• Home
  • Thomas Klingenheben
Thomas Klingenheben

Thomas Klingenheben
Cardiology Private Practice Bonn, and Private Cardiac CathLab Bonn

MD, Professor of Medicine and Cardiology

About

162
Publications
51,450
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
6,107
Citations
Introduction
Skills and Expertise

Publications

Publications (162)
Article
Patients with highly symptomatic tachycardia may suffer significantly; in addition to a standardized rule-out of structural heart disease, secondary causes need to be excluded. Disorders such as inappropriate sinus tachycardia and postural tachycardia syndrome are caused by cardiac autonomic dysregulation which may be part of a rare underlying nonc...
Article
Patients with primary neurogenic disorders such as pure autonomic failure or multiple system atrophy may initially present with cardiocirculatory symptoms such as orthostatic intolerance or fluctuations in heart rate with symptomatic tachycardia. It is therefore clinically important to identify such patients since circulatory manifestations are onl...
Chapter
Sex-specific differences in the electrocardiogram (ECG) have rarely been considered in terms of disease prognosis and—more specifically—arrhythmia risk stratification. Patients with heart failure (HF) are at increased risk for arrhythmic events and cardiac mortality, the latter corresponding with stages/progression of the disease. Approximately 55%...
Article
Full-text available
Background: Treatment with ivabradine became a new therapeutic alternative for patients with inappropriate sinus tachycardia (IST). The aim was to determine a relation between intrinsic heart rate (IHR) and response to ivabradine treatment. Methods: Twenty-seven patients (mean age 37 ± 11; 23 women) with symptomatic IST despite medical treatment...
Article
Full-text available
Microvolt-level T-wave alternans (TWA) assessed by spectral method during an exercise stress test has been widely studied for risk stratification. Several studies have documented the association of a positive TWA with total mortality and arrhythmic events. Nevertheless, the need to achieve an elevated and stabilized heart rate resulting in a consid...
Article
Die Bedeutung ventrikulärer Extrasystolen (VES) im Langzeit-EKG hat in den letzten 25 Jahren einen gewissen Wandel erfahren. Die prognostische Wertigkeit scheint stark abhängig von der Häufung der Arrhythmie und einer etwaigen begleitenden kardialen Grunderkrankung. Zudem scheint das Fehlen von Symptomen durch VES zumindest bei Patienten mit deutli...
Article
Background: There is limited evidence whether being on fludrocortisone prevents vasovagal syncope. Objectives: The authors sought to determine whether treatment with fludrocortisone reduces the proportion of patients with recurrent vasovagal syncope by at least 40%, representing a pre-specified minimal clinically important relative risk reductio...
Article
Full-text available
Background: Modulation of cardiac repolarization by sexual hormones is controversial and hormonal effects on ion channels remain largely unknown. In the present translational study, we therefore assessed the relationship between QTc duration and gonadal hormones and studied underlying mechanisms. Methods and results: We measured hormone levels a...
Article
Full-text available
While the implantable cardioverter-defibrillator (ICD) has been proven to be the best choice for patients with long-term risk for sudden cardiac arrest/sudden cardiac death (SCA/SCD), the question is how to manage patients with only temporary risk, e.g., during the guidelines-recommended waiting period until the decision for an ICD can be made. The...
Article
Neben der Katheterablation/Pulmonalvenenisolation hat auch die pharmakologische Therapie des Vorhofflimmerns in den letzten Jahren erhebliche Fortschritte erfahren. Einerseits ist die orale Antikoagulation durch Einführung der direkten oralen Antikoagulanzien (DOAKs) bereichert worden. Andererseits ist durch die Zulassung von Dronedaron das Arsenal...
Article
Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. Beta-blocker or calcium channel blocker therapy is often non-effective or not well tolerated. Another clinical entity with inadequate sinus tachycardia is the postural orthostatic tachycar...
Article
Die Therapie mit dem implantierbaren Kardioverter-Defibrillator (ICD) ist heute Standard bei selektierten Patienten mit systolischer Herzinsuffizienz und reduzierter linksventrikulärer Ejektionsfraktion (LVEF) auf dem Boden einer ischämischen oder nichtischämischen Kardiomyopathie [1, 2]. Dennoch ist eine verbesserte Patientenselektion wünschenswer...
Article
Full-text available
Die Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Schrittmacher- und kardialen Resynchronisationstherapie (CRT) von 2007 sind aktualisiert und umfangreich überarbeitet worden, um neue Studiendaten für die Indikationsstellung zu berücksichtigen und um diese im Alltag zu vereinfachen. Wichtigste Änderungen sind beim Sick-Sinus-Sy...
Article
(Foto: © beim Autor T.K.)Am 12. Februar verstarb 100-jährig in Newport-Beach Bruce E. Del Mar, der zusammen mit Norman Holter (1914–1983) ein Pionier der telemetrischen EKG-Aufzeichnung und Entwicklung der ersten kommerziell verfügbaren Langzeit-EKG-Geräte war. Geboren 1913 in Pasadena, CA, wurde er einer der sicher vielseitigsten Erfinder seiner Z...
Article
Dual antiplatelet therapy is the cornerstone of maintenance medication following invasive treatment of patients with acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated....
Article
Full-text available
Der Einsatz von Elektrokautern kann bei Patienten mit Herzschrittmachern oder implantierten Kardiovertern/Defibrillatoren eine Vielzahl von Störungen bis hin zu Aggregatbeschädigungen zur Folge haben. Ihr Einsatz muss daher in jedem Fall kritisch hinterfragt werden. Sofern Elektrokauter bei diesen Patienten eingesetzt werden müssen, werden hier Emp...
Article
Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional HR increase during exercise. The etiology of IST has not been fully elucidated and remains controversial. The aim of the present study was to assess autonomic function by means of noninvasive tests and commonly availabl...
Article
In clinical practice, telemonitoring systems are available today to monitor patients with pacemakers, defibrillators (ICD), and cardiac resynchronization systems (CRT). Despite the various technical realizations by manufacturers, these systems have uniform designs. With telemonitoring, data important for the management of the unit, arrhythmia, and...
Article
Background: Inappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or a disproportional increase in HR during exercise. β-blocker or calcium channel-blocker therapy is often noneffective or not well tolerated. The HR reduction on ivabradine is similar to β-blockers but in some patients its e...
Article
Background: Inappropriate sinus tachycardia (IST) occurs relatively common after catheter ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia. The treatment of IST symptoms using β-blockers or calcium channel-blockers are often noneffective or not well tolerated. Ivabradine is a new heart rate (HR)-decreasing age...
Article
Full-text available
Background: β-blockers have little effectiveness in preventing vasovagal syncope in unselected populations, but they might be effective in older patients. We determined whether β-blockers prevent vasovagal syncope in an age-related fashion. Methods and results: Two populations were studied. A proportional hazards analysis was performed on an obs...
Article
Full-text available
Riata® and Riata ST® implantable cardioverter defibrillator (ICD) leads (St. Jude Medical, Sylmar, CA) show an increased incidence of insulation defects, particularly "inside-out" lead fracture where inner, separately insulated cables penetrate through the surrounding silicone of the lead body. The exact incidence of Riata® lead problems is not cle...
Article
Full-text available
AimsInappropriate sinus tachycardia (IST) is a clinical syndrome characterized by excessive resting heart rate (HR) or disproportional increasing HR during exercise. The treatment of IST symptoms using beta-blockers or calcium channel-blockers is often non-effective or not well tolerated. Ivabradine is a new agent inhibiting sinus node If current,...
Article
Full-text available
Defibrillatorelektroden der Firma St. Jude Medical vom Typ Riata® und Riata ST® zeigen ein erhöhtes Auftreten von Isolationsdefekten, wobei die inneren, separat isolierten Leiter durch den Elektrodenkörper nach außen treten können („inside-out fracture“). Die genaue Inzidenz von Riata®-Elektrodenproblemen ist nicht klar. Nach neuen Daten von US-ame...
