5 results on '"Kottkamp H"'
Search Results
2. Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?
- Author
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Dagres N, Hindricks G, Kottkamp H, Sommer P, Gaspar T, Bode K, Arya A, Husser D, Rallidis LS, Kremastinos DT, and Piorkowski C
- Subjects
- Comorbidity, Female, Germany epidemiology, Humans, Incidence, Male, Middle Aged, Risk Assessment methods, Risk Factors, Survival Analysis, Survival Rate, Treatment Outcome, Atrial Fibrillation mortality, Atrial Fibrillation surgery, Catheter Ablation mortality, Postoperative Complications mortality
- Abstract
Introduction: Catheter ablation is potentially curative treatment for atrial fibrillation (AF). However, complications are more frequent and more severe compared with other ablation procedures. We investigated the complication rate in 1,000 AF ablation procedures in a high-volume center and examined possible risk factors., Methods and Results: One thousand consecutive circumferential pulmonary vein radiofrequency ablations were performed for symptomatic, drug-refractory AF. Major complications were defined as the ones that were life threatening, caused permanent harm, and required intervention or prolonged hospitalization. Thirty-nine (3.9%) major periprocedural complications were observed. There was no death immediately associated with the procedure. However, there were 2 deaths (0.2%) of unclear cause, 14 days and 4 weeks after ablation. The most common complications were tamponade (1.3%), treated mainly by percutaneous drainage, and vascular complications (1.1%). There were also 4 thromboembolic events (0.4%): 3 nonfatal strokes and one transient ischemic attack. Importantly, 2 cases (0.2%) of atrial-esophageal fistula and 2 cases (0.2%) of endocarditis were observed. Factors associated with an increased complication risk were age > or = 75 years (hazard ratio 3.977, P = 0.022) and congestive heart failure (hazard ratio 5.174, P = 0.001)., Conclusion: AF ablation still has a considerable number of major complications that may be life threatening or may lead to severe residues. Atrial-esophageal fistula is still observed despite continuous systematic methods to prevent it. Stroke, tamponade, and vascular complications are the most frequent major complications. However, in most patients treatment can be conservative and results in complete recovery. Advanced age and congestive heart failure seem to be associated with an increased risk of complications.
- Published
- 2009
- Full Text
- View/download PDF
3. Steerable sheath catheter navigation for ablation of atrial fibrillation: a case-control study.
- Author
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Piorkowski C, Kottkamp H, Gerds-Li JH, Arya A, Sommer P, Dagres N, Esato M, Riahi S, Weiss S, Kircher S, and Hindricks G
- Subjects
- Atrial Fibrillation diagnosis, Body Surface Potential Mapping methods, Cardiac Catheterization methods, Case-Control Studies, Female, Germany epidemiology, Humans, Male, Middle Aged, Treatment Outcome, Atrial Fibrillation epidemiology, Atrial Fibrillation surgery, Body Surface Potential Mapping statistics & numerical data, Cardiac Catheterization statistics & numerical data, Catheter Ablation methods
- Abstract
Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath., Methods and Results: In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow-up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 +/- 9 vs 41 +/- 4 W; P < 0.0005) and total RF energy delivery (97,498 vs 111,864 J; P < 0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P < 0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success., Conclusions: An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%.
- Published
- 2008
- Full Text
- View/download PDF
4. Intracardiac thrombus causing systemic embolism in a child with idiopathic ventricular tachycardia and heterozygous activated protein C resistance.
- Author
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Scheer K, Wild F, Kottkamp H, Battellini R, Schneider P, and Weidenbach M
- Subjects
- Child, Preschool, Female, Germany, Heterozygote, Humans, Protein C Deficiency, Tachycardia, Ventricular physiopathology, Thromboembolism etiology
- Abstract
Systemic embolism in childhood is rare but often disastrous. Most often the concomitant occurrence of more than one prothrombotic factor is responsible for the acute event. We report on a child in whom an intracardiac thrombus embolized into the descending aorta resulting in subtotal occlusion. Causative for thrombus formation was an idiopathic ventricular tachycardia and a heterozygous activated protein C resistance, both previously unknown. Immediate surgical thrombectomy was successful without sequelae. Antithrombotic and antiarrhythmispioproptylactic treatment was started afterwards. We suggest that in cases of longstanding or repeated tachycardia and in children after thromboembolic events diagnostic work-up for thrombophilia should be undertaken.
- Published
- 2006
- Full Text
- View/download PDF
5. Value of different follow-up strategies to assess the efficacy of circumferential pulmonary vein ablation for the curative treatment of atrial fibrillation.
- Author
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Piorkowski C, Kottkamp H, Tanner H, Kobza R, Nielsen JC, Arya A, and Hindricks G
- Subjects
- Atrial Fibrillation physiopathology, Clinical Trials as Topic, Electrocardiography, Electrocardiography, Ambulatory, Female, Follow-Up Studies, Germany, Humans, Male, Middle Aged, Prospective Studies, Telemetry, Time Factors, Atrial Fibrillation therapy, Catheter Ablation, Pulmonary Veins
- Abstract
Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear., Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly., Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30-40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after., Conclusions: The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients.
- Published
- 2005
- Full Text
- View/download PDF
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