RFCA) OF VT IN PATIENTS WITH NIDCM AS COMPARED TO ISCHEMIC CARDIOMYOPATHY (ICM). Two hundred and twenty-seven (227) patients with NIDCM (63 pts.) and ICM (164 pts.), presenting with sustained VT were ablated using RFCA. Non-inducibility of any clinical and non-clinical VT was achieved in 66.7% in NIDCM and in 77.4% in ICM. Ablation of the clinical VT only was achieved in 18.3% in ICM and in 22.2% in DCM. There was no statistically significant difference in the acute outcome between the two groups. At one year follow-up, the VT free survival in NIDCM was 40.5% versus 57% in ICM. In univariate analysis, the hazard ratio for VT recurrence was significantly higher for the NIDCM (HR 1.62; CI 95% 1.12- 2.34; p = 0.01). In both ICM and NIDCM subgroups, the procedure failure and incomplete procedural success were independent predictors for VT recurrence. Even though the acute success after VT ablation in NIDCM and ICM was similar, the long-term outcomes in NIDCM were significantly worse. Complete VT non-inducibility at the end of the ablation associates with beneficial long-term outcome in NIDCM. Pursuing compete elimination of all inducible VTs is desirable and may improve the long-term success in NIDCM.
    Circulation 11/2013; · 15.20 Impact Factor
  • K Bode, P Sommer, A Bollmann, G Hindricks
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    ABSTRACT: In western countries one in ten of elderly persons (> 65 years old) will develop atrial fibrillation. The main goal in atrial fibrillation therapy is the prophylaxis of thromboembolic complications through anticoagulation according to the individual risk profile (CHA2DS2-Vasc score) of patients and treatment of cardiovascular comorbidities. Symptoms during atrial fibrillation guide the further therapeutic concept. Doctors can deploy a rate control strategy with a heart rate at rest less than 110/min and/or a rhythm control strategy with cardioversion, antiarrhythmic drugs and catheter ablation to alleviate complaints. To what extent maintaining the sinus rhythm improves the prognosis of atrial fibrillation patients is part of ongoing trials.
    Herz 09/2013; · 0.78 Impact Factor
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    ABSTRACT: -There are limited data on the predictive value of stroke risk scores for thromboembolic events (TE) after catheter ablation of atrial fibrillation (AF). Our objectives were to report the incidence of TE after AF ablation in a large contemporary AF ablation cohort. -Using the Leipzig Heart Center AF Ablation Registry, we documented TE in patients undergoing radiofrequency AF catheter ablation. TE was defined as stroke, transient ischaemic attack (TIA) or systemic embolism. Study population (n=2,069, 66% male, 60±10 years; 62% paroxysmal AF; mean CHADS2 1.2 ± 0.9, CHA2DS2-VASc 2.1 ± 1.4 and R2CHADS2 1.3 ± 1.1) were followed-up for a median 18 [Q1-to-Q3 12-29] months (i.e. 3.078 patient-years). Overall 31 TE occurred, with 16 events within 30 days of ablation and 15 TE (0.72%) during the follow-up period. On multivariate analysis, CHADS2 (p<0.001), R2CHADS2 (p<0.001), CHA2DS2-VASc (p=0.003) scores were independent predictors of TE during follow-up and AF recurrence conferred a non-significant trend for increased TE risk (p=0.071 - 0.094). The CHA2DS2-VASc score further differentiated TE risk in patients with CHADS2 and R2CHADS2 0-1 (0.13% if CHA2DS2-VASc was 0-1 and 0.71% if CHA2DS2-VASc was >2) and had the best predictive value in patients with AF recurrences (c-index 0.894, p=0.022 vs CHADS2, p=0.031 vs R2CHADS2). -CHADS2, CHA2DS2-VASc, R2CHADS2 scores were associated with TE risk. The CHA2DS2-VASc score differentiated TE risk in the "low" risk strata based on CHADS2 and R2CHADS2 scores, and may be superior in the subgroup with AF recurrences.
    Circulation Arrhythmia and Electrophysiology 09/2013; · 5.95 Impact Factor
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    ABSTRACT: -Cardiac resynchronization therapy (CRT) device implantation can be challenging, time consuming, and fluoroscopy intense. To facilitate left ventricular (LV) lead placement, a novel sensor-based electromagnetic tracking system [MediGuide (MGT), St. Jude Medical] has been developed. We report the results of the First Human Use (FHU) study evaluating the feasibility, safety, and performance of a novel CRT implantation approach using electromagnetic trackable operation equipment. -Fifteen consecutive patients (66±8 years, 53% male) with an established indication for CRT were implanted using the new tracking technology. Demographics, anatomical information, detailed fluoroscopy need, procedure time, and adverse events were collected. Patients were followed for 4 weeks after implantation. The CRT system was successfully implanted with a lateral or posterolateral LV lead position in all patients. The total procedure time was 116±43 minutes, the median total fluoroscopy time (skin to skin) 5.2 (Q1-Q3 3.0 - 8.4) minutes, and the median fluoroscopy time for LV lead deployment (CS cannulation to withdrawal of CS sheath) measured 2.6 (Q1-Q3 1.6 - 5.6) minutes. There were no severe complications that required an acute intervention or re-operation during the peri- and postoperative period. -Use of the MGT tracking technology allows for safe and successful CRT implantation with the potential for reduced fluoroscopy time. Future randomized studies are needed to validate these data. Clinical Trial Registration Information-ClinicalTrials.gov; Identifier: NCT01519739.
    Circulation Arrhythmia and Electrophysiology 09/2013; · 5.95 Impact Factor

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4k Citations
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Institutions

  • 1970–2014
    • University of Leipzig
      • • Department of Cardiac Surgery
      • • Klinik und Poliklinik für Kinderchirurgie
      Leipzig, Saxony, Germany
  • 2013
    • Technische Universität Dresden
      Dresden, Saxony, Germany
  • 2006–2013
    • Attikon University Hospital
      • Department of Cardiology
      Athens, Attiki, Greece
    • Handelshochschule Leipzig
      Leipzig, Saxony, Germany
  • 2003–2013
    • Kunststoff-Zentrum in Leipzig
      Leipzig, Saxony, Germany
  • 2012
    • Mount Sinai School of Medicine
      Manhattan, New York, United States
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Cardiovascular Center Bethanien
      Frankfurt, Hesse, Germany
  • 2010
    • St. David's North Austin Medical Center
      Austin, Texas, United States
  • 2008
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 1987–2008
    • Universitätsklinikum Münster
      • Department für Kardiologie und Angiologie
      Münster, North Rhine-Westphalia, Germany
  • 1988–2007
    • University of Münster
      • • Department of Cardiology
      • • Faculty of Medicine
      Münster, North Rhine-Westphalia, Germany
  • 1994
    • Medical University of Gdansk
      • Department of Cardiology II
      Gdańsk, Pomeranian Voivodeship, Poland