Article
In one interesting aspect, the letter by Jackson et al. ([1][1]) pertains to risk stratification in general. They suggest that evidence-based cardiac risk assessment should be an automatic process devoid of individual clinical judgment. We disagree and maintain that any risk assessment requires
Article
Percutaneous coronary intervention (PCI) revolutionized the management of patients with coronary artery disease, but has to be accompanied by effective (dual) antiplatelet therapy. Two novel ADP inhibitors have recently entered clinical practice as combination partners for aspirin, prasugrel and ticagrelor. International societies have already esta...
Article
This consensus guideline was prepared on behalf of the International Society for Holter and Noninvasive Electrocardiology and is cosponsored by the Japanese Circulation Society, the Computers in Cardiology Working Group on e-Cardiology of the European Society of Cardiology, and the European Cardiac Arrhythmia Society. It discusses the electrocardio...
Article
Catheter ablation therapy of atrial fibrillation (AF) by means of pulmonary vein isolation (PVI) has been widely established and its indication has been defined in the current AF guidelines. Initially restricted to patients with paroxysmal AF, PVI has meanwhile been applied to broader patient populations. PVI is subject to ongoing methodological an...
Article
Cases of temporary and permanent dysfunction of implanted pacemaker leads and devices have been reported after external cardioversion of atrial fibrillation that posed a risk to the patient. New data show, however, that external cardioversion can safely be performed in contemporary pacemakers, ICD, and CRT systems if some safety measures are respec...
Article
Microvolt T-wave alternans (MTWA) has been used for arrhythmogenic risk stratification in cardiac disease conditions associated with increased risk of sudden cardiac death. Macroscopic T-wave alternans has been observed in patients with congenital long-QT syndrome (LQTS). The role of MTWA testing in patients with LQTS has not been established. Obje...
Article
Vasovagal syncope is common, often recurrent, and reduces quality of life. No therapies have proven useful to improve quality of life in adequately designed randomized clinical trials. Beta-blockers have mixed evidence for effectiveness in preventing syncope. The Prevention of Syncope Trial was a randomized, placebo-controlled, double-blind, multin...
Article
Vasovagal syncope is common and distressing. One important symptom is presyncope, but there are no clinimetric measures of this. We developed the Calgary Presyncope Form (CPF) and used it to test whether metoprolol reduces presyncope in a randomized trial. The CPF captures the frequency, duration, and severity of presyncope. We administered it to p...
Article
Noninvasive arrhythmia risk stratification in patients with nonischemic dilated cardiomyopathy (DCM) using autonomic markers have yielded disappointing results. Heart rate turbulence is a new method to assess cardiac autonomic function. The aim of the study was to compare the predictive value of heart rate turbulence with those of conventional auto...
Article
The present review summarizes current aspects on how to perform noninvasive microvolt T-wave alternans (mTWA) testing in clinical practice. The focus is on methodologic issues such as patient-related, or technical aspects, and interpretation of the results. Special attention is given to the different sources of noise that may interfere with mTWA as...
Article
Full-text available
We hypothesize that the neural component (NC) of the baroreflex sensitivity (BRS) is a better risk stratifier for ventricular tachycardia/fibrillation (VT/VF) than conventional BRS itself, because it is both independent of vessel wall stiffness and can be measured non-invasively. NC was determined by correlating spontaneous carotid artery diameter...
Article
Much of the natural history of vasovagal syncope is unknown. We determined whether patients presenting for care have had a recently worsened syncope frequency. We compared 208 subjects in the referral-based Prevention of Syncope Trial (POST) and 122 subjects who fainted > or =1 in a community survey study. Their mean ages and gender proportions wer...
Article
Sympathetic Activation in Neurocardiogenic Syncope. Introduction: Tilt table testing is widely used in the management of patients with neurocardiogenic syncope. However, the exact pathophysiologic mechanism of this disorder is still under debate. Likewise, therapy of these patients continues to represent a challenge in many cases. Therefore, the pr...
