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1. Prevention of cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation: the ODIn-AF trial

Author

Schrickel, Jan Wilko, Beiert, Thomas, Linhart, Markus, Luetkens, Julian A., Schmitz, Jennifer, Schmid, Matthias, Hindricks, Gerhard, Arentz, Thomas, Stellbrink, Christoph, Deneke, Thomas, Bogossian, Harilaos, Sause, Armin, Steven, Daniel, Gonska, Bernd-Dieter, Rudic, Boris, Lewalter, Thorsten, Zabel, Markus, Geisler, Tobias, Schumacher, Burghard, Jung, Werner, Kleemann, Thomas, Luik, Armin, Veltmann, Christian, Coenen, Martin, and Nickenig, Georg

Published
2024
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2. Atrial Topology for a Unified Understanding of Typical and Atypical Flutter

Author

Duytschaever, Mattias, Van den Abeele, Robin, Carlier, Niels, Bezerra, Arthur Santos, Verstraeten, Bjorn, Lootens, Sebastiaan, Desplenter, Karel, Okenov, Arstanbek, Nezlobinsky, Timur, Shah, Dipen, Haas, Annika, Luik, Armin, Martens, Jordi, El Haddad, Milad, De Smet, Maarten, De Becker, Benjamin, Francois, Clara, Le Polain de Waroux, Jean-Benoit, Tavernier, Rene, Knecht, Sebastien, Hendrickx, Sander, and Vandersickel, Nele

Published
2024
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7. Telemedical cardiac risk assessment by implantable cardiac monitors in patients after myocardial infarction with autonomic dysfunction (SMART-MI-DZHK9): a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial

Author

May, Andreas, Seitzer, Peter, Schmidt, Roland, Keta, Dritan, Janke, Viktoria, Schläger, Christian, André, Elisabeth, Brandt, Niels, Schön, Alexandra, Zollner, Alfred, Freyer, Luisa, Hamm, Wolfgang, Beil, Johannes, Strüven, Anna Katharina, Loew, Anja, Fichtner, Stephanie, Lange, Philipp, Krasniqi, Aresa, Grabmeier, Ulrich, Estner, Heidi, Bengel, Philipp, Lüthje, Lars, Kirova, Aleksandra, Fischer, Thomas, Bergau, Leonard, Herting, Jonas, Schlögl, Simon, Haarmann, Helge, Schlögl (Illes), Klaudia, Uecer, Ekrem, Sag, Sabine, Tafelmeier, Maria, Jungbauer, Carsten, Fredersdorf-Hahn, Sabine, Strack, Christina, Seither, Benedikt, Seegers, Joachim, Millenaar, Dominic, Wintrich, Jan, Fischer, Patrick, Buob, Axel, Razouk, Amjad, Demming, Thomas, Frank, Johanne, Kühl, Constantin, Ellendt, Ulrike, Sandrock, Sarah, Gänsbacher, Julia, Cupa, Janosch, Sinnecker, Daniel, Laugwitz, Karl-Ludwig, Steger, Alexander, Berkefeld, Anna, Schinke, Karin, Barthel, Petra, Dommasch, Michael, Amadei, Maiwand, Hindricks, Gerhard, Obradovic, Danilo, Döring, Michael, Bode, Kerstin, Hilbert, Sebastian, Löbe, Susanne, Knopp, Helge, König, Sebastian, John, Silke, Schöne, Katharina, Hartung, Philipp, Binner, Christian, Meyer-Zürn, Christine, Duckheim, Martin, Eick, Christian, Simpfle, Fabian, Schreieck, Jürgen, Mizera, Lars, Tscholl, Verena, Steinbeck, Lisa, Güc, Nadija, Schatz, Anne-Sophie, Attanasio, Philipp, Heuberger, Andrea, Roser, Mattias, Bellmann, Barbara, Nagel, Patrick, Biewener, Sebastian, Suhail, Saba, Juri, Benjamin, Meyer, Christian, Wiilems, Stephan, Jungen, Christiane, Schmitt, Susanne, Münkerer, Paula, Vogler, Julia, Kaiser, Lukas, Schäffer, Benjamin, Nies, Moritz, Tönnis, Tobias, Fluschnik, Nina, Grahn, Hanno, Waldeyer, Christoph, Kany, Shinwan, Sörensen, Nils Arne, Winkelmann, Simon, Akbulak, Özge, Gosau, Nils Arne, Würger, Tilman, Arnold, Natalie, Geßler, Nele, Jobs, Alexander, Münkler, Paula, Rausch, Stefan, Köster, Jelena, Brüggemann, Ben, Abdin, Amr, Wacker, Christian, Grotherr, Philipp, Fries, Bastian, Faust, Maximilian, Steuer, Stefanie, Swojanowsky, Patrick, Willems, Stephan, Portz, Nathaniel, Ujeyl, Amar, Krüger, Matthias, Gramlich, Robert, Köhler, Till, Sause, Armin, Nover, Ina, Ziakos, Athanasios-Panagiotis, Ciobanu, Veaceslav, Spelsberg, Norman, Siebermair, Johannes, Mahabadi, Amir-Abbas, Köhler, Miriam, Vonderlin, Nadine, Riesinger, Lisa, Abdiu, Edison, Bachmann, Anja, Frenzel, Marie, Hummel, Astrid, Lehnert, Kristin, Krüger, Anne, Busse, Franke, Napp, Andreas, Müller-Wieland, Dirk, Battermann, Simone, Lacour, Philipp, Trippel, Tobias, Beetz, Nick Lasse, Schleußner, Leonhard, Zach, Veronika, Rozados, Christina, Mudra, Harald, Staubach, Stephan, Illmann, Alexander, Joner, Michael, Bock, Matthias, Kolb, Christof, Koch, Tobias, Fröhlich, Rebecca, Lennerz, Carsten, Lenz, Tobias, Fuchs, Patrick, Freißmuth, Markus, Grebmer, Christian, Kuschyk, Jürgen, Kranert, Malte, Fastenrath, Fabian, Yücel, Gökhan, Rudic, Boris, Würfel, Sarah, Römer, Albrecht, Böhmer, Andreas, Honold, Jörg, Georgopoulos, Stamatis, Gleirscher, Lukas, Lederle, Susanne, Chaplygin, Artem, Pauschinger, Matthias, Brinker-Paschke, Andrea, Kropacek, Jana, Eckardt, Lars, Ellermann, Christian, Bode, Niklas, Reinke, Florian, Engelke, Hauke, Höllriegel, Robert, Woitek, Felix, Winzer, Ephraim, Ibrahim, Karim, Pflücke, Christian, Ende, Georg, Speiser, Uwe, Haußig, Stephan, Wachter, Rolf, Uhe, Tobias, Konrad, Torsten, Zitron, Edgar, Destani, Jeton, Fu, Fangyi, Al Said, Samer, Kaya, Ziya, Schgör, Wilfried, Senoner, Thomas, Bauer, Axel, Sappler, Nikolay, von Stülpnagel, Lukas, Klemm, Mathias, Schreinlechner, Michael, Wenner, Felix, Schier, Johannes, Al Tawil, Amani, Dolejsi, Theresa, Eiffener, Elodie, Bongarth, Christa, Stühlinger, Markus, Huemer, Martin, Gori, Tommaso, Wakili, Reza, Sahin, Riza, Schwinger, Robert, Lutz, Matthias, Luik, Armin, Gessler, Nele, Clemmensen, Peter, Linke, Axel, Maier, Lars S, Hinterseer, Martin, Busch, Mathias C, Blaschke, Florian, Sack, Stefan, Licka, Manuela, Tilz, Roland R, Ukena, Christian, Ehrlich, Joachim R, Zabel, Markus, Schmidt, Georg, Mansmann, Ulrich, Kääb, Stefan, Rizas, Konstantinos D, and Massberg, Steffen

Published
2022
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8. Quantitative assessment of ventricular far field removal techniques for clinical unipolar electrograms

Author

Lorenz Nick Johannes, Unger Laura Anna, Luik Armin, and Dössel Olaf

Subjects
electroanatomic mapping, atrial electrograms, unipolar electrograms, ventricular far field removal., Medicine
Abstract

The incidence of atrial tachycardia steadily increases in industrial nations. During invasive electrophysiological studies, a catheter measures electrograms within the atrium to assist detailed diagnosis and treatment planning. With unipolar and bipolar electrograms, two different acquisition modes are clinically available. Unipolar electrograms have several advantages over bipolar electrograms. However, unipolar electrograms are more affected by noise and the ventricular far field. Therefore, only bipolar electrograms are typically used in clinical settings. A recently published ventricular far field removal technique models the ventricular far field by a set of dipoles and yielded promising results in a simulation study. However, the method lacks quantitative clinical validation. Therefore, we adapted the technique to clinical needs and applied it to data sets of two patients using four different lengths of the removal window. Results were compared quantitatively by a tailored residual error measure. The used method resulted in a median reduction of the ventricular far field by approximately 89% using a removal window of optimal length for both patients. The results showed that the dipole method provides an alternative to other VFF removal techniques in clinical practice because it can reveal AA originally hidden by VFF without leading to a prolongation of the electrophysiological study.

Published
2021
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11. Impact of effective refractory period personalization on arrhythmia vulnerability in patient-specific atrial computer models.

Author

Díaz, Patricia Martínez, Dasí, Albert, Goetz, Christian, Unger, Laura A, Haas, Annika, Luik, Armin, Rodríguez, Blanca, Dössel, Olaf, and Loewe, Axel

Abstract

Aims The effective refractory period (ERP) is one of the main electrophysiological properties governing arrhythmia, yet ERP personalization is rarely performed when creating patient-specific computer models of the atria to inform clinical decision-making. This study evaluates the impact of integrating clinical ERP measurements into personalized in silico models on arrhythmia vulnerability. Methods and results Clinical ERP measurements were obtained in seven patients from multiple locations in the atria. Atrial geometries from the electroanatomical mapping system were used to generate personalized anatomical atrial models. The Courtemanche M. et al. cellular model was adjusted to reproduce patient-specific ERP. Four modeling approaches were compared: homogeneous (A), heterogeneous (B), regional (C), and continuous (D) ERP distributions. Non-personalized approaches (A and B) were based on literature data, while personalized approaches (C and D) were based on patient measurements. Modeling effects were assessed on arrhythmia vulnerability and tachycardia cycle length, with sensitivity analysis on ERP measurement uncertainty. Mean vulnerability was 3.4 ± 4.0%, 7.7 ± 3.4%, 9.0 ± 5.1%, and 7.0 ± 3.6% for scenarios A–D, respectively. Mean tachycardia cycle length was 167.1 ± 12.6 ms, 158.4 ± 27.5 ms, 265.2 ± 39.9 ms, and 285.9 ± 77.3 ms for scenarios A–D, respectively. Incorporating perturbations to the measured ERP in the range of 2, 5, 10, 20, and 50 ms changed the vulnerability of the model to 5.8 ± 2.7%, 6.1 ± 3.5%, 6.9 ± 3.7%, 5.2 ± 3.5%, and 9.7 ± 10.0%, respectively. Conclusion Increased ERP dispersion had a greater effect on re-entry dynamics than on vulnerability. Inducibility was higher in personalized scenarios compared with scenarios with uniformly reduced ERP; however, this effect was reversed when incorporating fibrosis informed by low-voltage areas. Effective refractory period measurement uncertainty up to 20 ms slightly influenced vulnerability. Electrophysiological personalization of atrial in silico models appears essential and requires confirmation in larger cohorts. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Sex-specific efficacy and safety of cryoballoon versus radiofrequency ablation for atrial fibrillation: An individual patient data meta-analysis

Author

du Fay de Lavallaz, Jeanne, Badertscher, Patrick, Kobori, Atsushi, Kuck, Karl-Heinz, Brugada, Josep, Boveda, Serge, Providência, Rui, Khoueiry, Ziad, Luik, Armin, Squara, Fabien, Kosmidou, Ioanna, Davtyan, Karapet V., Elvan, Arif, Perez-Castellano, Nicasio, Hunter, Ross J., Schilling, Richard, Knecht, Sven, Kojodjojo, Pipin, Wasserlauf, Jeremiah, Oral, Hakan, Matta, Mario, Jain, Sandeep, Anselmino, Matteo, and Kühne, Michael

Published
2020
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18. Atrial Signals – Modeling Meets Biosignal Analysis

Author

Dössel, Olaf, Lenis, Gustavo, Loewe, Axel, Pollnow, Stefan, Rottmann, Markus, Verma, Bhawna, Schmitt, Claus, Luik, Armin, Oesterlein, Tobias, Magjarevic, Ratko, Editor-in-chief, Ładyżyński, Piotr, Series editor, Ibrahim, Fatimah, Series editor, Lacković, Igor, Series editor, Rock, Emilio Sacristan, Series editor, Eskola, Hannu, editor, Väisänen, Outi, editor, Viik, Jari, editor, and Hyttinen, Jari, editor

Published
2018
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21. High-density Mapping Reveals Short-term Reversibility of Atrial Ablation Lesions

Author

Huhn Oliver, Pollnow Stefan, Unger Laura, Dössel Olaf, Oesterlein Tobias, Luik Armin, and Schmitt Claus

Subjects
radiofrequency ablation, cardiac mapping, electrograms, signal processing, Medicine
Abstract

Cardiac arrhythmias such as atrial fibrillation occur frequently in industrialized countries. Radiofrequency ablation (RFA) is a standard treatment if drug therapy fails. This minimally invasive surgery aims at stabilizing the heart rhythm on a permanent basis. However, the procedure commonly needs to be repeated because of the high recurrence rate of arrhythmias. Non-transmural lesions as well as gaps within linear lesions are among the main problems during the RFA. The assessment of lesion formation is not adequate in state of the art procedures. Therefore, the aim of this study is to investigate the short-term reversibility of lesions using human electrograms recorded by a high-density mapping system during an electrophysiological study (EPS). A predefined measurement protocol was executed during the EPS in order to create three ablation points in the left atrium. Subsequently, after preprocessing the recorded signals, electrogram (EGM) paths were formed along the endocardial surface of the atrium. By analyzing changes of peak to peak amplitudes of unipolar EGMs before and after ablation, it was possible to distinguish lesion area and healthy myocardium. The peak to peak amplitudes of the EGMs decreased by 40-61% after 30 seconds of ablation. Furthermore, we analyzed the morphological changes of EGMs surrounding the lesion. High-density mapping data showed that not only the tissue, which had direct contact with the catheter tip during the RFA, but also the surrounding tissue was affected. This was demonstrated by low peak to peak amplitudes in large areas with a width of 14 mm around the center of the ablation lesion. After right pulmonary vein isolation, high-density mapping was repeated on the previous lesions. The outer region of RFA-treated tissue appears to recover as opposed to the central core of the ablation point. This observation suggests that the meaningfulness of an immediate remap after ablation during an EPS may lead the physician to false conclusions

Published
2018
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22. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study

Author

Ekanem, Emmanuel, Neuzil, Petr, Reichlin, Tobias, Kautzner, Joseph, van der Voort, Pepijn, Jais, Pierre, Chierchia, Gian-Battista, Bulava, Alan, Blaauw, Yuri, Skala, Tomas, Fiala, Martin, Duytschaever, Mattias, Szeplaki, Gabor, Schmidt, Boris, Massoullie, Grégoire, Neven, Kars, Thomas, Olivier, Vijgen, Johan, Gandjbakhch, Estelle, Scherr, Daniel, Johannessen, Arne, Keane, David, Boveda, Serge, Maury, Philippe, García-Bolao, Ignacio, Anic, Ante, Hansen, Peter Steen, Raczka, Franck, Lepillier, Antoine, Guyomar, Yves, Gupta, Dhiraj, Van Opstal, Jurren, Defaye, Pascal, Sticherling, Christian, Sommer, Philipp, Kucera, Pavel, Osca, Joaquin, Tabrizi, Fariborz, Roux, Antoine, Gramlich, Michael, Bianchi, Stefano, Adragão, Pedro, Solimene, Francesco, Tondo, Claudio, Russo, Antonio Dello, Schreieck, Jürgen, Luik, Armin, Rana, Obaida, Frommeyer, Gerrit, Anselme, Frédéric, Kreis, Ingo, Rosso, Raphael, Metzner, Andreas, Geller, Laszlo, Baldinger, Samuel H., Ferrero, Angel, Willems, Stephan, Goette, Andreas, Mellor, Greg, Mathew, Shibu, Szumowski, Lukasz, Tilz, Roland, Iacopino, Saverio, Jacobsen, Peter Karl, George, Andrikopoulos, Osmancik, Pavel, Spitzer, Stefan, Balasubramaniam, Richard, Parwani, Abdul Shokor, Deneke, Thomas, Glowniak, Andrzej, Rossillo, Antonio, Pürerfellner, Helmut, Duncker, David, Reil, Peter, Arentz, Thomas, Steven, Daniel, Olalla, Juan José, de Jong, Jonas S. S. G., Wakili, Reza, Abbey, Selim, Timo, Gottschling, Asso, Antonio, Wong, Tom, Pierre, Bertrand, Ewertsen, Niels Christian, Bergau, Leonard, Lozano-Granero, Cristina, Rivero, Maximo, Breitenstein, Alexander, Inkovaara, Jaakko, Fareh, Samir, Latcu, Decebal Gabriel, Linz, Dominik, Müller, Patrick, Ramos-Maqueda, Javier, Beiert, Thomas, Themistoclakis, Sakis, Meininghaus, Dirk Grosse, Stix, Günter, Tzeis, Stylianos, Baran, Jakub, Almroth, Henrik, Munoz, Daniel Rodriguez, de Sousa, João, Efremidis, Michalis, Balsam, Pawel, Petru, Jan, Küffer, Thomas, Peichl, Petr, Dekker, Lukas, Della Rocca, Domenico G., Moravec, Ondrej, Funasako, Moritoshi, Knecht, Sebastien, Jauvert, Gael, Chun, Julian, Eschalier, Romain, Füting, Anna, Zhao, Alexandre, Koopman, Pieter, Laredo, Mikael, Manninger, Martin, Hansen, Jim, O’Hare, Daniel, Rollin, Anne, Jurisic, Zrinka, Fink, Thomas, Chaumont, Corentin, Rillig, Andreas, Gunawerdene, Melanie, Martin, Claire, Kirstein, Bettina, Nentwich, Karin, Lehrmann, Heiko, Sultan, Arian, Bohnen, Jan, Turagam, Mohit K., and Reddy, Vivek Y.

Abstract

Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profile by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF.

Published
2024
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23. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study

Author

Martin, Claire A, Tilz, Roland RR, Anic, Ante, Defaye, Pascal, Luik, Armin, De Asmundis, Carlo, Champ-Rigot, Laure, Iacopino, Saverio, Sommer, Philipp, Albrecht, Elizabeth M, Raybuck, Jonathan D, Richards, Elizabeth, Cielen, Nele, Yap, Sing-Chien, POLAR ICE Investigators, Luik, Armin [0000-0001-5926-6696], Sommer, Philipp [0000-0002-3037-8704], Albrecht, Elizabeth M [0000-0002-2021-5434], Yap, Sing-Chien [0000-0003-4520-2725], Apollo - University of Cambridge Repository, Brussels Heritage Lab, Clinical sciences, Cardio-vascular diseases, Heartrhythmmanagement, and Faculty of Medicine and Pharmacy

Subjects
safety, cryoballoon ablation, Treatment Outcome, Fluoroscopy, Atrial Fibrillation, Humans, success rate, time to thaw, Prospective Studies, Heart Atria, Cardiology and Cardiovascular Medicine, paroxysmal atrial fibrillation, pulmonary vein isolation (PVI)
Abstract

INTRODUCTION: Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS: POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS: Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION: This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.

Published
2023

24. Assessment of local high-density mapping for the analysis of radiofrequency ablation lesions in the left atrium

Author

Stritt Michael, Oesterlein Tobias, Pollnow Stefan, Luik Armin, Schmitt Claus, and Dössel Olaf

Subjects
high-density mapping, radiofrequency ablation, left atrium, point-shaped lesions, intracardiac electrograms, Medicine
Abstract

Recent studies about the development of endocardial radiofrequency (RF) ablation lesions (ALs) tried to identify reliable electrogram (EGM) markers for assessment of lesion transmurality. Additional clinically relevant information for physicians can be provided by examining endocardial EGM parameters like signal morphology, amplitude or time points in the signal. We investigated EGM features of the pulmonary vein ostia before and after RF ablation for three point-shaped lesions. Using high-density (HD) mapping, local activation time (LAT) and voltage maps were created, which provided information about the RF ALs regarding the lesion size and showed activation time delay as well as low-voltage areas with bipolar peak-to-peak voltages smaller than 2mV. The time delay of the depolarization front comparing the activation times anterior and posterior to the RF AL was up to 51.5 ms. In a circular area with 5mm radius around an RF AL the mean peak-to-peak voltage decreased by 62-94% to about 0.12-0.44mV and the mean maximal absolute EGM derivative was reduced by 65-96 %. Comparing the results of this study with EGMs of similar clinical settings confirmed our expectations regarding the low-voltage areas caused by the ablation procedure. An improved understanding of the electrophysiological changes is of fundamental importance to provide more information for enhanced RF ablation assessment.

Published
2017
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26. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation:Results from the POLAR ICE study

Author

Martin, Claire A., Tilz, Roland R.R., Anic, Ante, Defaye, Pascal, Luik, Armin, de Asmundis, Carlo, Champ-Rigot, Laure, Iacopino, Saverio, Sommer, Philipp, Albrecht, Elizabeth M., Raybuck, Jonathan D., Richards, Elizabeth, Cielen, Nele, Yap, Sing Chien, Martin, Claire A., Tilz, Roland R.R., Anic, Ante, Defaye, Pascal, Luik, Armin, de Asmundis, Carlo, Champ-Rigot, Laure, Iacopino, Saverio, Sommer, Philipp, Albrecht, Elizabeth M., Raybuck, Jonathan D., Richards, Elizabeth, Cielen, Nele, and Yap, Sing Chien

Abstract

Introduction: Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. Methods: POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. Results: Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged −56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. Conclusion: This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.

Published
2023

28. Automatic detection and mapping of double potentials in intracardiac electrograms

Author

Oesterlein Tobias, Kramlich Alexander, Lenis Gustavo, Luik Armin, Schmitt Claus, and Dössel Olaf

Subjects
atrial flutter, double potential, intra-cardiac electrogram, Medicine
Abstract

Catheter ablation has become a very efficient strategy to terminate sustained cardiac arrhythmias like atrial flutter (AFlut). Identification of the optimal ablation spot, however, often proves difficult when scar from previous ablations is present. Although the application of electro-anatomical mapping systems allows to record thousands of intracardiac electrograms (EGMs) from each atrium, state-of-the-art techniques provide limited options for automatic signal processing. Goal of the presented research was the development of an algorithm to detect EGMs that present double potentials (DPs), as these often indicate functional or anatomical lines of block for cardiac excitation. Using an annotated database, we developed several features based on the morphological descriptors of DPs. These were used to train a binary decision tree which was able to detect DPs with a correct rate of over 90%.

Published
2016
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29. Preprocessing of unipolar signals acquired by a novel intracardiac mapping system

Author

Huck Salina, Oesterlein Tobias, Luik Armin, Schmitt Claus, Wakili Reza, and Dössel Olaf

Subjects
filtering, intracardiac mapping, unipolar electrogram, Medicine
Abstract

The novel high-density mapping system RhythmiaTM Medical (Boston Scientific, Marlborough, USA) allows a fast and automatic acquisition of intracardiac electrograms (EGMs). For recording the ORION mini-basket catheter is used. Due to the small electrode surface, the spatial averaging is smaller than with other commonly used mapping catheters. This results in a higher quality of unipolar signals. However, these are still corrupted by noise such as high frequency interference. Within this project, methods were developed and benchmarked that can be applied to detect and remove these undesired components. An algorithm was implemented to detect and eliminate artificial peaks in the spectrum of the EGM. The filtered signals showed improved quality in time domain. The performance of the spectral peak detection resulted in a median sensitivity of 92.1% and in a median positive predictive value of 91.9%.

Published
2016
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31. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study

Author

Martin, Claire A., Tilz, Roland R.R., Anic, Ante, Defaye, Pascal, Luik, Armin, de Asmundis, Carlo, Champ-Rigot, Laure, Iacopino, Saverio, Sommer, Philipp, Albrecht, Elizabeth M., Raybuck, Jonathan D., Richards, Elizabeth, Cielen, Nele, Yap, Sing Chien, and Cardiology

Abstract

Introduction: Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. Methods: POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. Results: Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged −56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. Conclusion: This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.

Published
2023

33. Locating regions of arrhythmogenic substrate by analyzing the duration of triggered atrial activities

Author

Verma Bhawna, Oesterlein Tobias, Luik Armin, Schmitt Claus, and Dössel Olaf

Subjects
atrial arrhythmia, pacing sequence, intraatrial electrogram, visualization, Medicine
Abstract

Catheter ablation is the most widely used minimum invasive technique to cure atrial arrhythmias. However, the success rate of the treatment is still moderate and depends on the experience and expertise of the physicians. The aim of this work is to present a simple and feasible method to identify the arrhythmogenic areas on the atrium based on the duration of atrial activities in the intraatrial electrograms. Depolarization waves are created by giving pacing impulses from coronary sinus (CS). The duration of the activity triggered from sinus node (SN) and pacing sequences are analysed by calculating the duration of the activity to mark regions with long atrial activity waves. The intraatrial electrograms have been analysed on the basis of temporal and spatial information. The region specific study may favour the localization of the critical sites in the patient specific atrial anatomy and aid the physician in ascertaining the efficacy of the cardiac therapies. The identification of suitable markers for critical patterns of the depolarization waves may be crucial to guide an effective ablation treatment. In this work a novel study for point-to-point analysis of the intraatrial electrograms was carried out.

Published
2015
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36. Atrial Signals – Modeling Meets Biosignal Analysis

Author

Dössel, Olaf, primary, Lenis, Gustavo, additional, Loewe, Axel, additional, Pollnow, Stefan, additional, Rottmann, Markus, additional, Verma, Bhawna, additional, Schmitt, Claus, additional, Luik, Armin, additional, and Oesterlein, Tobias, additional

Published
2017
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38. Basic principles

Author

Zrenner, Bernhard, Kolb, Christof, Luik, Armin, Ndrepepa, Gjin, Schmitt, Claus, editor, Deisenhofer, Isabel, editor, and Zrenner, Bernhard, editor

Published
2006
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42. AV-Knoten-Reentrytachykardie: Diagnostik und Therapie

Author

von Bary, Christian, Eckardt, Lars, Steven, Daniel, Neuberger, Hans-Ruprecht, Tilz, Roland Richard, Bonnemeier, Hendrik, Thomas, Dierck, Deneke, Thomas, Estner, Heidi L., Kuniss, Malte, Luik, Armin, Sommer, Philipp, Voss, Frederik, Meyer, Christian, Shin, D.I., and Kriatselis, Charalampos

Published
2015
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46. Telemedical cardiac risk assessment by implantable cardiac monitors in patients after myocardial infarction with autonomic dysfunction (SMART-MI-DZHK9): a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial

Author

Bauer, Axel, primary, Sappler, Nikolay, additional, von Stülpnagel, Lukas, additional, Klemm, Mathias, additional, Schreinlechner, Michael, additional, Wenner, Felix, additional, Schier, Johannes, additional, Al Tawil, Amani, additional, Dolejsi, Theresa, additional, Krasniqi, Aresa, additional, Eiffener, Elodie, additional, Bongarth, Christa, additional, Stühlinger, Markus, additional, Huemer, Martin, additional, Gori, Tommaso, additional, Wakili, Reza, additional, Sahin, Riza, additional, Schwinger, Robert, additional, Lutz, Matthias, additional, Luik, Armin, additional, Gessler, Nele, additional, Clemmensen, Peter, additional, Linke, Axel, additional, Maier, Lars S, additional, Hinterseer, Martin, additional, Busch, Mathias C, additional, Blaschke, Florian, additional, Sack, Stefan, additional, Lennerz, Carsten, additional, Licka, Manuela, additional, Tilz, Roland R, additional, Ukena, Christian, additional, Ehrlich, Joachim R, additional, Zabel, Markus, additional, Schmidt, Georg, additional, Mansmann, Ulrich, additional, Kääb, Stefan, additional, Rizas, Konstantinos D, additional, Massberg, Steffen, additional, May, Andreas, additional, Seitzer, Peter, additional, Schmidt, Roland, additional, Keta, Dritan, additional, Janke, Viktoria, additional, Schläger, Christian, additional, André, Elisabeth, additional, Brandt, Niels, additional, Schön, Alexandra, additional, Zollner, Alfred, additional, Freyer, Luisa, additional, Hamm, Wolfgang, additional, Beil, Johannes, additional, Strüven, Anna Katharina, additional, Loew, Anja, additional, Fichtner, Stephanie, additional, Lange, Philipp, additional, Grabmeier, Ulrich, additional, Estner, Heidi, additional, Bengel, Philipp, additional, Lüthje, Lars, additional, Kirova, Aleksandra, additional, Fischer, Thomas, additional, Bergau, Leonard, additional, Herting, Jonas, additional, Schlögl, Simon, additional, Haarmann, Helge, additional, Schlögl (Illes), Klaudia, additional, Uecer, Ekrem, additional, Sag, Sabine, additional, Tafelmeier, Maria, additional, Jungbauer, Carsten, additional, Fredersdorf-Hahn, Sabine, additional, Strack, Christina, additional, Seither, Benedikt, additional, Seegers, Joachim, additional, Millenaar, Dominic, additional, Wintrich, Jan, additional, Fischer, Patrick, additional, Buob, Axel, additional, Razouk, Amjad, additional, Demming, Thomas, additional, Frank, Johanne, additional, Kühl, Constantin, additional, Ellendt, Ulrike, additional, Sandrock, Sarah, additional, Gänsbacher, Julia, additional, Cupa, Janosch, additional, Sinnecker, Daniel, additional, Laugwitz, Karl-Ludwig, additional, Steger, Alexander, additional, Berkefeld, Anna, additional, Schinke, Karin, additional, Barthel, Petra, additional, Dommasch, Michael, additional, Amadei, Maiwand, additional, Hindricks, Gerhard, additional, Obradovic, Danilo, additional, Döring, Michael, additional, Bode, Kerstin, additional, Hilbert, Sebastian, additional, Löbe, Susanne, additional, Knopp, Helge, additional, König, Sebastian, additional, John, Silke, additional, Schöne, Katharina, additional, Hartung, Philipp, additional, Binner, Christian, additional, Meyer-Zürn, Christine, additional, Duckheim, Martin, additional, Eick, Christian, additional, Simpfle, Fabian, additional, Schreieck, Jürgen, additional, Mizera, Lars, additional, Tscholl, Verena, additional, Steinbeck, Lisa, additional, Güc, Nadija, additional, Schatz, Anne-Sophie, additional, Attanasio, Philipp, additional, Heuberger, Andrea, additional, Roser, Mattias, additional, Bellmann, Barbara, additional, Nagel, Patrick, additional, Biewener, Sebastian, additional, Suhail, Saba, additional, Juri, Benjamin, additional, Meyer, Christian, additional, Wiilems, Stephan, additional, Jungen, Christiane, additional, Schmitt, Susanne, additional, Münkerer, Paula, additional, Vogler, Julia, additional, Kaiser, Lukas, additional, Schäffer, Benjamin, additional, Nies, Moritz, additional, Tönnis, Tobias, additional, Fluschnik, Nina, additional, Grahn, Hanno, additional, Waldeyer, Christoph, additional, Kany, Shinwan, additional, Sörensen, Nils Arne, additional, Winkelmann, Simon, additional, Akbulak, Özge, additional, Gosau, Nils Arne, additional, Würger, Tilman, additional, Arnold, Natalie, additional, Geßler, Nele, additional, Jobs, Alexander, additional, Münkler, Paula, additional, Rausch, Stefan, additional, Köster, Jelena, additional, Brüggemann, Ben, additional, Abdin, Amr, additional, Wacker, Christian, additional, Grotherr, Philipp, additional, Fries, Bastian, additional, Faust, Maximilian, additional, Steuer, Stefanie, additional, Swojanowsky, Patrick, additional, Willems, Stephan, additional, Portz, Nathaniel, additional, Ujeyl, Amar, additional, Krüger, Matthias, additional, Gramlich, Robert, additional, Köhler, Till, additional, Sause, Armin, additional, Nover, Ina, additional, Ziakos, Athanasios-Panagiotis, additional, Ciobanu, Veaceslav, additional, Spelsberg, Norman, additional, Siebermair, Johannes, additional, Mahabadi, Amir-Abbas, additional, Köhler, Miriam, additional, Vonderlin, Nadine, additional, Riesinger, Lisa, additional, Abdiu, Edison, additional, Bachmann, Anja, additional, Frenzel, Marie, additional, Hummel, Astrid, additional, Lehnert, Kristin, additional, Krüger, Anne, additional, Busse, Franke, additional, Napp, Andreas, additional, Müller-Wieland, Dirk, additional, Battermann, Simone, additional, Lacour, Philipp, additional, Trippel, Tobias, additional, Beetz, Nick Lasse, additional, Schleußner, Leonhard, additional, Zach, Veronika, additional, Rozados, Christina, additional, Mudra, Harald, additional, Staubach, Stephan, additional, Illmann, Alexander, additional, Joner, Michael, additional, Bock, Matthias, additional, Kolb, Christof, additional, Koch, Tobias, additional, Fröhlich, Rebecca, additional, Lenz, Tobias, additional, Fuchs, Patrick, additional, Freißmuth, Markus, additional, Grebmer, Christian, additional, Kuschyk, Jürgen, additional, Kranert, Malte, additional, Fastenrath, Fabian, additional, Yücel, Gökhan, additional, