627 results on '"Erik Wissner"'
Search Results
2. Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach
- Author
-
Shibu Mathew, Ardan M. Saguner, Niklas Schenker, Lukas Kaiser, Pengpai Zhang, Yoshiga Yashuiro, Christine Lemes, Thomas Fink, Tilman Maurer, Francesco Santoro, Peter Wohlmuth, Bruno Reißmann, Christian H. Heeger, Roland Tilz, Erik Wissner, Andreas Rillig, Andreas Metzner, Karl‐Heinz Kuck, and Feifan Ouyang
- Subjects
arrhythmogenic right ventricular dysplasia/cardiomyopathy ,catheter ablation ,epicardial ablation ,ventricular tachycardia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background It has been suggested that endocardial and epicardial ablation of ventricular tachycardia (VT) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1‐ and 5‐year outcome data for the first occurrence of the study end points (sustained VT/ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT/ventricular fibrillation for multiple procedures) are reported. Eighty‐one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty‐five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo‐ and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow‐up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT/ventricular fibrillation was 63% (95% CI, 52–75) at 1 year, and 45% (95% CI, 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P=0.058) towards an improved outcome using a combined endo‐/epicardial approach was observed after multiple procedures. Conclusion Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT, potentially obviating the need for an epicardial approach.
- Published
- 2019
- Full Text
- View/download PDF
3. Radiofrequency ablation of premature ventricular contractions originating from the aortomitral continuity localized by use of a novel noninvasive epicardial and endocardial electrophysiology system
- Author
-
Erik Wissner, MD, PhD, FHRS, Ardan M. Saguner, MD, Andreas Metzner, MD, PhD, Mikhail Chmelesky, MD, Alexey Tsyganov, MD, Sebastian Deiss, MD, Tilman Maurer, MD, and Karl-Heinz Kuck, MD, PhD, FHRS
- Subjects
Premature ventricular contraction ,Noninvasive mapping ,Aortomitral continuity ,Catheter ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2016
- Full Text
- View/download PDF
4. Should voltage mapping be an integral part of the cryoballoon ablation procedure?
- Author
-
Dana C. Johnson and Erik Wissner
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
5. Advances in Cardiac Electrophysiology
- Author
-
Jonathan P. Piccini, Andrea M. Russo, Parikshit S. Sharma, Jordana Kron, Wendy Tzou, William Sauer, David S. Park, Ulrika Birgersdotter-Green, David S. Frankel, Jeff S. Healey, John Hummel, Jacob Koruth, Dominik Linz, Suneet Mittal, Devi G. Nair, Stanley Nattel, Peter A. Noseworthy, Benjamin A. Steinberg, Natalia A. Trayanova, Elaine Y. Wan, Erik Wissner, Emily P. Zeitler, and Paul J. Wang
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.
- Published
- 2022
6. Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis
- Author
-
Christian-H Heeger, Sorin Ștefan Popescu, Christian Sohns, Alexander Pott, Andreas Metzner, Osamu Inaba, Florian Straube, Malte Kuniss, Arash Aryana, Shinsuke Miyazaki, Serkan Cay, Joachim R Ehrlich, Ibrahim El-Battrawy, Martin Martinek, Ardan M Saguner, Verena Tscholl, Kivanc Yalin, Evgeny Lyan, Wilber Su, Giorgi Papiashvili, Maichel Sobhy Naguib Botros, Alessio Gasperetti, Riccardo Proietti, Erik Wissner, Daniel Scherr, Masashi Kamioka, Hisaki Makimoto, Tsuyoshi Urushida, Tolga Aksu, Julian K R Chun, Kudret Aytemir, Ewa Jędrzejczyk-Patej, Karl-Heinz Kuck, Tillman Dahme, Daniel Steven, Philipp Sommer, and Roland Richard Tilz
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
AimsCryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures.Methods and resultsIn the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 ± 45.1 s in patients with persistent PVI and 133.5 ± 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence.ConclusionIn patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT03645577?term=YETI&cntry=DE&draw=2&rank=1 ClinicalTrials.gov Identifier: NCT03645577.
- Published
- 2022
7. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry
- Author
-
Christian-H. Heeger, Christian Sohns, Alexander Pott, Andreas Metzner, Osamu Inaba, Florian Straube, Malte Kuniss, Arash Aryana, Shinsuke Miyazaki, Serkan Cay, Joachim R. Ehrlich, Ibrahim El-Battrawy, Martin Martinek, Ardan M. Saguner, Verena Tscholl, Kivanc Yalin, Evgeny Lyan, Wilber Su, Giorgi Papiashvili, Maichel Sobhy Naguib Botros, Alessio Gasperetti, Riccardo Proietti, Erik Wissner, Daniel Scherr, Masashi Kamioka, Hisaki Makimoto, Tsuyoshi Urushida, Tolga Aksu, Julian K.R. Chun, Kudret Aytemir, Ewa Jędrzejczyk-Patej, Karl-Heinz Kuck, Tillman Dahme, Daniel Steven, Philipp Sommer, and Roland Richard Tilz
- Subjects
Male ,Time Factors ,cryoballoon ,Iatrogenic Disease ,Cryosurgery ,Risk Assessment ,phrenic nerve injury ,Peripheral Nerve Injuries ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,catheter ablation ,Humans ,Registries ,Aged ,Retrospective Studies ,Incidence ,Original Articles ,Middle Aged ,Phrenic Nerve ,Treatment Outcome ,Pulmonary Veins ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Cardiology and Cardiovascular Medicine - Abstract
Supplemental Digital Content is available in the text., Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
- Published
- 2021
8. Abstract 11351: Efficacy of Catheter Ablation for Atrial Fibrillation Across Race-Ethnicity
- Author
-
Bahaa Al-azzam, Annette Diaz, Taylor Tso, Miles Barney, Pranati Sreepathy, Mustafa Ali, Ishita Aggarwal, Miguel Perez, Victor Qiao, Ana Ongtengco, Sreenivas Konda, Erik Wissner, and Dawood Darbar
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Catheter ablation (CA) is now an established therapy for symptomatic atrial fibrillation (AF). Although the procedural success rate is high, the role of race-ethnicity and clinical predictors in preventing recurrence of AF remains unclear. Methods: Patients prospectively enrolled in an AF clinical-DNA biorepository and treated with CA for AF were included in the study. Recurrence of AF was assessed with symptom assessment, ECG, Holter, and event recorder evaluations in all patients during follow-up visits and Holter recordings were done when appropriate. Recurrence of AF was defined as AF detected Results: Of the 238 enrolled, 84 (35.3%) were European American (EAs), 106 (44.5%) were African American (AA) and 48 (20.2%) were Hispanic American (HA). Baseline clinical characteristics were similar across the groups. Eighty-eight (37%) patients had AF recurrence within 12 months of CA. Multivariate analysis showed that compared to EAs, AAs (odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.96, P+0.048) and HAs (OR 0.42, 95% CI: 0.18 - 0.94, P+0.048) are less likely to experience AF recurrence after CA (Table 1). Other clinical predictors included left atrial dilatation (OR 1.88, 95% 1.04 - 3.44, P+0.036), persistent AF (OR] 1.94, 95% [CI]: 1.04-3.64, P+0.074), valvular heart disease (VHD) (OR 2.66, 95% CI: 1.02-7.20; P=0.046) and history of smoking (OR 2.16, 95% CI: 1.18-3.99; P=0.012). Conclusion: We showed that clinical predictors of recurrence of AF after CA included left atrial dilatation, VHD, persistent AF and a history of smoking. Surprisingly, we found that AAs and HAs were less likely to experience AF recurrence than EAs and reasons for this differential response remains unclear.
- Published
- 2021
9. Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons
- Author
-
Jean-Pierre Lalonde, Erik Wissner, Michael K. Getman, and Ravi Ranjan
- Subjects
computational modeling ,Time Factors ,cryoballoon ,medicine.medical_treatment ,Operative Time ,Action Potentials ,Catheter ablation ,030204 cardiovascular system & hematology ,Arctic front ,Balloon ,Cryosurgery ,Cardiac Catheters ,Pulmonary vein ,Experimental ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Physiology (medical) ,Atrial Fibrillation ,catheter ablation ,medicine ,Humans ,Computer Simulation ,030212 general & internal medicine ,Dosing ,pulmonary vein isolation ,Cryoballoon ablation ,business.industry ,Models, Cardiovascular ,Cryoablation ,Equipment Design ,Original Articles ,Ablation ,Pulmonary Veins ,Cardiology and Cardiovascular Medicine ,business ,Biomedical engineering - Abstract
Background Preclinical and clinical studies have utilized periprocedural parameters to optimize cryoballoon ablation dosing, including acute time-to-isolation (TTI) of the pulmonary vein, balloon rate of freezing, balloon nadir temperature, and balloon-thawing time. This study sought to predict the Arctic Front Advance (AFA) vs Arctic Front Advance Pro (AFA Pro) ablation durations required for transmural pulmonary vein isolation at varied tissue depths. Methods A cardiac-specific, three-dimensional computational model that incorporates structural characteristics, temperature-dependent cellular responses, and thermal-conductive properties was designed to predict the propagation of cold isotherms through tissue. The model assumed complete cryoballoon-to-pulmonary vein (PV) circumferential contact. Using known temperature thresholds of cardiac cellular electrical dormancy (at 23°C) and cellular nonviability (at -20°C), transmural time-to-isolation electrical dormancy (TTIED ) and cellular nonviability (TTINV ) were simulated. Results For cardiac thickness of 0.5, 1.25, 2.0, 3.0, 4.0, and 5.0 mm, the 23°C isotherm passed transmurally in 33, 38, 46, 62, 80, and 95 seconds during cryoablation utilizing AFA and 33, 38, 46, 63, 80, and 95 seconds with AFA Pro. Using the same cardiac thicknesses, the -20°C isotherm passed transmurally in 40, 55, 78, 161, 354, and 696 seconds during cryoablation with AFA and 40, 54, 78, 160, 352, and 722 seconds with AFA Pro. Conclusion This model predicted a minimum duration of cryoballoon ablation (TTINV ) to obtain a transmural lesion when acute TTI of the PV was observed (TTIED ). Consequently, the model is a useful tool for characterizing CBA dosing, which may guide future cryoablation dosing strategies.
- Published
- 2019
10. Time-to-effect guided pulmonary vein isolation utilizing the third-generation versus second generation cryoballoon: One year clinical success
- Author
-
Erik Wissner, Thomas Fink, Feifan Ouyang, Valentina Seitelberger, Christopher Schuette, Francesco Santoro, Andreas Metzner, Christian-Hendrik Heeger, Karl-Heinz Kuck, Osamu Inaba, Bruno Reissmann, Andreas Rillig, Naotaka Hashiguchi, Shibu Mathew, Christine Lemes, and Tilman Maurer
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Time to effect ,Clinical Cardiology ,030204 cardiovascular system & hematology ,Cryosurgery ,Clinical success ,Cardiac Catheters ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Recurrence ,Interquartile range ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Aged ,Retrospective Studies ,business.industry ,Atrial fibrillation ,Equipment Design ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Third generation ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Female ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging and reproducible clinical outcome data. The latest- -generation cryoballoon (CB3) incorporates a 40% shorter distal tip, thus allowing for an increased rate of PVI real-time signal recording and facilitating individualized ablation strategies taking the time-to- -effect (TTE) into account. However, whether this characteristic translates into favorable clinical success has not been evaluated yet. Herein was investigated 1-year clinical success after CB3 in comparison to CB2 based-PVI. Methods: One hundred and ten consecutive patients with paroxysmal or short-standing persistent atrial fibrillation (AF) underwent CB2 (n = 55 patients) -or CB3 (n = 55 patients) -based PVI. The freeze-cycle duration was set to TTE + 120 s if TTE could be recorded, otherwise a fixed freeze-cycle duration of 180 s was applied. Results: A total of 217/218 (99%, CB3) and 217/217 (100%, CB2) pulmonary veins (PV) were successfully isolated. The real-time PVI visualization rate was 69.2% (CB3) and 54.8% (CB2; p = 0.0392). The mean freeze-cycle duration was 194 ± 77 s (CB3) and 206 ± 85 s (CB2; p = 0.132), respectively. During a median follow-up of 409 days (interquartile range [IQR] 378–421, CB3) and 432 days (IQR 394–455, CB2) 73.6% (CB3) and 73.1% of patients (CB2) remained in stable sinus rhythm after a single procedure (p = 0.806). Conclusions: A higher rate of real-time electrical PV recordings was seen using the CB3 as compared to CB2. There was no difference in 1-year clinical follow-up.
- Published
- 2019
11. Case report: Cryoballoon ablation of the mitral isthmus using a novel mapping system
- Author
-
Erik Wissner and Patrick Badertscher
- Subjects
Epicardial Mapping ,Male ,medicine.medical_specialty ,animal structures ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cryosurgery ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Major complication ,Cryoballoon ablation ,urogenital system ,business.industry ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Mapping system ,embryonic structures ,cardiovascular system ,Mitral Valve ,Mitral isthmus ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Radiofrequency energy ,Atrial flutter - Abstract
Perimitral atrial flutter is commonly treated by deployment of a mitral isthmus line. However, the creation of a contiguous, transmural linear lesion across the anterior mitral isthmus using radiofrequency energy ablation is technically challenging and can be associated with major complications. Herein, we describe the successful deployment of a superolateral mitral isthmus line using the 28-mm cryoballoon in combination with a new mapping system.
- Published
- 2019
12. PO-651-01 THE YETI REGISTRY: RESULTS OF A WORLD-WIDE ANALYSIS OF PHRENIC NERVE INJURY DURING CRYOBALOON BASED PULMONARY VEIN ISOLATION
- Author
-
Christian H. Heeger, Christian Sohns, Alexander Pott, Andreas Metzner, Osamu Inaba, Florian Straube, Malte Kuniss, Arash Aryana, Shinsuke Miyazaki, SERKAN CAY, Joachim R. Ehrlich, Martin Martinek, Ardan Saguner, Verena Tscholl, Kivanc Yalin, Evgeny Lyan, Wilber W. Su, Giorgi Papiashvili, MAICHEL Sobhy naguib Botros, Alessio Gasperetti, Riccardo Proietti, Erik Wissner, Daniel Scherr, Masashi Kamioka, Hisaki Makimoto, Tolga Aksu, Julian Kyoung-Ryul Chun, KUDRET AYTEMIR, Karl-Heinz Kuck, Tillman Dahme, Daniel Steven, Philipp Sommer, and Roland R. Tilz
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
13. What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring
- Author
-
Bruno Reißmann, Christian-Hendrik Heeger, Feifan Ouyang, Barbara Bellmann, Thomas Fink, Tilman Maurer, Andreas Metzner, Karl-Heinz Kuck, Erik Wissner, Mattias Roser, Laura Rottner, Ulf Landmesser, Francesco Santoro, Shibu Mathew, Peter Wohlmuth, Verena Tscholl, Christine Lemes, Omar Salloum, Britta Goldmann, and Andreas Rillig
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Cryosurgery ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Recurrence ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Implantable loop recorder ,Humans ,Medicine ,Heart Atria ,030212 general & internal medicine ,Lead (electronics) ,Aged ,business.industry ,Atrial fibrillation ,Equipment Design ,medicine.disease ,Implantable cardioverter-defibrillator ,Confidence interval ,Defibrillators, Implantable ,Treatment Outcome ,Pulmonary Veins ,Cohort ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results for the treatment of paroxysmal atrial fibrillation (AF) and persistent AF. However, rhythm follow-up after PVI is mainly based on Holter electrocardiography of limited duration. Objective The purpose of this study was to assess the real AF burden following CB2-based PVI in patients with implanted cardiac devices. Methods A total of 670 consecutive patients underwent CB2-based PVI at 3 electrophysiology centers. In 66 patients (9.9%), an implantable cardiac device with continuous monitor function was independently implanted before the procedure (device group). This patient cohort was compared to propensity score-matched patients without cardiac devices (n = 66; control group). Results A total of 254 of 258 PVs (98.4%0 in the device group were successfully isolated using only CB2. Postprocedural device interrogation found no device or lead malfunction related to the procedure. Periprocedural complications were registered in 7 of 66 patients (11%) in the device group and in 6 of 66 patients (9%) in the control group (P = .770). Phrenic nerve palsy occurred in 6 of 66 patients (9%) in the device group) and in 2 of 66 patients (3%) in the control group) (P = .274). Clinical success in terms of freedom from AF recurrence after a 1-year follow-up period was 63.8% (95% confidence interval 53–77) in the device group and 77.3% (95% confidence interval 68–88) in the control group (P = .038). In the device group, AF/AT burden decreased from 41.8% ± 35.0% before the procedure to 10.2% ± 22.4% after 1 year (P Conclusion CB2-PVI seems safe and feasible in patients with an implanted cardiac device. A significantly higher AF/AT burden was seen in patients with an implanted cardiac device compared to a control group.
- Published
- 2018
14. Complications and mortality after catheter ablation of ventricular arrhythmias: risk in VT ablation (RIVA) score
- Author
-
Sebastian Feickert, Peter Wohlmuth, Erik Wissner, Michael Schlüter, Karl-Heinz Kuck, Christian-Hendrik Heeger, Feifan Ouyang, Laura Rottner, Roland Richard Tilz, Andreas Rillig, Bruno Reissmann, Andreas Metzner, Naotaka Hashiguchi, Shibu Mathew, Thomas Fink, Osamu Inaba, and Tilman Maurer
- Subjects
medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Cardiac tamponade ,Medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Framingham Risk Score ,business.industry ,Arrhythmias, Cardiac ,General Medicine ,Ablation ,medicine.disease ,Cardiac Tamponade ,Treatment Outcome ,Cardiology ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Aims Catheter ablation of ventricular arrhythmias (VA) has proven to be an effective therapeutic option for secondary arrhythmia prophylaxis. We sought to assess the procedural efficacy, safety and in-hospital mortality of a large patient cohort with and without structural heart disease undergoing VA ablation. Methods A total of 1417 patients (804 patients with structural heart disease) undergoing 1792 endo- and epicardial procedures were analyzed. Multivariable risk factor analysis for occurrence of major complications and intrahospital mortality was obtained and a score to allow preprocedural risk assessment for patients undergoing VA ablation procedures was established. Results Major complication occurred in 4.4% of all procedures and significantly more often in patients with structural heart disease than in structurally normal hearts (6.0 vs. 1.8%). The frequency of these periprocedural complications was significantly different between procedures with sole right ventricular and a combination of RV and LV access (0.5 vs. 3.1%). The most common complication was cardiac tamponade in 46 cases (3.0%). Intrahospital death was observed in 32 patients (1.8%). Logistic regression model revealed presence of ischemic heart disease, epicardial ablation, presence of oral anticoagulation or dual antiplatelet therapy as independent risk factors for the occurrence of complications or intrahospital death, while a history of previous heart surgery was an independent predictor with a decreased risk. Based on this analysis a risk score incorporating 5 standard variables was established to predict the occurrence of complications and intrahospital mortality. Conclusions Safety of VA catheter ablation mainly relies on patient baseline characteristics and the type of access into the ventricles or epicardial space.
- Published
- 2020
15. Ablation of atrial fibrillation using the fourth-generation cryoballoon Arctic Front Advance PRO
- Author
-
Erik Wissner
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ablation of atrial fibrillation ,Catheter ablation ,Arctic front ,Cryosurgery ,Pulmonary vein ,Electrical isolation ,Internal medicine ,Atrial Fibrillation ,Fourth generation ,Medicine ,Humans ,Retrospective Studies ,business.industry ,digestive, oral, and skin physiology ,Atrial fibrillation ,Equipment Design ,Ablation ,medicine.disease ,Treatment Outcome ,Cardiology ,Molecular Medicine ,Cardiology and Cardiovascular Medicine ,business ,geographic locations - Abstract
The cryoballoon (CB) is a popular ablation technology used for pulmonary vein isolation. The fourth-generation CB, Arctic Front Advance PRO features a 40% shorter distal tip but retains the internal design from its second-generation predecessor. The Arctic Front Advance PRO and the second-generation CB demonstrated similar thermodynamic characteristics in a computational model. Several observational and retrospective studies established the acute safety and efficacy of the Arctic Front Advance PRO. Real-time electrical isolation was observed in 75–85% of pulmonary veins targeted with the Arctic Front Advance PRO resulting in shorter fluoroscopy and procedure times.
- Published
- 2020
16. The predicament of an electrophysiologist: Ablating the left common pulmonary vein
- Author
-
Erik Wissner
- Subjects
medicine.medical_specialty ,Cardiac electrophysiology ,business.industry ,Radiofrequency ablation ,Atrial fibrillation ,medicine.disease ,law.invention ,law ,Pulmonary Veins ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Cardiology ,medicine ,Catheter Ablation ,Humans ,Heart Atria ,Cardiology and Cardiovascular Medicine ,business ,Left common pulmonary vein - Published
- 2020
17. Second-generation cryoballoon-based pulmonary vein isolation: Lessons from a five-year follow-up
- Author
-
Peter Wohlmuth, Christian-Hendrik Heeger, Karl-Heinz Kuck, Erik Wissner, Shibu Mathew, Tilman Maurer, Feifan Ouyang, Andreas Rillig, Christine Lemes, Roland Richard Tilz, Andreas Metzner, Bruno Reissmann, Behnam Subin, and Thomas Fink
- Subjects
medicine.medical_specialty ,Time Factors ,Radiofrequency ablation ,030204 cardiovascular system & hematology ,Cryosurgery ,law.invention ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,law ,Recurrence ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,Sinus rhythm ,In patient ,030212 general & internal medicine ,Paroxysmal AF ,business.industry ,Five year follow up ,Atrial fibrillation ,medicine.disease ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB2) for atrial fibrillation (AF) treatment has demonstrated encouraging procedural success rates and mid-term results. However, long-term follow-up data on outcome is sparse. The current study is reporting on five-year clinical outcomes following CB2-based PVI in patients with paroxysmal AF (PAF) and persistent AF (PersAF). Methods A total of 139 patients underwent index CB2-based PVI patients (PAF: n = 105, 76% and PersAF: n = 34, 34%) in two electrophysiology centers. Freeze-cycle duration was 240 s. After successful PVI a bonus freeze-cycle of the same duration was applied in the first 71 patients while the bonus-freeze was omitted in 68 following patients. Three patients (2.2%) were lost to follow-up. Results After a median follow-up duration of 60 months (interquartile range: 46, 72 months) 74/136 (54.4%) patients remained in stable sinus rhythm (PAF: 62/104, 59.6%; PersAF: 15/32, 46.9%). Significant differences were observed concerning 5-year clinical outcome between PAF and PersAF patients (p = 0.0315). After a mean of 1.32 ± 0.6 procedures (2nd and 3rd procedure by radiofrequency ablation) and a median follow-up duration of 60 (37, 68) months 90/136 (66.2%) patients remained in stable sinus rhythm (PAF: 72/104 (69.2%), PersAF: 21/32 (65.6%), p = 0.0276). For the comparison of bonus-freeze vs no-bonus-freeze protocols no differences were observed (53.5% vs 57.4%, p = 0.650). Conclusions The five-year single-procedure success rate for CB2-based PVI was 54.4% and increased to 66.2% following repeat RF-based procedures. No differences were detected comparing bonus-freeze and no-bonus-freeze protocols.