Article
Several studies have recently proven that primary preventive therapy of sudden arrhythmogenic death is possible in selected patients with congestive heart failure, particularly in the setting of ischemic cardiomyopathy [1, 2]. However, a number needed to treat between 11 and 17 to save one life over three years in these studies indicates that a mor...
Article
We present the case of a patient with highly symptomatic tachyarrhythmias for 2 years without any arrhythmia documentation despite numerous ECG and Holter registrations. By means of telemedicine, it was possible to document the arrhythmia--in this case atrial fibrillation--within 10 days and to start antiarrhythmic drug treatment with flecainide an...
Article
Background and Objectives: In patients with paroxysmal lone AF, clinical data indicate a predominance of vagal modulation preceding attacks of the arryhthmia. Systematic data derived from time-domain analysis of HRV evaluating changes in autonomic modulation prior to AF onset are sparse, both in patients without and with evidence for structural hea...
Article
Various disorders of autonomic circulatory control are characterized by symptoms of orthostatic intolerance and syncope. Since the introduction of tilt-table testing as a cardiac diagnostic tool by Kenny et al., definition of these disorders has changed significantly. This review summarizes the current knowledge of diagnosis and treatment of the sy...
Article
Previous studies that assessed the effects of beta-blockers in preventing vasovagal syncope provided mixed results. Our goal was to determine whether treatment with metoprolol reduces the risk of syncope in patients with vasovagal syncope. The multicenter Prevention of Syncope Trial (POST) was a randomized, placebo-controlled, double-blind, trial d...
Article
Understanding whether vasovagal syncope is a lifelong disorder might shed insight into its physiology and affect management strategies. Accordingly, we determined the age of the first syncopal spell in adult patients who sought care for syncope. Patients were 42 +/- 18 years old with 64% women. They had had a median 8 syncope spells (interquartile...
Article
Prognosis of prehospital cardiac arrest due to ventricular fibrillation is dependent on the first minutes, as survival decreases by 10% for each minute by which resuscitation attempts are delayed. Thus, early defibrillation plays a key role in improving outcome of cardiac arrest victims. The effectiveness of automated external defibrillators (AEDs)...
Article
The Brugada syndrome is an autosomal dominant disorder characterized by life-threatening ventricular tachyarrhythmias due to cardiac conductance disturbance without structural heart disease. Mutations of the SCN5A gene cause either a reduction in cardiac Na(+) channel expression or alterations in channel-gating properties, leading to a reduction in...
Article
T-wave alternans has been shown to be linked to the genesis of ventricular tachyarrhythmias. Currently, only qualitative assessment of microvolt T-wave alternans (MTWA) is recommended in clinical practise. Whether quantitative assessment of MTWA yields complementary information is unknown. Noninvasive MTWA determination was performed in 204 consecu...
Article
Background: The Brugada syndrome is an autosomal dominant disorder characterized by life-threatening ventricular tachyarrhythmias due to cardiac conductance disturbance without structural heart disease. Mutations of the SCN5A gene cause either a reduction in cardiac Na+ channel expression or alterations in channel-gating properties, leading to a re...
Article
Prognosis of prehospital cardiac arrest due to ventricular fibrillation is dependent on the first minutes, as survival decreases by 10% for each minute by which resuscitation attempts are delayed. Thus, early defibrillation plays a key role in improving outcome of cardiac arrest victims. The effectiveness of automated external defibrillators (AEDs)...
Article
This study evaluated the predictive power of heart rate (HR) assessed from the standard 12-lead electrocardiogram (ECG) or from Holter recordings for future mortality and arrhythmic events in survivors of acute myocardial infarction (AMI). Data from 432 consecutive survivors of AMI (343 men, 89 women; mean [SD] age, 58 [11] years) were analyzed. He...
Article
Initiation of effective cardiopulmonary resuscitation (CPR) at the earliest possible moment is the most important determinant of prognosis for prehospital cardiac arrest. The prognosis is essentially defined by two parameters: survival to hospital admission and survival to discharge. In connection with prehospital cardiac arrest, early defibrillati...
Article
Initiation of effective cardiopulmonary resuscitation (CPR) at the earliest possible moment is the most important determinant of prognosis for prehospital cardiac arrest. The prognosis is essentially defined by two parameters: survival to hospital admission and survival to discharge. In connection with prehospital cardiac arrest, early defibrillati...
Article
This study was designed to evaluate the ability of microvolt-level T-wave alternans (MTWA) to identify prospectively patients with idiopathic dilated cardiomyopathy (DCM) at risk of ventricular tachyarrhythmic events and to compare its predictive accuracy with that of conventional risk stratifiers. Patients with DCM are at increased risk of sudden...
Article
A patient with ischemic cardiomyopathy presented with burning pain of his body surface with consecutive orthostatic intolerance and recurrent syncopes. A diagnosis of acute autonomic dysfunction was made and the patient was treated with midodrine, resulting in restoration of orthostatic tolerance after 6 weeks of therapy.
Article
Although primary preventive therapy with implantable cardioverter defibrillators has recently been shown to be effective in patients with coronary artery disease and left ventricular dysfunction, further identification of patients at particularly high risk for arrhythmic death would improve the cost effectiveness of device therapy. The value of ris...
Article
Since the publication of the two MADIT trials, the implantable cardioverter defibrillator has moved from a tool for secondary prevention to a primary preventive strategy against sudden cardiac death in high risk patients with coronary artery disease. However, the general use of the ICD in post myocardial infarction patients with impaired left ventr...
Article
Microvolt-level T-wave alternans (TWA) is a new arrhythmia risk marker to assess subtle changes in repolarization that has been introduced for arrhythmia risk stratification. Recent experimental studies have demonstrated that it reflects a heartrate dependent increased spatial dispersion of repolarization associated with unidirectional conduction b...
Article
Störungen der autonomen Funktion, die mit orthostatischer Intoleranz und Hypotonie einhergehen, stellen eine diagnostische und therapeutische Herausforderung dar. Die Kipptischuntersuchung hat in den letzten Jahren ganz entscheidende Beiträge zur Differenzierung der zugrundeliegenden Kreislaufreaktionen und damit der Pathophysiologie dieser Erkrank...
Article
Electrocardiographic risk stratification of patients with inherited arrhythmopathies, such as the long-QT syndrome and Brugada syndrome, is unsatisfactory at present. Changes in ventricular depolarization and repolarization as well as autonomic triggers play a pivotal role in the genesis of malignant tachyarrhythmias in these disorders. However, on...
Article
The study evaluated the effects of metoprolol, a pure beta-blocker, and d,l-sotalol, a beta-blocker with additional class III antiarrhythmic effects, on microvolt-level T-wave alternans (TWA). Assessment of TWA is increasingly used for purposes of risk stratification in patients prone to sudden death. There are only sparse data regarding the effect...
Article
OBJECTIVES The study evaluated the effects of metoprolol, a pure beta-blocker, and d,l-sotalol, a beta-blocker with additional class III antiarrhythmic effects, on microvolt-level T-wave alternans (TWA).BACKGROUND Assessment of TWA is increasingly used for purposes of risk stratification in patients prone to sudden death. There are only sparse data...
Article
Sudden cardiac death remains a therapeutic challenge for the clinical cardiologist. Although treatment of malignant ventricular tachyarrhythmias has been improved by introduction of the implantable cardioverter defibrillator (ICD) 20 years ago, primary prevention of fatal arrhythmic events in patients with structural heart diseases still constitute...
Article
Full-text available
The study was done to determine whether variables of QT dispersion from the 12-lead electrocardiogram (ECG) are dependent on heart rate. The dispersion of the QT interval is under evaluation as a risk marker in patients at risk for ventricular arrhythmias. Assuming that a similar rate correction is necessary as for the QT interval itself, investiga...
Article
Atrial Fibrillation and Appropriate ICD Therapy. Introduction: Atrial fibrillation(AF) is associated with significant morbidity and mortality that may be related to heniodynamic Impairment, thromboembolic events, or enhanced electrical instability of the ventricular myocardium. There is, however, a lack of data concerning the association of AF and...