Thomas Kleemann

Klinikum Ludwigshafen, Ludwigshafen, Rheinland-Pfalz, Germany

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Publications (27)124.97 Total impact

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    ABSTRACT: Outcome data of patients with implantable cardioverter defibrillators (ICD) and atrial fibrillation (AF) are conflicting. The German DEVICE registry aims to add further information on this particular cohort. The German DEVICE registry is a nationwide prospective multicenter database of ICD implantations. 3261 patients are included (81% males, 2701 (82.8%) first ICD implantations, 560 (17.2%) ICD replacements). Cardiac resynchronization therapy (CRT-D) was performed in 882 patients (27.0%). Sinus rhythm (SR) was present in 2654 (81.4%) and atrial fibrillation (AF) in 607 (18.6%). Left ventricular ejection fraction (LVEF) did not differ between groups (SR 32.3%, AF 30.4%; p=0.09). AF patients were older (AF 70.9 versus SR 63.9years; p<0.0001), presented with more co-morbidities (diabetes, hypertension, chronic kidney disease; all p<0.001). In-hospital complications were not significantly different between groups (p=0.58). Follow-up information after one year was available in 2967 patients (91%). One-year overall mortality after first ICD implantation was 4.9% for SR and 11.2% for AF patients (p<0.0001); mortality one year after ICD replacement was 8.4% for SR and 12.0% for AF (p=0.34). No statistically significant difference between SR and AF patients receiving a CRT device was observed (SR 6.9%, AF 10.7%, p=0.16) in terms of one-year mortality. The German DEVICE registry demonstrates that patients with AF who receive ICD devices are older, have more co-morbidity and more severe heart failure. AF carries an independent 1.39 fold risk (95% CI 1.02-1.89) of death after one year in patients only with first ICD implantation.
    International journal of cardiology 08/2013; · 6.18 Impact Factor
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    ABSTRACT: The wearable cardioverter-defibrillator (WCD) is indicated in patients who are considered to be at temporarily high risk for sudden cardiac death (SCD), when an implantable defibrillator is not yet clearly indicated.We report the case of a 41-year-old patient with a newly diagnosed severely reduced left ventricular (LV) function for suspected myocarditis and repeated nonsustained ventricular tachycardia (VT). This patient was supplied with a WCD who came back to the hospital 4 weeks after discharge with an electrical storm and adequate discharge of the WCD. After application of amiodarone, no further arrhythmias were detected during intrahospital course.For further risk stratification, we performed a magnetic field imaging (MFI), that was reported to be useful in risk assessment of SCD in patients with ischemic cardiomyopathy. This measurement showed a normal result, but we decided to give an implantable cardioverter-defibrillator (ICD) to the patient. During a follow-up of 1 year, no further arrhythmias occurred.With this case, we report the efficacy of a WCD, which is a novel tool in patients at temporarily high risk of SCD and we report a novel method of risk stratification in patients with a high risk of SCD.
    Herzschrittmachertherapie & Elektrophysiologie 05/2013;
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    ABSTRACT: BACKGROUND: Magnet field imaging (MFI) is a noninvasive method to determine cardiac electromagnetic activity. AIM OF THE STUDY: This study aims to compare the electromagnetic QRS fragmentation index (eQFI) in survivors of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) to healthy individuals. METHODS: Twenty-five consecutive patients with documented sustained VT or VF who underwent a MFI investigation between December 2009 and October 2011 were compared with 25 age- and sex-matched healthy individuals. RESULTS: Patients with documented VT or VF showed a trend to higher eQFI values compared with the control group (p = 0.06). This increase was mainly driven by VT/VF patients with ischemic cardiomyopathy (CMP) which was markedly elevated compared with the healthy controls (1.48 vs. 1.07; p = 0.01). In patients with nonischemic CMP or acute coronary syndrome, eQFI was not different from the healthy group. CONCLUSIONS: Electromagnetic QRS fragmentation is increased in VT/VF patients with ischemic CMP but not in patients with ventricular arrhythmias of other origin. Further investigations in prospective cohorts should evaluate the prognostic value of electromagnetic QRS fragmentation in patients with ischemic heart disease to predict the occurrence of VT/VF and to guide therapy.