- Published
- 2020
18. Mapping of ventricular arrhythmias using a novel noninvasive epicardial and endocardial electrophysiology system
- Author
-
Andreas Metzner, Karl-Heinz Kuck, Erik Wissner, Mikhail Chmelevsky, Christine Lemes, Maria Chaykovskaya, S. Mironovich, Alexey Tsyganov, and Vitaly Kalinin
- Subjects
Adult ,Epicardial Mapping ,Male ,medicine.medical_specialty ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Coronary Angiography ,Imaging data ,Electrocardiography ,03 medical and health sciences ,Electrophysiology study ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Cardiac mapping ,medicine.diagnostic_test ,business.industry ,Arrhythmias, Cardiac ,Mean age ,Middle Aged ,medicine.disease ,Electrophysiological Phenomena ,Electrophysiology ,Nonischemic cardiomyopathy ,Anesthesia ,cardiovascular system ,Cardiology ,Female ,Cardiomyopathies ,Electrophysiologic Techniques, Cardiac ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Endocardium - Abstract
Introduction The aim of this study was to assess the use of a novel noninvasive epicardial and endocardial electrophysiology system (NEEES) for mapping of ventricular arrhythmias. Methods Eight patients (2 females, mean age 50 ± 17 years) with ischemic (n = 3) and nonischemic (n = 5) cardiomyopathy and inducible ventricular arrhythmias during electrophysiology study were enrolled. Noninvasive mapping of ventricular arrhythmias was performed using the NEEES based on body-surface electrocardiograms and computed tomography imaging data. Arrhythmia patterns were analyzed using noninvasive phase mapping. Results Macro-reentrant VT circuits were observed in 3 ischemic and 1 nonischemic cardiomyopathy patient, respectively. In the remaining 4 patients, phase mapping revealed relatively stable rotor activity and multiple wavelets. Conclusions Noninvasive cardiac mapping was able to visualize the macro-reentrant circuits in patients with scar-related VT. In patients without myocardial scar only polymorphic VT or VF was inducible, and rotor activity and multiple wavelets were observed.
- Published
- 2018
19. Cryoballoon pulmonary vein isolation and voltage mapping for symptomatic atrial fibrillation 9 months after Watchman device implantation
- Author
-
Zenith A Jameria, Erik Wissner, Henry D. Huang, Sorin Lazar, Parikshit S. Sharma, Richard G. Trohman, and Viren Patel
- Subjects
medicine.medical_specialty ,Isolation (health care) ,Left atrial appendage ,medicine.medical_treatment ,Population ,Case Report ,Catheter ablation ,Ablation ,030204 cardiovascular system & hematology ,Cryoballoon ,Left atrial appendage occlusion ,Watchman device ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,Atrial fibrillation ,medicine.disease ,Catheter ,RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,PVI - Abstract
Left atrial appendage occlusion (LAAO) with the Watchman device (Boston Scientific, Natick, MA) is frequently performed as a nonpharmacologic, second-line therapy for stroke prevention in patients with atrial fibrillation (AF)1, 2 and contraindications to long-term anticoagulation. Although combined catheter pulmonary vein isolation (PVI) and Watchman procedures may be performed successfully for patients with symptomatic AF, a simultaneous approach is not always feasible or in some cases PVI may not be clinically indicated at the time of Watchman implantation. Staged radiofrequency PVI and left atrial (LA) catheter ablation following Watchman device placement has been shown to be feasible3, 4, 5; however, other modalities for PVI have not been reported in the postimplant population.
- Published
- 2018
20. Higher contact force, energy setting, and impedance rise during radiofrequency ablation predicts charring: New insights from contact force-guided in vivo ablation
- Author
-
Karl-Heinz Kuck, Andreas Rillig, Hisaki Makimoto, Feifan Ouyang, Tina Lin, Erik Wissner, Christine Lemes, Roland Richard Tilz, Christian-H. Heeger, Shibu Mathew, and Andreas Metzner
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Radiofrequency ablation ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Cardiac Catheters ,030218 nuclear medicine & medical imaging ,law.invention ,Contact force ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,In vivo ,law ,Physiology (medical) ,Atrial Fibrillation ,Electric Impedance ,Pressure ,Humans ,Medicine ,Char ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Female ,Charring ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Higher contact force (CF) theoretically increases the risk of blood charring, diminishing lesion formation. We aimed to investigate the relationship between CF, impedance change, and char formation during pulmonary vein isolation (PVI).CF was assessed during PVI in 65 patients. Radiofrequency ablation (RFA) with power-controlled mode was applied in the point-by-point manner. The RFA were divided into five groups: group A (CF 10 g), group B (10 g ≤ CF 20 g), group C (20 g ≤ CF 30 g), group D (30 g ≤ CF 40 g), and group E (CF ≥ 40 g). Gradual impedance rise (gIR) was defined as 5 Ω increase during each 10-second period of RFA. Catheter tip was assessed for charring during, and at the end of each procedure.In total, 2,064 applications were analyzed. During 0-10 seconds, impedance was significantly decreased in groups with higher CF (P 0.05). During 10-20 seconds, an impedance decrease was not significantly different among the five groups. During 20-30 seconds, mean impedance increased in group E. A gIR was noted at least once during RFA in 63 patients (97%). The incidence of gIR during RFA after 20 seconds was significantly higher in groups D and E (77/504 [15.3%] vs. 90/1560 [5.8%], P 0.001). Charring occurred in 8 of 65 (12%) patients. A gIR after 20 seconds was significantly associated with a higher incidence of macroscopic charring (6/20 [30%] vs. 2/45 [4%], P 0.01).gIR was noted with higher applied CFs after 20 seconds of RFA. This impedance rise may be avoided by keeping the applied CF under 26.9 g with negative predictive value of 95%. Our data suggested that gIR may be related to the incidence of charring.
- Published
- 2017
21. Durability of wide-area left atrial appendage isolation: Results from extensive catheter ablation for treatment of persistent atrial fibrillation
- Author
-
Peter Wohlmuth, Francesco Santoro, Michael Schlüter, Feifan Ouyang, Roland Tilz, Johannes Riedl, Andreas Rillig, Erik Wissner, Christine Lemes, Tilman Maurer, Christian Heeger, Shibu Mathew, Andreas Metzner, Christian Sohns, Bruno Reissmann, Karl-Heinz Kuck, and Thomas Fink
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Atrial Appendage ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Germany ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Secondary Prevention ,medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Aged ,business.industry ,Thrombosis ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
Background Extensive ablation strategies are currently performed in addition to pulmonary vein isolation (PVI) to improve the clinical outcome of patients with drug-refractory persistent atrial fibrillation (AF). Ablation of complex fractionated atrial electrograms (CFAEs), linear lesions, and/or isolation of the left atrial appendage (LAA) are thought to improve arrhythmia-free survival. Objective The purpose of this study was to assess the durability of wide-area left atrial appendage isolation (LAAI) achieved by PVI, an anterior line, and a mitral isthmus line. Methods Seventy-one patients with intentional or incidental LAAI during repeat catheter ablation for treatment of persistent AF were included. The initial ablation strategy was PVI. Additional ablation strategies were performed only if PVI failed to maintain stable sinus rhythm. Durability of LAAI was assessed during a subsequent ablation procedure for arrhythmia recurrences (n = 23) or a subsequent percutaneous LAA closure (n = 48). Results LAAI was performed after a mean of 3 ± 1 procedures. Ablation strategies included circumferential PVI in 71 patients (100%), mitral isthmus line in 64 (90%), anterior line in 60 (85%), CFAE in 27 (38%), and roof line in 13 (18%). LAAI occurred after ablation and bidirectional block of LA linear lesions in 63 patients (89%) and during extensive CFAE ablation in 8 patients (11%). After a median of 105 [61;426] days, the LAA remained electrically isolated in 52 of 71 patients (73%). Conclusion Wide-area LAAI after extensive catheter ablation for persistent AF is durable in the majority of patients. The potential clinical benefit of LAAI for maintaining stable sinus rhythm requires further investigation.
- Published
- 2017
22. Focal Impulse and Rotor Modulation for the Treatment of Atrial Fibrillation: Locations and 1 Year Outcomes of Human Rotors Identified Using a 64-Electrode Basket Catheter
- Author
-
Tudor Bucur, Andreas Metzner, Leonie Scholz, Peter Wohlmuth, Tina Lin, Roland Richard Tilz, Karl-Heinz Kuck, Christian-H. Heeger, Andreas Rillig, Erik Wissner, Feifan Ouyang, and Shibu Mathew
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Atrial fibrillation ,030204 cardiovascular system & hematology ,Impulse (physics) ,medicine.disease ,Ablation ,Surgery ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Right atrium ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Basket catheter ,business ,Antrum - Abstract
Rotor Locations and 1 Year Outcomes of FIRM AblationIntroduction Pulmonary vein isolation (PVI) is currently the gold standard for catheter ablation of atrial fibrillation (AF). The mechanism for AF-maintenance is still controversial. The concept of rapidly activating spiral rotors perpetuating AF has led to the development of several rotor-mapping systems. We present our experience with focal impulse and rotor modulation (FIRM) using a 64-electrode basket catheter and computational system and evaluate its feasibility in conjunction with PVI to treat AF. Methods and Results Twenty-five patients underwent FIRM mapping and ablation to treat AF (paroxysmal = 10, 40%). A basket catheter was used for rotor identification within the right atrium (RA) then left atrium (LA). Radiofrequency energy was applied at and around each rotor core for 300 seconds and rotor-mapping and ablation was repeated until all rotors were eliminated before circumferential PVI was performed. Three (1.0, 4.0) rotors were identified per patient, predominantly in the LA (LA = 59). Note that 7/59 left-sided rotors were located 8/59 at the PV antrum. Twelve (48%) patients had either AF termination (termination = 6/12) or conversion to another rhythm, or cycle length (CL) prolongation ≥10% after rotor ablation. After a single procedure, 13 (52%) patients were free of atrial tachyarrhythmia after a follow-up period of 13 ± 1 months. Conclusion Early results suggest that FIRM-ablation can terminate AF in a significant number of patients. Rotors were frequently identified in the PVs and PV antrum, supporting PVI as the cornerstone of AF ablation.
- Published
- 2017
23. MAGNETIC VT study: a prospective, multicenter, post-market randomized controlled trial comparing VT ablation outcomes using remote magnetic navigation-guided substrate mapping and ablation versus manual approach in a low LVEF population
- Author
-
Jan Skoda, Peter Weiss, Roderick Tung, J. David Burkhardt, Tamas Szili-Torok, Magnetic Vt investigators, Dhanunjaya Lakkireddy, Ken Lock, Erik Wissner, Rene Tavernier, William Spear, Andrea Natale, Adam E. Berman, Luigi Di Biase, Xu Chen, Petr Neužil, Bruno Schwagten, and Cardiology
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Substrate mapping ,Adolescent ,medicine.medical_treatment ,Population ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Magnetics ,Ventricular Dysfunction, Left ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Single-Blind Method ,030212 general & internal medicine ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Ischemic cardiomyopathy ,business.industry ,Remote magnetic navigation ,Body Surface Potential Mapping ,Stroke Volume ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,United States ,Treatment Outcome ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with ischemic cardiomyopathy (ICM) are prone to scar-related ventricular tachycardia (VT). The success of VT ablation depends on accurate arrhythmogenic substrate localization, followed by optimal delivery of energy provided by constant electrode-tissue contact. Current manual and remote magnetic navigation (RMN)-guided ablation strategies aim to identify a reentry circuit and to target a critical isthmus through activation and entrainment mapping during ongoing tachycardia. The MAGNETIC VT trial will assess if VT ablation using the Niobe™ ES magnetic navigation system results in superior outcomes compared to a manual approach in subjects with ischemic scar VT and low ejection fraction. This is a randomized, single-blind, prospective, multicenter post-market study. A total of 386 subjects (193 per group) will be enrolled and randomized 1:1 between treatment with the Niobe ES system and treatment via a manual procedure at up to 20 sites. The study population will consist of patients with ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) of ≤35% and implantable cardioverter defibrillator (ICD) who have sustained monomorphic VT. The primary study endpoint is freedom from any recurrence of VT through 12 months. The secondary endpoints are acute success; freedom from any VT at 1 year in a large-scar subpopulation; procedure-related major adverse events; and mortality rate through 12-month follow-up. Follow-up will consist of visits at 3, 6, 9, and 12 months, all of which will include ICD interrogation. The MAGNETIC VT trial will help determine whether substrate-based ablation of VT with RMN has clinical advantages over manual catheter manipulation. Clinicaltrials.gov identifier: NCT02637947
- Published
- 2017
24. The importance of antral pulmonary vein isolation during visually‐guided laser balloon ablation
- Author
-
Erik Wissner
- Subjects
medicine.medical_specialty ,Isolation (health care) ,business.industry ,Lasers ,medicine.medical_treatment ,Visually guided ,Atrial fibrillation ,Ablation ,medicine.disease ,Balloon ,Pulmonary vein ,Pulmonary Veins ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,medicine ,Humans ,Laser Therapy ,Radiology ,Cardiology and Cardiovascular Medicine ,Pulmonary vein stenosis ,business ,Antrum - Published
- 2020
25. Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach
- Author
-
Thomas Fink, Lukas Kaiser, Tilman Maurer, Ardan M. Saguner, Francesco Santoro, Christian Heeger, Christine Lemes, Yoshiga Yashuiro, Niklas Schenker, Peng-Pai Zhang, Karl-Heinz Kuck, Roland Tilz, Andreas Metzner, Peter Wohlmuth, Bruno Reißmann, Shibu Mathew, Erik Wissner, Andreas Rillig, Feifan Ouyang, University of Zurich, and Mathew, Shibu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Cardiomyopathy ,medicine.medical_treatment ,Epicardial ablation ,Action Potentials ,Catheter ablation ,610 Medicine & health ,arrhythmogenic right ventricular dysplasia/cardiomyopathy ,epicardial ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Right ventricular cardiomyopathy ,2705 Cardiology and Cardiovascular Medicine ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Recurrence ,Risk Factors ,Internal medicine ,catheter ablation ,Medicine ,Humans ,In patient ,Arrhythmia and Electrophysiology ,030212 general & internal medicine ,Arrhythmogenic Right Ventricular Dysplasia ,Original Research ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Dysplasia ,Cardiology ,10209 Clinic for Cardiology ,Tachycardia, Ventricular ,Female ,ventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business ,Catheter Ablation and Implantable Cardioverter-Defibrillator ,Pericardium ,Endocardium - Abstract
Background It has been suggested that endocardial and epicardial ablation of ventricular tachycardia ( VT ) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1‐ and 5‐year outcome data for the first occurrence of the study end points (sustained VT /ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT /ventricular fibrillation for multiple procedures) are reported. Eighty‐one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty‐five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo‐ and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow‐up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT /ventricular fibrillation was 63% (95% CI , 52–75) at 1 year, and 45% (95% CI , 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P =0.058) towards an improved outcome using a combined endo‐/epicardial approach was observed after multiple procedures. Conclusion Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT , potentially obviating the need for an epicardial approach.
- Published
- 2019
26. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital Heart Disease, endorsed by HRS, PACES, APHRS, and SOLAECE
- Author
-
Georgia Sarquella-Brugada, Laurent Pison, J Kautzner, Fabrizio Drago, Nikolaos Dagres, Erik Wissner, Pastora Gallego, Tamas Szili-Torok, Thomas Paul, Thomas Kriebel, Jian Chen, Antonio Hernández-Madrid, Nico A. Blom, Laszlo Kornyei, Massimo Chessa, Gerhard P. Diller, Rafael A. Peinado, Shigeru Tateno, Narayanswami Sreeram, Nicolas Combes, Dominic Abrams, Javier Moreno, Ornella Milanesi, Jan Janoušek, Jonathan R. Skinner, Jose M. Moltedo, Peter F. Aziz, Armando Alfaro, Christian Sticherling, Markus Schwerzmann, Werner Budts, Joachim Hebe, Eric Rosenthal, Katja Zeppenfeld, Alessandro Giamberti, Philipp Sommer, Sabine Ernst, Dhiraj Gupta, Anne M. Dubin, Hernández-Madrid, A, Paul, T, Abrams, D, Aziz, Pf, Blom, Na, Chen, J, Chessa, M, Cardiology, ACS - Amsterdam Cardiovascular Sciences, Paediatric Cardiology, ACS - Heart failure & arrhythmias, Cardiologie, RS: CARIM - R2.01 - Clinical atrial fibrillation, and MUMC+: MA Med Staf Spec Cardiologie (9)
- Subjects
Heart disease ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ablation ,Sudden cardiac death ,0302 clinical medicine ,LONG-TERM OUTCOMES ,IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS ,RADIOFREQUENCY CATHETER ABLATION ,030212 general & internal medicine ,education.field_of_study ,CARDIAC-RESYNCHRONIZATION THERAPY ,Cardiac resynchronization therapy ,European Heart Rhythm Association position paper ,ATRIOVENTRICULAR RECIPROCATING TACHYCARDIA ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,3. Good health ,Europe ,Pacemaker ,Catheter Ablation ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Arrhythmia ,Atrioventricular block ,Heart Defects, Congenital ,medicine.medical_specialty ,Macroreentry tachycardia ,Population ,Catheter ablation ,Heart failure ,ATRIAL-SEPTAL-DEFECT ,Sudden death ,Young Adult ,03 medical and health sciences ,LEFT-VENTRICULAR DYSFUNCTION ,Physiology (medical) ,Internal medicine ,medicine ,SINUS NODE DYSFUNCTION ,Bradycardia ,Humans ,BradycardiaImplantable cardioverter-defibrillator ,Cardiac Surgical Procedures ,education ,Congenital heart disease ,business.industry ,Arrhythmias, Cardiac ,medicine.disease ,Patient Care Management ,ANTIARRHYTHMIC-DRUG-THERAPY ,Death, Sudden, Cardiac ,business ,INTRAATRIAL REENTRANT TACHYCARDIA - Abstract
The population of patients with congenital heart disease (CHD) is continuously increasing with more and more patients reaching adulthood. A significant portion of these young adults will suffer from arrhythmias due to the underlying congenital heart defect itself or as a sequela of interventional or surgical treatment. The medical community will encounter an increasing challenge as even most of the individuals with complex congenital heart defects nowadays become young adults. Within the past 20 years, management of patients with arrhythmias has gained remarkable progress including pharmacological treatment, catheter ablation, and device therapy. Catheter ablation in patients with CHD has paralleled the advances of this technology in pediatric and adult patients with structurally normal hearts. Growing experience and introduction of new techniques like the 3D mapping systems into clinical practice have been particularly beneficial for this growing population of patients with abnormal cardiac anatomy and physiology. Finally, device therapies allowing maintanence of chronotropic competence and AV conduction, improving haemodynamics by cardiac resynchronization, and preventing sudden death are increasingly used. For pharmacological therapy, ablation procedures, and device therapy decision making requires a deep understanding of the individual pathological anatomy and physiology as well as detailed knowledge on natural history and long-term prognosis of our patients. Composing expert opinions from cardiology and paediatric cardiology as well as from non-invasive and invasive electrophysiology this position paper was designed to state the art in management of young individuals with congenital heart defects and arrhythmias.
- Published
- 2018
27. Incidence of Significant Delayed Esophageal Temperature Drop After Cryoballoon-Based Pulmonary Vein Isolation
- Author
-
Christine Lemes, Roland Tilz, Karl-Heinz Kuck, Christian-H. Heeger, Andreas Metzner, Sebastian Deiss, Erik Wissner, Shibu Mathew, Feifan Ouyang, and Tilman Maurer
- Subjects
medicine.medical_specialty ,Esophageal temperature ,business.industry ,medicine.medical_treatment ,Drop (liquid) ,Catheter ablation ,Safety margin ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Cryosurgery ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Physiology (medical) ,Anesthesia ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Esophagus ,Cardiology and Cardiovascular Medicine ,business - Abstract
Significant Delayed ET Drop After CB-Based PV Vein IsolationBackground The second-generation cryoballoon (CB2) has demonstrated superior clinical outcome. Potential procedural complications include esophageal thermal lesions due to excessive esophageal temperature (ET). Safety cut-offs for the ET have previously been published. A safety margin was incorporated due to a delayed esophageal temperature decline even after termination of the CB2 freeze cycle. The extent of these delayed temperature drops requires further systematic evaluation. Methods and Results The study enrolled 29 patients with paroxysmal or shortstanding persistent AF who underwent CB2-based PVI. Freeze cycle duration was 240 seconds. No bonus freeze was applied after successful PVI. The intraluminal ET was continuously measured via a transorally inserted probe (SensiTherm, St. Jude Medical, Inc.). The CB2 temperature and ET were recorded throughout the procedure using a camera setup. The mean number of freeze cycles per patient was 4.3 ± 2. A total of 147 cryoenergy applications were analyzed. A delayed decline in ET of >0.5 °C was recorded following termination of 23.1% of freeze cycles. The maximum drop in delayed ET was 6.4 °C. Excessive esophageal cooling during the freeze cycle exceeding 8.5 °C/min may result in ET ≤10 °C. Conclusions Following termination of cryoenergy delivery, the ET may decline an additional 6.4 °C. Proposed ET safety cut-offs during CB2-based PVI need to account for a significant ET drop that may occur even after termination of the individual freeze cycle.
- Published
- 2016
28. Ablation of atrial fibrillation in patients ≥75 years: long-term clinical outcome and safety
- Author
-
Andreas Rillig, Erik Wissner, Peter Wohlmuth, Karl-Heinz Kuck, Tilman Maurer, Roland Tilz, Feifan Ouyang, Shibu Mathew, Sebastian Deiss, Christine Lemes, Julian Chun, Andreas Metzner, Thomas Fink, Ilka Metzner, Boris Schmidt, and Christian Heeger
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Ablation of atrial fibrillation ,Drug Resistance ,Catheter ablation ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Germany ,Physiology (medical) ,Atrial Fibrillation ,Humans ,Medicine ,Outpatient clinic ,In patient ,Sinus rhythm ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Age Factors ,Atrial fibrillation ,medicine.disease ,Ablation ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Aims The prevalence of atrial fibrillation (AF) increases with age. Catheter ablation is an established treatment option for patients with symptomatic AF. We sought to determine the safety and long-term clinical efficacy of AF ablation in patients ≥75 years. Methods and results Patients ≥75 years with symptomatic, drug-refractory AF were included in the study. Circumferential pulmonary vein isolation (PVI) was performed in all patients, extended to ablation of complex fractionated atrial electrograms, and/or linear lesions in PVI non-responders. Retrospective follow-up (FU) was based on routine outpatient clinic visits and regular telephone interviews. A total of 94 patients (54 male, age 78 ± 2 years, and left atrium diameter 46 ± 6 mm) with drug-refractory AF [55/94 (59%) paroxysmal AF (PAF), 29/94 (31%) persistent AF, and 10/94 (11%) long-standing persistent AF] underwent ablation. Follow-up was obtained in 93/94 (99%) patients. Following a single procedure, 35/93 (38%) patients were in stable sinus rhythm (SR; 46% PAF, 31% persistent AF, and 10% long-standing persistent AF) after a mean FU of 37 ± 20 months. After a mean of 1.5 ± 0.6 procedures, 55/93 (59%) patients were ultimately in stable SR (76% PAF, 41% persistent AF, and 20% long-standing persistent AF). In a total of 137 procedures, 8 major (5.8%) and 26 minor (19%) complications occurred. Conclusions Catheter ablation in patients ≥75 years is associated with a favourable clinical long-term outcome in patients with PAF, while results are less promising in persistent or long-standing persistent patients. The safety profile of AF ablation in patients ≥75 years is comparable with patients of younger age.
- Published
- 2016
29. Short tip–big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon
- Author
-
Feifan Ouyang, Shibu Mathew, Ardan M. Saguner, Christine Lemes, Kentaro Hayashi, Johannes Riedl, Erik Wissner, Andreas Metzner, Christian-H. Heeger, Bruno Reißmann, Thomas Fink, Karl-Heinz Kuck, Christian Sohns, Francesco Santoro, T. Maurer, University of Zurich, and Metzner, Andreas
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Operative Time ,Time to effect ,610 Medicine & health ,030204 cardiovascular system & hematology ,Cryosurgery ,2705 Cardiology and Cardiovascular Medicine ,Cardiac Catheters ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Aged ,business.industry ,Atrial fibrillation ,Equipment Design ,General Medicine ,Middle Aged ,Ablation ,medicine.disease ,Third generation ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Right superior ,10209 Clinic for Cardiology ,Cardiology ,Female ,lipids (amino acids, peptides, and proteins) ,Outcome data ,Cardiology and Cardiovascular Medicine ,business - Abstract
The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome data. The novel third-generation cryoballoon (CB3) incorporates a 40 % shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). Thirty consecutive patients with paroxysmal or short-standing persistent atrial fibrillation underwent CB3-based PVI and were compared to 30 patients treated with the CB2. Individual freeze-cycle duration was set to TTE + 120 s for both groups. A total of 118 (CB3) and 119 (CB2) pulmonary veins (PV) were identified and all PVs successfully isolated utilizing the CB3 and CB2, respectively. The real-time PVI visualization rate was 74 % (CB3) and 40 % (CB2; p = 0.001) and the mean freeze-cycle duration 204 ± 88 s (CB3) and 215 ± 90 s (CB2; p = 0.15). Per individual PV, a shorter mean freeze-duration was found for the CB3 and the right superior PVs (188 ± 92 vs. 211 ± 124 s, p = 0.04) and right inferior PVs (192 ± 75 vs. 200 ± 37 s, p = 0.02). No differences were found for the left-sided PVs. A higher rate of real-time electrical PV recordings is seen using the novel CB3 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.
- Published
- 2015
30. Apixaban, Rivaroxaban, and Dabigatran in Patients Undergoing Atrial Fibrillation Ablation
- Author
-
Feifan Ouyang, Peter Wohlmuth, Tina Lin, Andreas Metzner, Joaquina Plesman, Karl-Heinz Kuck, Andreas Rillig, Erik Wissner, Roland Richard Tilz, Christian-H. Heeger, Shibu Mathew, and Christine Lemes
- Subjects
medicine.medical_specialty ,Rivaroxaban ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,Catheter ablation ,030204 cardiovascular system & hematology ,medicine.disease ,Dabigatran ,Phenprocoumon ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Anesthesia ,medicine ,Cardiology ,Apixaban ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Stroke ,medicine.drug - Abstract
Periprocedural Anticoagulation in AF AblationIntroduction Data on the novel oral anticoagulants (NOACS) during catheter ablation (CA) of atrial fibrillation (AF) are still limited. This study evaluated the periprocedural major complications (MC) of CA of AF, and compared Apixaban, Dabigatran, and Rivaroxaban with continuous phenoprocoumon. Methods and Results A total of 444 patients (mean age = 65.1 ± 9.4 years; 283 [64%] male) with paroxysmal (n = 180 [41%]), persistent (n = 256 [58%]), or longstanding-persistent AF were enrolled. CA was performed in all patients using radiofrequency energy in conjunction with a 3D-mapping system. MCs were defined according to the current guidelines. Continuous phenprocoumon-therapy was administered in 120/444 (27%) patients (group 1) and 324/444 (73%) patients were treated with NOACs (group 2; Dabigatran: n = 51 [15.7%]; Rivaroxaban: n = 193 [59.6%]; Apixaban: n = 80 [24.7%]). Procedure times were comparable between groups 1 and 2 (128.2 ± 39.7 minutes vs. 129.7 ± 51.2 minutes; P = 0.77). CHA2DS2-Vasc (3.0 [2.0, 4.0)] vs. 2.0 [1.0, 3.0]; P < 0.01) and HASBLED scores (2.0 [2.0, 2.5] vs. 2.0 [1.0, 2.0]; P = 0.002) were higher in group 1 patients. The incidence of MCs in the overall group was 8/444 (2%) and was equally distributed between groups 1 and 2 (2/120 [2%] vs. 6/324 [2%], P = 0.90). The incidence of MCs was comparable between the three different NOACs. There were no significant differences between patients with and without MCs with regard to age, CHA2DS2-Vasc-score or HASBLED-score. Conclusions The major complication rate between all three NOACs currently available and continuous phenprocoumon during AF ablation seem to be comparable. Complication rates were similar between patients treated with the three different available NOACs.
- Published
- 2015
31. Balloon-based pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (cryoballoon and laserballoon)
- Author
-
Sebastian Deiss, Karl-Heinz Kuck, and Erik Wissner
- Subjects
medicine.medical_specialty ,Isolation (health care) ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Catheter ablation ,Balloon ,Pulmonary vein ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Atrial fibrillation ,Ablation ,medicine.disease ,Surgery ,Pulmonary Veins ,Catheter Ablation ,cardiovascular system ,Cardiology ,Molecular Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Electrical isolation of the pulmonary veins still remains one of the major objectives during catheter ablation of atrial fibrillation. In patients with paroxysmal atrial fibrillation, balloon-based technologies hold great promise to simplify the approach to successful pulmonary vein isolation. While the cryoballoon represents the only true ‘single-shot’ technology, the laserballoon allows real-time endoscopic visualization of the pulmonary vein antrum during energy delivery. Either technology aims at complete electrical isolation, requiring continuous transmural lesion sets encircling the pulmonary veins. Strategies to confirm and to improve upon the efficacy of pulmonary vein isolation are the key to acute and long-term clinical success and will be reviewed in this article.
- Published
- 2015
32. Association Between Family History and Early-Onset Atrial Fibrillation Across Racial and Ethnic Groups
- Author
-
Dawood Darbar, Abdullah Farooqui, Denise Mol, Adarsh Bhan, Sreenivas Konda, Sara D. Darbar, Brandon Chalazan, Zain Alzahrani, Aylin Ornelas-Loredo, Sorin Lazar, Erik Wissner, N. Elizabeth Villagrana, and Mark McCauley
- Subjects
Proband ,Adult ,Male ,Time Factors ,Heart disease ,Ethnic group ,Black People ,030204 cardiovascular system & hematology ,Article ,White People ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,medicine ,Genetic predisposition ,Ethnicity ,Odds Ratio ,Humans ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Prospective Studies ,Registries ,Family history ,Medical History Taking ,business.industry ,Medical record ,Atrial fibrillation ,General Medicine ,Hispanic or Latino ,Middle Aged ,medicine.disease ,Female ,Illinois ,business ,Demography ,Cohort study - Abstract
There is a genetic predisposition to early-onset atrial fibrillation (EOAF) in European American individuals. However, the role of family history in the pathogenesis of EOAF in racial and ethnic minorities remains unclear.To determine whether probands with EOAF across racial and ethnic groups have a higher rate of AF in first-degree family members than racially and ethnically matched control patients with non-early-onset AF (non-EOAF).In this cohort study, patients prospectively enrolled in a clinical and genetic biorepository were administered baseline questionnaires that included questions about family history of AF. Early-onset AF was defined as AF occurring in probands aged 60 years or younger in the absence of structural heart disease. All other forms were categorized as non-EOAF. Recruitment took place from July 2015 to December 2017. Analysis was performed in January 2018.Primary analysis of reported family history of AF in first-degree relatives with sensitivity analysis restricted to those in whom a family history was confirmed by medical record review and electrocardiogram.Of 664 patients enrolled (mean [SD] age, 62 [12] years; 407 [61%] male), 267 (40%) were European American; 258 (39%), African American; and 139 (21%), Hispanic/Latino. There was a family history of AF in 36 probands with EOAF (49%) compared with 128 patients with non-EOAF (22%) (difference, 27%; 95% CI, 14%-40%; P .001). On multivariable analysis, the adjusted odds of a proband with EOAF who was of African descent (odds ratio [OR], 2.69; 95% CI, 1.06-6.91; P .001) or Hispanic descent (OR, 9.25; 95% CI, 2.37-36.23; P = .002) having a first-degree relative with AF were greater than those of European descent (OR, 2.51; 95% CI, 1.29-4.87; P = .006). Overall, probands with EOAF were more likely to have a first-degree relative with AF compared with patients with non-EOAF (adjusted OR, 3.02; 95% CI, 1.82-4.95; P .001) across the 3 racial and ethnic groups. Atrial fibrillation in a first-degree family member was confirmed in 32% of probands with EOAF vs 11% of those with non-EOAF (difference, 21%; 95% CI, 11%-33%; P .001). Furthermore, African American (28% vs 5%; difference, 23%; 95% CI, 4%-43%; P = .001), European American (35% vs 20%; difference, 15%; 95% CI, 1%-30%; P = .03), and Hispanic/Latino (30% vs 5%; difference, 25%; 95% CI, 4%-54%; P = .02) probands with EOAF were more likely to have a first-degree relative with confirmed AF vs racially and ethnically matched control patients with non-EOAF. The positive and negative predictive values for a family history of confirmed AF were both 89%.Probands of African or Hispanic/Latino descent with EOAF were more likely to have a first-degree relative with AF when compared with European American individuals. These findings support genetic predisposition to EOAF across all 3 races.
- Published
- 2018
33. Pacemaker and ICD Troubleshooting
- Author
-
Sorin Lazar, Henry Huang, and Erik Wissner
- Subjects
business.industry ,medicine ,Medical emergency ,Troubleshooting ,medicine.disease ,business ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) - Published
- 2017
34. First insights into cryoballoon-based pulmonary vein isolation taking the individual time-to-isolation into account
- Author
-
Karl-Heinz Kuck, Ardan M. Saguner, Michael Schlueter, Sebastian Deiss, Peter Wohlmuth, Christine Lemes, Tilman Maurer, Kentaro Hayashi, Andreas Metzner, Johannes Riedl, Erik Wissner, Bruno Reissmann, Christian Sohns, Shibu Mathew, Christian Heeger, Feifan Ouyang, Francesco Santoro, University of Zurich, and Reissmann, Bruno
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Action Potentials ,610 Medicine & health ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Cryosurgery ,Cardiac Catheters ,Disease-Free Survival ,2705 Cardiology and Cardiovascular Medicine ,Time-to-Treatment ,Pulmonary vein ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,2737 Physiology (medical) ,Heart Rate ,Recurrence ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Fluoroscopy ,Sinus rhythm ,030212 general & internal medicine ,Aged ,Phrenic Nerve Palsy ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Treatment Outcome ,Pulmonary Veins ,Persistent atrial fibrillation ,Catheter Ablation ,Electrocardiography, Ambulatory ,Cardiology ,10209 Clinic for Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an established treatment for symptomatic atrial fibrillation (AF). In the present study, we sought to assess the efficacy and safety of CB-based PVI taking the individual time-to-isolation (TTI) into account. Methods and results Sixty consecutive patients with drug-refractory paroxysmal atrial fibrillation [n = 49 (82%)] or short-standing persistent atrial fibrillation [n = 11 (18%)] underwent ablation with a 28-mm second-generation CB. The TTI was assessed by spiral mapping-catheter recordings and subsequently followed by an additional freeze-time of 120 s. No bonus freeze-cycle was applied. If the TTI could not be assessed, a fixed freeze-cycle duration of 240 s was applied and successful PVI confirmed thereafter. Clinical follow-up (FU) included 12-lead ECGs and 24 h Holter-ECGs at 3, 6, and 12 months. A blanking period of 3 months was defined. A total of 239 pulmonary veins (PVs) were identified and successfully isolated. The mean TTI assessed in 170/239 (71%) PVs was 52 ± 32 s. The mean number of CB applications was 1.2 ± 0.5; mean freeze-cycle duration was 192 ± 41 s. Mean procedure and fluoroscopy times were 80 ± 24 min and 16 ± 7 min, respectively. Transient phrenic nerve palsy occurred in one patient (2%). During a mean FU of 405 ± 67 days, 43 patients (72%) remained in stable sinus rhythm. Conclusions Integrating an individual TTI protocol to CB-based PVI results in shorter freeze-cycle applications in a substantial portion of targeted PVs and an arrhythmia-free survival comparable to conventional ablation protocols. The complication rate is low.
- Published
- 2017
35. Six-Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function
- Author
-
Tina Lin, Feifan Ouyang, Shibu Mathew, Karl-Heinz Kuck, Hisaki Makimoto, Christian Heeger, Andreas Rillig, Roland Richard Tilz, Erik Wissner, Andreas Metzner, Thomas Fink, Peter Wohlmuth, Jascha Wegner, and Christine Lemes
- Subjects
medicine.medical_specialty ,Ejection fraction ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,Catheter ablation ,Impaired left ventricular function ,medicine.disease ,Ablation ,Pulmonary vein ,Physiology (medical) ,Internal medicine ,Heart failure ,medicine ,Cardiology ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
AF Ablation in Patients With Impaired LVEFIntroduction Long-term data after pulmonary vein isolation (PVI) in patients with impaired systolic left ventricular ejection fraction (LVEF) are sparse. This study assessed the outcomes in patients with atrial fibrillation (AF) and reduced LVEF treated with PVI after a median follow-up period of 6 years. Methods and Results Eighty-one patients with an LVEF≤45% were evaluated; however, 1 patient was lost to follow-up. In the remaining 80 patients (male: n = 68 (85%), median age 61.6 (54.8–67.5) years) with paroxysmal (n = 16, 20%), persistent (n = 37, 46.2%), and longstanding-persistent AF (LS-AF), catheter ablation of AF using radiofrequency and 3D mapping was performed. Follow-up included Holter monitoring or pacemaker/ICD interrogation to assess for arrhythmia recurrence and echocardiography to assess LVEF. Median follow-up was 72 (67–75) months. Death occurred in 21 patients. Single-procedure success rate was 35.1% and multiple-procedure success rate was 56.8% in the overall group. Baseline median LVEF (35% [28.5–40%]) significantly increased at 6-year follow-up (56.5% [40.0–60.0%], P < 0.01). In patients with single- or multiple-procedure ablation success, there was a higher improvement of LVEF (single procedure: 25% [15.0–35] vs. 10.0% [–1.0–20.0], P < 0.01; multiple procedures: 20.0% [15–34] vs. 5.0% [5.00–15.0]; P < 0.01). The single (43.8% vs. 40%, P = 0.96) and multiple procedure success rates (62.5% vs. 60%, P = 0.47) were comparable between patients with PAF and persistent AF and lowest in patients with LS-AF (single procedure success: 23.1%, multiple-procedure success: 47.8%). Conclusion Single-procedure success rates after PVI during 6 years of follow-up were low. In patients with single- or multiple-procedure ablation success, a higher improvement of LVEF was observed.
- Published
- 2015
36. Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation
- Author
-
Tina Lin, Andreas Metzner, Karl-Heinz Kuck, Peter Wohlmuth, Feifan Ouyang, Erik Wissner, Boris Schmidt, Roland Richard Tilz, Anita Arya, Jascha Wegner, Christian Heeger, Shibu Mathew, Britta Feige, and Andreas Rillig
- Subjects
Male ,medicine.medical_specialty ,Robotic navigation ,Time Factors ,Isolation (health care) ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,Prospective Studies ,030212 general & internal medicine ,Aged ,business.industry ,Robotics ,General Medicine ,Long term results ,Middle Aged ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Fluoroscopy ,Catheter Ablation ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Long-term results after circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF) using a robotic navigation system (RNS) have not yet been reported.To evaluate long-term results of patients with PAF after CPVI using RNS.In this study, 200 patients (n = 151 (75.5%) male; median age 62.2 (54.7-67.7) years) with PAF were evaluated. In 100 patients, RNS (RN-group) was used for CPVI and compared to 100 manually ablated control patients (MN-group). Radiofrequency was used in conjunction with 3D electroanatomic mapping. Power was limited to 30 watts (W) at the posterior left atrial (LA) wall in the first 49 RNS patients (RN-group-a). After esophageal perforation occurred in one RN-group-a patient, maximum power was reduced to 20 W for the subsequent 51 patients (RN-group-b).After a median follow-up of 2 years, single (77/100 vs 77/100, p = 0.89) and multiple (90/100 vs 93/100, p = 0.29) procedure success rates were comparable between RN-group and MN-group. Single procedure success rate was significantly lower in RN-group-a as compared to RN-group-b (65.3 vs 88.2%, p = 0.047). In RN-group-a patients, procedural times [200 (170-230) vs 152 (132-200) minutes, p0.01] and fluoroscopy times [16.6 (12.9-21.6) minutes vs 13.7 (9.5-19) minutes, p = 0.043] were significantly longer compared to RN-group-b patients.Long-term success rate after CPVI using RNS was comparable to manual ablation. Despite a lower power limit of 20 W at the posterior LA wall, single procedure success rate was higher in RN-group-b as compared to RN-group-a. Procedure time and fluoroscopy time decreased, whilst success rate increased with increasing experience in the RN-group.
- Published
- 2015
37. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation
- Author
-
Dan Wichterle, Aude Yulzari, Petr Neuzil, Erik Wissner, Jan Petru, Josef Kautzner, Karl-Heinz Kuck, Petr Peichl, Hendrik Lambert, Jan Skoda, and Robert Cihak
- Subjects
medicine.medical_specialty ,business.industry ,Paroxysmal atrial fibrillation ,medicine.medical_treatment ,Atrial fibrillation ,Catheter ablation ,Cardiac Ablation ,medicine.disease ,Ablation ,Pulmonary vein ,Catheter ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims A challenge of pulmonary vein isolation (PVI) in catheter ablation for paroxysmal atrial fibrillation (PAF) is electrical reconnection of the PV. EFFICAS I showed correlation between contact force (CF) parameters and PV durable isolation but no prospective evaluation was made. EFFICAS II was a multicentre study to prospectively assess the impact of CF guidance for an effective reduction of PVI gaps. Methods and results Pulmonary vein isolation using a radiofrequency (RF) ablation catheter with an integrated force sensor (TactiCath™) was performed in patients with PAF. Operators were provided EFFICAS I-based CF guidelines [target 20 g, range 10–30 g, minimum 400 g s force-time integral (FTI)]. Conduction gaps were assessed by remapping of PVs after 3 months, and gap rate was compared with EFFICAS I outcome. At follow up, 24 patients had 85% of PVs remaining isolated, compared with 72% in EFFICAS I ( P = 0.037) in which CF guidelines were not used. The remaining 15% of gaps correlated to the number of catheter moves at creating the PVI line, quantified as Continuity Index. For PV lines with contiguous lesions and low catheter moves, durable isolation was 81% in EFFICAS I and 98% in EFFICAS II ( P = 0.005). At index procedure, the number of lesions was reduced by 15% in EFFICAS II vs. EFFICAS I. Conclusion The use of CF with the above guidelines and contiguous deployment of RF lesions in EFFICAS II study resulted in more durable PVI in catheter ablation of PAF. [10.1093/europace/euv131][1] [1]: /lookup/doi/10.1093/europace/euv131
- Published
- 2015
38. One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis
- Author
-
Erik Wissner, Roland Tilz, Andreas Rillig, Peter Wohlmuth, Bruno Reissmann, Sebastian Deiss, Feifan Ouyang, Christian Heeger, Tina Lin, Karl-Heinz Kuck, Andreas Metzner, Christine Lemes, and Shibu Mathew
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Radiation Dosage ,Radiography, Interventional ,Cryosurgery ,Cardiac Catheters ,Disease-Free Survival ,Pulmonary vein ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Retrospective analysis ,Humans ,Outpatient clinic ,Sinus rhythm ,030212 general & internal medicine ,Aged ,Retrospective Studies ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,Equipment Design ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Pulmonary Veins ,Persistent atrial fibrillation ,Electrocardiography, Ambulatory ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Aims The purpose of this study was to determine efficacy of pulmonary vein isolation (PVI) using the 28 mm cryoballoon (CB) in patients with persistent atrial fibrillation (AF). Superior acute and 1-year outcome has been demonstrated following PVI, using the second-generation CB in patients with paroxysmal AF. Data on the outcome in patients with persistent AF are sparse. Methods and results Forty-nine patients (20 female, mean age 63 ± 10 years, mean left atrial diameter 46 ± 5 mm) with persistent AF [median AF duration since first diagnosis: 48 (20:192) months] underwent second-generation 28 mm CB-based PVI. The freeze cycle duration was set at 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 11/49 (22%) patients, and no bonus freeze cycle was used in the remaining 38/49 (78%) patients. Follow-up (FU) was based on outpatient clinic visits at 3, 6, and 12 months, which included Holter electrocardiograms and telephone interviews. Recurrence was defined as an episode of symptomatic and/or documented atrial tachyarrhythmia >30 s beyond the 3-month blanking period. A total of 193 pulmonary veins (PVs) were identified and 193/193 (100%) PVs were successfully isolated. No phrenic nerve paralysis occurred. Follow-up was obtained in 49/49 (100%) patients with a mean FU duration of 416 ± 178 days. After the 3-month blanking period, antiarrhythmic medication was discontinued in 33/49 (67%) patients. Thirty-four of 49 (69%) patients remained in stable sinus rhythm. Conclusions In patients with persistent AF, use of the second-generation 28 mm CB was associated with a 69% 1-year clinical success rate.
- Published
- 2015
39. MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study
- Author
-
Moussa Mansour, Gerhard Hindricks, Nassir F. Marrouche, Lluís Mont, Bengt Herweg, Mathew D. Hutchinson, David J. Wilber, Pierre Jaïs, Thomas Deneke, Erik Wissner, Nazem Akoum, Johannes Brachmann, Emile G. Daoud, Nan Hu, Mattias Duytschaever, Christian Mahnkopf, Eugene G. Kholmovski, Josh Cates, Nathan S. Burgon, Francis E. Marchlinski, and Thomas Neumann
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Atrial fibrillation ,Catheter ablation ,medicine.disease ,Atrial wall ,Ablation ,Pulmonary vein ,Fibrosis ,Physiology (medical) ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
MRI Assessment of Ablation-Induced Scarring in Atrial FibrillationBackground There is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF. Methods We conducted a prospective multicenter study that enrolled 329 AF patients presenting for catheter ablation. Delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium was obtained preablation. Scarring was evaluated in 177 patients with a DE-MRI scan obtained 90 days postablation. We evaluated residual fibrosis, defined as preablation atrial fibrosis not covered by ablation scar. The primary outcome was freedom from recurrent atrial arrhythmia. Results In the analysis cohort of 177 patients, preablation fibrosis was 18.7 ± 8.7% of the atrial wall. Ablation aimed at pulmonary vein (PV) isolation was performed in 163 patients (92.1%). Ablation-induced scar averaged 10.6 ± 4.4% of the atrial wall. Scarring completely encircled all 4 PVs only in 12 patients (7.3%). Residual fibrosis was calculated at 15.8 ± 8.0%. At 325 days follow-up, 35% of patients experienced recurrent arrhythmia. Multivariable Cox proportional hazards models demonstrated that baseline atrial fibrosis (HR and 95% CIs) (1.09 [1.06–1.12], P < 0.001) and residual fibrosis (1.09 [1.05–1.13], P < 0.001) were associated with atrial arrhythmia recurrence, while PV encirclement and overall scar were not. Conclusions Catheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia.
- Published
- 2015
40. Comparison of contact force-guided procedure with non-contact force-guided procedure during left atrial mapping and pulmonary vein isolation: impact of contact force on recurrence of atrial fibrillation
- Author
-
Erik Wissner, Karl-Heinz Kuck, Hisaki Makimoto, Andreas Rillig, Feifan Ouyang, Shibu Mathew, Tina Lin, Christine Lemes, Sebastian Deiss, Andreas Metzner, Roland Richard Tilz, Christian-H. Heeger, and Peter Rausch
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Sensitivity and Specificity ,Group B ,Pulmonary vein ,User-Computer Interface ,Heart Conduction System ,Left atrial ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Aged ,business.industry ,Body Surface Potential Mapping ,Significant difference ,Reproducibility of Results ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Treatment Outcome ,Surgery, Computer-Assisted ,Pulmonary Veins ,Cohort ,Cardiology ,Female ,Stress, Mechanical ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of this study was to evaluate the impact of contact force (CF) visualization on the incidence of low and high CF during left atrial (LA) mapping and pulmonary vein isolation (PVI). CF was assessed in 70 patients who underwent PVI. Three highly experienced operators performed all procedures. The operators were blinded to CF in group A (35 patients), and CF was displayed in group B (35 patients). In group B, optimal CF was defined as mean CF between 10 and 39g, and operators attempted to acquire points and ablate within this range. A total of 8401 mapping points were analyzed during LA mapping (group A: 4104, group B: 4297). Low CF
- Published
- 2015
41. Electrophysiological and electrocardiographic predictors of ventricular arrhythmias originating from the left ventricular outflow tract within and below the coronary sinus cusps
- Author
-
Tina Lin, Andreas Metzner, Feifan Ouyang, Andreas Rillig, Hesheng Hu, Erik Wissner, Karl-Heinz Kuck, Sebastian Deiss, Hisaki Makimoto, Roland Richard Tilz, Dongpo Liang, Masashi Kamioka, Christine Lemes, Peter Rausch, and Shibu Mathew
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,animal structures ,Heart Ventricles ,medicine.medical_treatment ,Sensitivity and Specificity ,Diagnosis, Differential ,Electrocardiography ,Heart Conduction System ,Internal medicine ,Aortic sinus ,Humans ,Medicine ,Ventricular outflow tract ,cardiovascular diseases ,Coronary sinus ,medicine.diagnostic_test ,business.industry ,Body Surface Potential Mapping ,Coronary Sinus ,Reproducibility of Results ,General Medicine ,Middle Aged ,Ablation ,Ventricular Premature Complexes ,Electrophysiology ,medicine.anatomical_structure ,embryonic structures ,Tachycardia, Ventricular ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can originate from within or below the aortic sinus of valsalva (ASV). Mapping and ablation below the ASV is challenging and there are limited data predicting VA origins using electrocardiographic and electrophysiological features.Thirty-four patients (56.7 ± 15.2 years; 19 males) with symptomatic VAs were analyzed. VA origins were determined by successful ablation. Patients were classified into 2 groups (group 1, VAs within the ASV; group 2, VAs below the ASV). Local activation and QRS morphology were compared between these 2 groups.Twelve patients were classified as group 1 and 22 as group 2. Presystolic potentials (PPs) during VAs were present in 11 patients (91 %) in group 1 and 3 (13 %) in group 2. S-wave amplitude and duration in lead I were lower and shorter in group 1 vs. group 2, respectively. Q-wave aVL/aVR ratio (Q-aVL/aVR) was smaller in group 1 vs. group 2. No group 1 patients had Q-aVL/aVR1.45. PPs in the ASV was the strongest independent predictor for VAs originating within the ASV (OR: 30.003, P = 0.006).Deeper and longer S-waves in lead I and Q-aVL/aVR1.45 suggest VAs originating below the ASV. Local PPs strongly suggest an origin within the ASV. ECG characteristics combined with local PPs can be a practical guide for ablating LVOT-VAs.
- Published
- 2015
42. Innovative Verfahren der Vorhofflimmertherapie
- Author
-
Feifan Ouyang, Erik Wissner, Karl-Heinz Kuck, Andreas Metzner, and T. Fink
- Subjects
Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Die Pulmonalvenenisolation (PVI) ist der etablierte Endpunkt und integraler Bestandteil der meisten ablativen Therapiestrategien bei Vorhofflimmern (VHF). Die Anlage kontinuierlicher, transmuraler und dauerhafter Lasionen mittels hochfrequenzstrombasierter Katheter in Kombination mit einem 3-dimensionalen Mappingsystem stellt jedoch weiterhin eine grose Herausforderung dar. Um diesen Limitationen zu begegnen, sind innovative zirkulare Mapping- und Ablationskatheter sowie ballonbasierte Ablationssysteme mit integrierten alternativen Energiequellen (Kryo, Laser) eingefuhrt und evaluiert worden und konnten ihr Potenzial zur sicheren und effektiven PVI unter Beweis stellen. Zudem sind unser aktuelles Spektrum erweiternde Ablationsstrategien wie die Identifizierung von VHF auslosenden Foci bzw. VHF aufrechterhaltenden Rotoren mittels endo- und epikardialer Mapping-Systeme und deren Ablation entwickelt worden und befinden sich derzeit in der klinischen Evaluierungsphase. Gleiches gilt fur die Identifizierung und Modulation von atrialen Ganglien und somit des autonomen Nervensystems als weiterer potenzieller, additiver Therapieansatz in der ablativen Therapie von VHF.
- Published
- 2015
43. Radiofrequency ablation of premature ventricular contractions originating from the aortomitral continuity localized by use of a novel noninvasive epicardial and endocardial electrophysiology system
- Author
-
Alexey Tsyganov, Sebastian Deiss, Tilman Maurer, Erik Wissner, Karl-Heinz Kuck, Mikhail Chmelesky, Ardan M. Saguner, and Andreas Metzner
- Subjects
medicine.medical_specialty ,Premature ventricular contraction ,Radiofrequency ablation ,medicine.medical_treatment ,0206 medical engineering ,Case Report ,Catheter ablation ,02 engineering and technology ,030204 cardiovascular system & hematology ,Noninvasive mapping ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,business.industry ,020601 biomedical engineering ,Electrophysiology ,Aortomitral continuity ,RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
44. Ablation of ventricular arrhythmias
- Author
-
Erik Wissner and William Spear
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Cardiology ,medicine ,Ablation ,business - Published
- 2017
45. Five-year clinical outcomes of visually guided laser balloon pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation
- Author
-
Feifan Ouyang, Johannes Riedl, Shibu Mathew, Thorsten Budelmann, Christian-Hendrik Heeger, Francesco Santoro, Karl-Heinz Kuck, Andreas Metzner, Thomas Fink, Michael Schlüter, Bruno Reissmann, Christine Lemes, Andreas Rillig, Tilman Maurer, and Erik Wissner
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,030204 cardiovascular system & hematology ,Balloon ,Cardiac Catheters ,Disease-Free Survival ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Heart Rate ,Recurrence ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Outpatient clinic ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Endoscopes ,business.industry ,Atrial fibrillation ,Endoscopy ,General Medicine ,Equipment Design ,Middle Aged ,Ablation ,medicine.disease ,Confidence interval ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Electrocardiography, Ambulatory ,Female ,Clinical Competence ,Laser Therapy ,Cardiology and Cardiovascular Medicine ,business ,Learning Curve - Abstract
Visually guided laser balloon (VGLB) ablation allows for pulmonary vein isolation (PVI) under direct endoscopic control. Short- and midterm clinical outcomes are in accordance with results of radiofrequency current (RFC) ablation for the treatment of paroxysmal atrial fibrillation (PAF). The current study sought to assess the long-term clinical outcomes of VGLB-based PVI for PAF. A total of 90 patients [60 ± 10 years; 33 (37%) female, left atrial diameter 42 ± 4 mm] with drug-refractory PAF underwent VGLB ablation. The median duration of PAF until VGLB ablation was 36 (interquartile range 12; 84) months. Follow-up was based on outpatient clinic visits including Holter ECGs and telephone interviews. Repeat ablation due to arrhythmia recurrences was performed using RFC ablation. After a single VGLB procedure, 5-year freedom from arrhythmia recurrence was 51% [95% confidence interval (CI) 39–62%]. Thirty-three patients underwent repeat RFC ablation procedures, resulting in multiple procedure freedom from arrhythmia recurrence of 78% (95% CI 68–88%). Major periprocedural complications occurred in four patients (4%). VGLB ablation for the treatment of drug-refractory PAF is safe and results in 5-year single and multiple procedure arrhythmia-free survival of 51 and 78%, respectively.
- Published
- 2017
46. Noninvasive epicardial and endocardial mapping of premature ventricular contractions
- Author
-
Christine Lemes, Eugene Labarkava, Tilman Maurer, Oleg Sopov, Alexey Tsyganov, Ardan M. Saguner, Mikhail Chmelevsky, Sebastian Deiss, Andreas Metzner, Karl-Heinz Kuck, Amiran Revishvili, Erik Wissner, Vitaly Kalinin, University of Zurich, and Wissner, Erik
- Subjects
Male ,medicine.medical_treatment ,Radiography ,02 engineering and technology ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,0302 clinical medicine ,2737 Physiology (medical) ,Non-invasive epicardial and endocardial electrophysiology system ,Non-invasive imaging ,medicine.diagnostic_test ,Body Surface Potential Mapping ,Equipment Design ,Torso ,Middle Aged ,Ablation ,Ventricular Premature Complexes ,medicine.anatomical_structure ,Cardiology ,10209 Clinic for Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Pericardium ,Adult ,medicine.medical_specialty ,Premature ventricular contraction ,0206 medical engineering ,Catheter ablation ,610 Medicine & health ,Sensitivity and Specificity ,2705 Cardiology and Cardiovascular Medicine ,Diagnosis, Differential ,03 medical and health sciences ,Ventricular arrhythmias ,Clinical Research ,Physiology (medical) ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Endocardium ,Aged ,business.industry ,Reproducibility of Results ,Magnetic resonance imaging ,Cardiac Ablation ,medicine.disease ,020601 biomedical engineering ,Equipment Failure Analysis ,Tachycardia, Ventricular ,Cardiac Electrophysiology ,business - Abstract
Aims The aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations. Methods and results The study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tachycardia (VT). All patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were semi-automatically processed by the NEEES to reconstruct a realistic 3D model of the heart and torso. In the electrophysiology laboratory, body-surface electrodes were connected to the NEEES followed by unipolar EKG recordings during episodes of PVC/VT. The body-surface EKG data were processed by the NEEES using its inverse-problem solution software in combination with anatomical data from the heart and torso. The earliest site of activation as denoted on the NEEES 3D heart model was compared with the PVC/VT origin using a 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. A total of 21 PVC/VT morphologies were analysed and ablated. The chamber of interest was correctly diagnosed non-invasively in 20 of 21 (95%) PVC/VT cases. In 18 of the 21 (86%) cases, the correct ventricular segment was diagnosed. Catheter ablation resulted in acute success in 19 of the 20 (95%) patients, whereas 1 patient underwent successful surgical ablation. During 6 months of follow-up, 19 of the 20 (95%) patients were free from recurrence off antiarrhythmic drugs. Conclusion The NEEES accurately identified the site of PVC/VT origin. Knowledge of the potential site of the PVC/VT origin may aid the physician in planning a successful ablation strategy.
- Published
- 2017
47. Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system
- Author
-
Karl-Heinz Kuck, Johannes Riedl, Laura Rottner, Francesco Santoro, Andreas Metzner, Bruno Reißmann, Christian Sohns, Feifan Ouyang, Shibu Mathew, Sebastian Deiss, Christine Lemes, Peter Wohlmuth, Erik Wissner, Christian Heeger, and Tilman Maurer
- Subjects
Male ,medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,Operative Time ,Catheter ablation ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Pulmonary vein ,Cohort Studies ,03 medical and health sciences ,Magnetics ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Monitoring, Intraoperative ,Severity of illness ,Atrial Fibrillation ,Medicine ,Fluoroscopy ,Humans ,030212 general & internal medicine ,Cardiac catheterization ,Aged ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Prognosis ,Surgery ,Catheter ,Treatment Outcome ,Surgery, Computer-Assisted ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
The magnetic navigation system (MNS) has shown to be safe and effective for catheter ablation of atrial fibrillation (AF). However, longer procedure duration as compared to manual catheter ablation may limit its widespread use. This study aimed to assess the impact of the newest generation MNS using an optimized mapping and ablation protocol on the efficacy and safety of remote magnetic catheter (RMC)-guided pulmonary vein isolation (PVI). This observational study included 52 patients with symptomatic AF who underwent RMC-guided PVI using the second-generation MNS Niobe II (initial 28 patients, group I) or the third-generation MNS Niobe ES in combination with an optimized mapping and ablation protocol (24 patients, group II). Acute PVI was achieved in 26/28 (93%) patients in group I and 24/24 patients (100%) in group II. Mean procedure time was 263.9 ± 81.9 min in group I and significantly lower in group II (139.7 ± 22.6 min, p
- Published
- 2017
48. Catheter Ablation of the Superolateral Mitral Isthmus Line: A Novel Approach to Reduce the Need for Epicardial Ablation
- Author
-
Christine Lemes, Erik Wissner, Kentaro Hayashi, Johannes Riedl, Bruno Reißmann, Peter Wohlmuth, Tilman Maurer, Christian Heeger, Ardan M. Saguner, Andreas Metzner, S. Yen Ho, Karl-Heinz Kuck, Christian Sohns, Feifan Ouyang, and Shibu Mathew
- Subjects
Tachycardia ,Epicardial Mapping ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,030212 general & internal medicine ,Coronary sinus ,Atrial tachycardia ,Aged ,business.industry ,Coronary Sinus ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Surgery ,Treatment Outcome ,Atrial Flutter ,Echocardiography ,Pulmonary Veins ,Cardiology ,Catheter Ablation ,Mitral Valve ,Mitral isthmus ,Female ,Tamponade ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Endocardium - Abstract
Background The mitral isthmus is a critical part of perimitral reentrant tachycardia, as well as an important substrate of persistent atrial fibrillation. Deployment of an endocardial mitral isthmus line (MIL) with the end point of bidirectional block may be challenging and often requires additional epicardial ablation within the coronary sinus. Methods and Results The study population comprised 114 patients with perimitral flutter who underwent de novo ablation of an MIL. The initial 57 patients (group A) underwent catheter ablation using a novel superolateral MIL design, connecting the left-sided pulmonary veins with the mitral annulus along the posterior base of the left atrial appendage visualized by selective angiography. The next 57 patients (group B) served as a control group and underwent ablation using a conventional MIL design, connecting the left inferior pulmonary vein with the mitral annulus. Bidirectional block was achieved in 56 of 57 patients in group A (98.2%) and 50 of 57 patients in group B (87.7%; P =0.06). Deployment of a superolateral MIL required significantly less ablation from within the coronary sinus (7.0% versus 71.9%; P P P =0.005). A higher rate of pericardial tamponade was observed in group A (5.2% versus 0%; P =0.24). Conclusions The superolateral MIL is associated with a high acute success rate to achieve bidirectional block using endocardial ablation only with minimal need for epicardial ablation from within the coronary sinus.
- Published
- 2017
49. Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study
- Author
-
Shibu Mathew, Karl-Heinz Kuck, Ulf Landmesser, Laura Rottner, Andreas Metzner, Johannes Riedl, Thomas Fink, Feifan Ouyang, Christian Sohns, Bruno Reißmann, Christian Heeger, Francesco Santoro, Britta Goldmann, Peter Wohlmuth, Tilman Maurer, Erik Wissner, Mattias Roser, Christine Lemes, Verena Tscholl, Barbara Bellmann, and Andreas Rillig
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,030204 cardiovascular system & hematology ,Cryosurgery ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Recurrence ,Physiology (medical) ,Internal medicine ,Heart rate ,Occlusion ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Heart Atria ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Angiography ,Atrial fibrillation ,Retrospective cohort study ,Equipment Design ,Middle Aged ,medicine.disease ,Surgery ,Ostium ,Treatment Outcome ,Pulmonary Veins ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
Background Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). However, the CB2 features a maximal diameter of 28 mm, and its adaptability to anatomic variations of the pulmonary veins (PVs) might be challenging. Objective The purpose of this study was to assess the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV). Methods Six hundred seventy consecutive patients underwent CB2-based PVI in 3 electrophysiology centers. In 74 patients (11%), an LCPV was identified (LCPV group). The data were compared to those from matched patients (n = 74) with normal PV anatomy and comparable baseline characteristics (control group). An antral occlusion of the complete LCPV ostium was feasible in 50% of patients in the LCPV group. If an antral occlusion could not be obtained, a sequential isolation of the first superior and inferior branches was applied. Results All 74 LCPVs were successfully isolated. A total of 64% patients (LCPV group) and 66% patients (control group) remained in sinus rhythm after mean follow-up of 1.9 ± 0.9 years ( P = .820). In 18 of 26 patients (69%) with atrial tachyarrhythmia recurrence, a repeat procedure using radiofrequency energy was performed, and a total of 56% LCPVs were found to be persistently isolated (control group: 61% of left-sided PVs, P = .801). Conclusion Patients with an LCPV undergoing CB2-based PVI demonstrate a high acute success rate. Comparable results with regard to clinical success and durability of PVI were shown when comparing patients of the LCPV group and the control group.
- Published
- 2017
50. Atrial Fibrillation Ablation: Substrate Modification and Other Strategies
- Author
-
Karl-Heinz Kuck, Erik Wissner, and Tilman Maurer
- Subjects
medicine.medical_specialty ,Materials science ,Internal medicine ,medicine.medical_treatment ,Cardiology ,medicine ,Atrial fibrillation ,medicine.disease ,Ablation ,Substrate modification - Published
- 2017
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.