    Journal of Interventional Cardiac Electrophysiology 11/2012; · 1.39 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population-based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF-associated stroke. METHODS: Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population-based stroke register, we analyzed all patients with a first-ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007. We determined whether AF was diagnosed before stroke and assessed pre-stroke CHADS(2) and CHA(2) DS(2) -VASc scores. RESULTS: In total, 187 of 626 patients with FEIS suffered from cardioembolic stroke owing to AF, which was newly diagnosed in 57 (31%) patients. Retrospective pre-stroke risk stratification according to CHADS(2) score indicated low/intermediate risk in 34 patients (18%) and high risk (CHADS(2) ≥ 2) in 153 patients (82%). Application of CHA(2) DS(2) -VASc score reduced number of patients at low/intermediate risk (CHA(2) DS(2) -VASc score 0-1) to five patients (2.7%). In patients with a CHADS(2) score ≥ 2 and known AF (n = 106) before stroke, 38 (36%) were on treatment with vitamin K antagonists on admission whilst only in 16 patients (15%) treatment was in therapeutic range. CONCLUSIONS: Our study strongly supports the hypothesis that underuse of oral anticoagulants in high-risk patients importantly contributes to AF-associated stroke. CHA(2) DS(2) -VASc score appears to be a more valuable risk stratification tool than CHADS(2) score. Preventive measures should focus on optimizing pre-stroke detection of AF and better implementation of present AF-guidelines with respect to anticoagulation therapy.
    European Journal of Neurology 07/2012; · 4.16 Impact Factor
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    ABSTRACT: Recent studies suggest a worse impact of inappropriate shock therapies on the outcome of patients with an implantable cardioverter-defibrillator (ICD). However, it is not known whether the worse impact is attributed to the ICD shock itself or due to the underlying heart disease. The aim of the study was to evaluate the impact of inappropriate ICD shocks on clinical outcome by comparing ICD shocks triggered by atrial fibrillation (AF) with shocks caused by lead failure. A total of 1,411 consecutive patients of the prospective single-center ICD-registry Ludwigshafen who underwent an ICD implantation between 1992 and 2008 for primary or secondary prevention of sudden cardiac death were analyzed. During the median follow-up of 3 years, 297 (21%) patients experienced inappropriate ICD shocks. Sixty percent of patients had inappropriate shocks due to AF and 24% due to lead defect or T-wave oversensing. Multiple ICD shocks (≥2) triggered by AF were associated with a worse prognosis, whereas a single shock due to AF or 1 or multiple shocks resulting from lead failure were not. ICD shocks caused by AF occurred more often in tandem with a serious adverse event than in patients with a lead failure (15% vs 6%, P < 0.05). Multiple ICD shocks triggered by AF are associated with a worse prognosis in ICD patients, whereas a single shock due to AF or shocks resulting from lead failure are not. These data support that the ICD shock itself has no worse impact on the outcome of ICD patients.
    Journal of Cardiovascular Electrophysiology 02/2012; 23(7):735-40. · 3.48 Impact Factor
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    ABSTRACT: Stroke etiology in ischemic stroke guides preventive measures and etiological stroke subgroups may show considerable differences between both sexes. In a population-based stroke registry we analyzed etiological subgroups of ischemic stroke and calculated sex-specific incidence and mortality rates. The Ludwigshafen Stroke Study is a prospective ongoing population-based stroke registry. Multiple overlapping methods of case ascertainment were used to identify all patients with incident stroke or transient ischemic attack. Modified TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria were applied for subgroup analysis in ischemic stroke. Out of 626 patients with first-ever ischemic stroke in 2006 and 2007, women (n = 327) were older (73.5 ± 12.6 years) than men (n = 299; 69.7 ± 11.5 years; p < 0.001). The age-adjusted incidence rate of ischemic stroke was significantly higher in men (1.37; 95% CI 1.20-1.56) than in women (1.12; 95% CI 0.97-1.29; p = 0.04). Cardioembolism (n = 219; 35.0%), small-artery occlusion (n = 164; 26.2%), large-artery atherosclerosis (n = 98; 15.7%) and 'probable atherothrombotic stroke' (n = 84; 13.4%) were common subgroups of ischemic stroke. Stroke due to large-artery atherosclerosis (p = 0.025), current smoking (p = 0.008), history of smoking (p < 0.001), coronary artery disease (p = 0.0015) and peripheral artery disease (p = 0.024) was significantly more common in men than in women. Overall, 1-year survival was not different between both sexes; however, a significant age-sex interaction with higher mortality in elderly women (>85 years) was detected. Cardioembolism is the main source for ischemic stroke in our population. Etiology of ischemic stroke differs between sexes, with large-artery atherosclerotic stroke and associated diseases (coronary artery disease and peripheral artery disease) being more common in men.
    Cerebrovascular Diseases 12/2011; 33(1):69-75. · 2.81 Impact Factor
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    ABSTRACT: We report the case of a 63-year-old man with ischemic cardiomyopathy having an implantable cardioverter defibrillator (ICD) implanted for repeated ventricular tachycardia (VT). After several revisions of the ICD lead, a thrombosis of the left venous system was diagnosed. A right pectoral ICD device was implanted, and a sufficient defibrillation threshold (DFT) could not be achieved during the operation. Thus, a further defibrillation lead was implanted into the coronary sinus, which successfully terminated ventricular fibrillation.
    Herzschrittmachertherapie & Elektrophysiologie 06/2011; 22(2):121-3.
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    ABSTRACT: Aim of this study is to evaluate reproducibility, consistency and the impact of moderate exercise workload on optimized PV and VV delays as determined by the IEGM-based QuickOpt™ method (St. Jude Medical), that was shown to produce hemodynamic performance similar to that obtained by echo-guided aortic VTI maximization. Sixty patients with CRT-ICD (65 ± 9 years, 12% female, LVEF 28 ± 9%, 48% CAD and 52% DCM) were enrolled. IEGM-based PV/VV optimization was conducted six times: twice at rest, twice immediately after a 6-min walk test and twice following a 3-min recovery period. Timing cycle delays were programmed in accordance with the optimization results. Follow-up was performed after 1 year. Although significant difference in heart rate was reached [68 ± 9 bpm (REST) vs. 79 ± 12 (6MWT), p < 0.001], differences were not observed between IEGM-based optimized PV/VV delays: PV(opt) = 128 ± 14 ms (REST) versus 130 ± 17 ms (6MWT) versus 129 ± 16 ms (RECOV); VV(opt) = 15 ± 24 ms (REST) versus 15 ± 22 ms (6MWT) versus 16 ± 24 ms (RECOV). During 1-year follow-up PV(opt) and VV(opt) remained stable (ΔPV(opt) = 10 ± 10 ms, ΔVV(opt) = 9 ± 11 ms). Optimized IEGM-based timing cycle delays are independent of moderate exercise status within a particular patient but varied between patients. This supports the use of PV/VV optimization in each CRT patient.
    Clinical Research in Cardiology 11/2010; 99(11):735-41. · 3.67 Impact Factor
  • K Seidl, M Strauss, T Kleemann
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    ABSTRACT: Patients who survive out-of-hospital cardiac arrest or symptomatic ventricular tachyarrhythmias are at considerable risk of recurrence of these events and ultimately death. The implantation of an implantable cardioverter defibrillator (ICD) in patients with previous sustained ventricular tachyarrhythmias (VT) is considered secondary prevention of sudden cardiac death. The purpose of this review is to summarize the most important trials on secondary prevention with an ICD. The results from a meta-analysis showed a relative-risk reduction of 28% in overall mortality. Compared with amiodarone, an ICD provided maximal benefit for those patients with an ejection fraction between 20% and 35%. The results of the ICD trial demonstrate that there is clear evidence for the effectiveness of an ICD in patients with unstable VT; however, for patients with stable VT the results are less clear. Data on older patients are scant, and whether the survival benefit observed in the middle aged and younger-old also extend to older elderly patients with a more limited life span is less clear. Therefore, as the population becomes older, it is important to evaluate the safety, effectiveness, and the cost effectiveness of ICD implantation in this population. Guidelines are important and helpful to guide clinical decisions, but the indication for an ICD still remains an individual decision after evaluation of the risks and benefits for the individual patient. However, the patient needs to be involved, which emphasizes the importance of dialogue between the patient and physician.
    Herzschrittmachertherapie & Elektrophysiologie 06/2010; 21(2):96-101.
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    ABSTRACT: The aim of the study was to evaluate the incidence of ventricular arrhythmia and clinical outcome in patients receiving a cardiac resynchronization therapy (CRT) depending on the left ventricular (LV) lead position. A total of 187 consecutive patients with advanced heart failure who received a CRT-implantable cardioverter defibrillator were analyzed. Forty patients (21%) had a LV lead in the anterior/apical (anterior) and 147 patients (79%) in the posterior/posterolateral (posterior) region. The total median follow-up time was 644 days. The incidence of ventricular arrhythmia was 35% in patients with an anterior LV lead versus 30% in patients with a posterior LV lead (p = 0.53). The 1- and 2-year mortality in the anterior LV lead group was 19% and 22%, as compared with 0.7% and 3.2%, respectively, in the posterior LV lead group (p < 0.001). In a multivariable analysis, an anterior LV lead was independently associated with an increased mortality (hazard ratio 5.88, 95% confidence interval 2.22-16.67). The major cause of death was end-stage heart failure whereas the incidence of sudden cardiac death was not different between both groups. Thus, biventricular pacing with an anterior LV lead seems to have no impact on the incidence of ventricular arrhythmia but may be associated with an increased mortality rate due to worsening heart failure.
    Journal of Interventional Cardiac Electrophysiology 03/2010; 28(2):109-16. · 1.39 Impact Factor
  • Karlheinz Seidl, Thomas Kleemann
    Kardiologie up2date 01/2010; 6(02):141-151.
  • K. Seidl, M. Strauss, T. Kleemann
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    ABSTRACT: Bei Patienten, die bereits einen Herzstillstand, eine hämodynamische Beeinträchtigung oder eine Synkope aufgrund von ventrikulären Tachyarrhythmien überlebt haben, wird die Implantation eines ICD als Sekundärprophylaxe bezeichnet. Ziel ist es, eine Übersicht zur Studienlage bei der ICD-Therapie aus sekundärprophylaktischen Gründen zu geben. Die Implantation eines ICD zur Sekundärprävention von lebensbedrohlichen ventrikulären Tachykardien ist effektiv bei der Verhinderung des plötzlichen arrhythmogenen Todes. Die Gesamtmortalität wurde durch den ICD relativ um 28% gesenkt. Es zeigt sich zwar ein moderater Benefit durch die ICD-Therapie zur Sekundärprävention, aber nur in einem engen Rahmen bei einer EF (Ejektionsfraktion) zwischen 20 und 35%. Die bisherigen Studien wurden vorwiegend bei Patienten mit hämodynamisch instabiler Tachyarrhythmie durchgeführt und der Nutzen des ICD gezeigt. Bei Patienten mit stabiler ventrikulärer Tachyarrhythmie ist der Nutzen weniger eindeutig, und alternative Therapieverfahren müssen in die Differenzialtherapie einbezogen werden. Aufgrund des demografischen Wandels mit der Zunahme der älteren Patienten ist es von besonderer Bedeutung, die Frage nach der Sicherheit, Wirksamkeit und Kosten-Nutzen-Effektivität gerade beim älteren Patienten zu stellen. Die Empfehlungen der Leitlinien sind wichtig und sollten uns als Richtschnur dienen. Dennoch sollte die Indikation für einen ICD individuell nach einer Risiko-Nutzen-Abwägung gestellt werden und der Patient und dessen Angehörige in diese Entscheidung mit einbezogen werden. Patients who survive out-of-hospital cardiac arrest or symptomatic ventricular tachyarrhythmias are at considerable risk of recurrence of these events and ultimately death. The implantation of an implantable cardioverter defibrillator (ICD) in patients with previous sustained ventricular tachyarrhythmias (VT) is considered secondary prevention of sudden cardiac death. The purpose of this review is to summarize the most important trials on secondary prevention with an ICD. The results from a meta-analysis showed a relative-risk reduction of 28% in overall mortality. Compared with amiodarone, an ICD provided maximal benefit for those patients with an ejection fraction between 20% and 35%. The results of the ICD trial demonstrate that there is clear evidence for the effectiveness of an ICD in patients with unstable VT; however, for patients with stable VT the results are less clear. Data on older patients are scant, and whether the survival benefit observed in the middle aged and younger-old also extend to older elderly patients with a more limited life span is less clear. Therefore, as the population becomes older, it is important to evaluate the safety, effectiveness, and the cost effectiveness of ICD implantation in this population. Guidelines are important and helpful to guide clinical decisions, but the indication for an ICD still remains an individual decision after evaluation of the risks and benefits for the individual patient. However, the patient needs to be involved, which emphasizes the importance of dialogue between the patient and physician. SchlüsselwörterPlötzlicher Herztod-Implantierbarer Kardioverter/Defibrillator (ICD)-Sekundärprophylaxe KeywordsSudden cardiac death-Implantable cardioverter defibrillator (ICD)-Secondary prevention
    Herzschrittmachertherapie & Elektrophysiologie 01/2010; 21(2):96-101.
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    ABSTRACT: This study was designed to evaluate the prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator (ICD) patients without signs of infection and to analyse the impact of bacterial colonization on the incidence of device infection during follow-up. In 122 ICD patients undergoing generator replacement or surgical lead revision between January 2006 and July 2008, microbiological cultures of generator pockets and extracted leads were consecutively obtained. Patients with clinical evidence of a device infection were excluded. Positive cultures from the generator pocket and leads were found in 40 (33%) patients. The most common bacteria isolated were coagulase negative staphylococci (68%). During a median follow-up time of 203 days after the revision device infection occurred in three [7.5%, confidence interval (CI) 1.6-20.4%] patients with a positive culture vs. two (2.4%, CI 0.3-8.5%) patients with a negative culture (P = 0.33). Time from revision to infection was 108 +/- 73 days in patients with positive culture vs. 60 +/- 39 days in patients with negative culture (P = 0.50). A third of ICD patients undergoing generator replacement or lead revision have an asymptomatic bacterial colonization of generator pockets. After revision 7.5% of these patients develop a device infection with the same species of microorganism.
    Europace 10/2009; 12(1):58-63. · 2.77 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the value of transesophageal echocardiography (TEE)-guided cardioversion (CV) to prevent thromboembolic complications in patients with short-term atrial fibrillation (AF) < 48 hours in duration. This single-center, observational study comprised 366 consecutive, unselected patients with short-term AF < 48 hours in duration. During the first 2 years, CV was performed using the conventional approach without TEE. Thereafter, CV guided by TEE was performed in consecutive patients. TEE revealed left atrial thrombi in 1.4% and left atrial dense spontaneous echo contrast in 10% of patients with short-term AF (n = 207), of whom 63% were receiving anticoagulation therapy. Patients without prior anticoagulation had a 4% prevalence of left atrial thrombi. A low ejection fraction and an enlarged left atrium tended to be associated with an increased prevalence of thrombus or dense spontaneous echo contrast. During the first month after CV, there were no significant differences in the rate of embolic events between the two treatment groups. These results underline the need for further studies on the usefulness of TEE-guided CV in patients with short-term AF who are not therapeutically anticoagulated at presentation.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 10/2009; 22(12):1403-8. · 2.98 Impact Factor
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    Thomas Kleemann, Karlheinz Seidl
    Circulation 02/2009; 119(1):e8; author reply e9. · 15.20 Impact Factor
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    ABSTRACT: To evaluate the prevalence and clinical impact of left atrial (LA) thrombus and dense spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) and low CHADS(2) score undergoing cardioversion. A total of 295 consecutive patients with non-valvular AF and a CHADS(2) score of 0 or 1 from the prospective single-centre registry ANTIK, who underwent transoesophageal echocardiography before cardioversion, were included in the study. Median follow-up was 5 years. LA thrombus was present in 3% and dense SEC in 8% of patients. Independent predictors for the presence of thrombus or dense SEC were ejection fraction (EF) <40% and LA diameter > or =50 mm. In anticoagulated patients, thrombus and dense SEC were not independently associated with an increased risk for stroke or death during the 5 year follow-up (OR 1.55, 95% CI 0.50-4.83). Despite a low CHADS(2) score of 0/1, 3% of patients have LA thrombus and 8% of patients have dense SEC. Independent predictors for the presence of thrombus and dense SEC were EF <40% and LA dimension > or =50 mm. Thus, echocardiography might be a useful tool for further risk stratification in patients with low CHADS(2) score.
    European Heart Journal – Cardiovascular Imaging 10/2008; 10(3):383-8. · 3.67 Impact Factor
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    ABSTRACT: Both left bundle branch block and right bundle branch block (RBBB) have been associated with increased inhospital and long-term mortality in patients with acute ST elevation myocardial infarction (STEMI). However, the prognostic role of RBBB in acute non-ST elevation myocardial infarction (NSTEMI) is not well known. Therefore, the aim of the study was to evaluate the incidence and clinical impact of RBBB in patients with NSTEMI compared to patients with STEMI. From the German prospective multicenter registry "Maximal Individual Therapy of Acute Myocardial Infarction" (MITRA PLUS), 6,403 consecutive patients with NSTEMI and 20,233 patients with STEMI were analyzed. Patients with left bundle branch block were excluded. The median follow-up time for NSTEMI was 378 days and for STEMI 479 days. A total of 455 (7.1%) patients with NSTEMI and 894 (4.4%) patients with STEMI presented with RBBB on admission. In general, RBBB patients were older, more often had comorbidities, and less often received short-term inhospital treatment according to guidelines. In STEMI, RBBB patients had higher peak enzyme levels and lower left ventricular ejection fraction (LV-EF) than patients without BBB. Right bundle branch block in STEMI was associated with an increased inhospital and long-term mortality. In NSTEMI, however, peak enzyme levels and LV-EF were similar in both groups with and without RBBB. Right bundle branch block in NSTEMI was not independently associated with a worse outcome. Unlike RBBB in STEMI, RBBB in NSTEMI is not an independent predictor of inhospital and long-term mortality.
    American heart journal 08/2008; 156(2):256-61. · 4.65 Impact Factor
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    ABSTRACT: According to the current guidelines for acute myocardial infarction, ventricular fibrillation during the acute phase of myocardial infarction is no indication for specific treatment like ICD implantation. Primary objective of our study was to evaluate the prognostic significance of cardiac arrest within the acute phase of myocardial infarction in patients with moderately reduced left ventricular function. From 1994 until 2004, we included 7111 patients with acute STEMI and an LVEF >30% from the MITRA plus registry who were discharged alive from hospital and had a complete follow up. We compared long term prognosis on total mortality in patients with and without prehospital cardiac arrest. 286 out of 7111 patients (4%) with moderately reduced LVEF >30% after STEMI had prehospital cardiac arrest and were discharged alive from hospital. In these patients, total mortality during a mean follow up of 13 months was 13.6% compared to 8.7% in patients without cardiac arrest, although patients with cardiac arrest were younger and had less risk factors. Higher mortality after cardiac arrest was independent from gender, risk factors and medical treatment. Only in patients with preserved LVEF >55% after STEMI, mortality was equal in patients with and without cardiac arrest. Prehospital cardiac arrest in the acute phase of STEMI is an independent risk indicator for higher mortality in patients with moderately reduced left ventricular function (LVEF 30-55%). To evaluate the prognostic impact of the implantation of an ICD in these patients, further investigation is needed.
    Clinical Research in Cardiology 05/2008; 97(10):748-52. · 3.67 Impact Factor
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    ABSTRACT: We evaluated the prognostic impact of a first episode of symptomatic atrial fibrillation under real life conditions. Most studies regarding the treatment and long-term outcome of patients with atrial fibrillation mainly refer to patients with recurrent episodes. In contrast, data on the prognostic implications of a first episode of atrial fibrillation are scarce. Over a follow-up period of 5 years, we analyzed 1053 patients, initially scheduled for cardioversion of symptomatic atrial fibrillation, who were included into the prospective registry ANTIK (Ludwigshafener ANTIKoagulationsstudie). Of those, 618 patients (59%) were included with a first episode of symptomatic atrial fibrillation whereas 435 patients (41%) presented with recurrent episodes. As a consequence of referral for cardioversion of symptomatic atrial fibrillation, structural heart disease was newly diagnosed in a significantly higher proportion of patients with a first episode (27 vs 13%, OR 2.4, 95% CI 1.7-3.3) and patients with a first episode were more likely to have an EF</=40% (21 vs 15%, OR 1.5, 95% CI 1.1-2.2). After 5 years, the mortality rate for patients with a first episode was higher than for those with recurrent episodes (27 vs 16%, OR 2.0, 95% CI 1.4-2.7). In the multivariate analysis, a first episode also was independently associated with an increased longterm mortality (HR 1.4, 95% CI 1.02-1.98). In contrast to patients with recurrent episodes, a first episode was associated with a significantly higher mortality, when compared to an age-matched control group calculated from mortality tables. The first episode of symptomatic atrial fibrillation intended for cardioversion serves as a marker for underlying cardiac diseases and is associated with impaired prognosis.
    Clinical Research in Cardiology 03/2008; 97(2):74-82. · 3.67 Impact Factor
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    ABSTRACT: The number of patients with longer follow-up after implantation of an implantable cardioverter-defibrillator is increasing continuously. Defibrillation lead failure is a typical long-term complication. Therefore, the long-term reliability of implantable cardioverter-defibrillator leads has become an increasing concern. The aim of the present study was to assess the annual rate of transvenous defibrillation lead defects related to follow-up time after lead implantation. A total of 990 consecutive patients who underwent first implantation of an implantable cardioverter-defibrillator between 1992 and May 2005 were analyzed. Median follow-up time was 934 days (interquartile range, 368 to 1870). Overall, 148 defibrillation leads (15%) failed during the follow-up. The estimated lead survival rates at 5 and 8 years after implantation were 85% and 60%, respectively. The annual failure rate increased progressively with time after implantation and reached 20% in 10-year-old leads (P<0.001). Lead defects affected newer as well as older models. Patients with lead defects were 3 years younger at implantation and more often female. Multiple lead implantation was associated with a trend to a higher rate of defibrillation lead defects (P=0.06). The major lead complications were insulation defects (56%), lead fractures (12%), loss of ventricular capture (11%), abnormal lead impedance (10%), and sensing failure (10%). An increasing annual lead failure rate is noted primarily during long-term follow-up and reached 20% in 10-year-old leads. Patients with lead defects are younger and more often female.
    Circulation 06/2007; 115(19):2474-80. · 15.20 Impact Factor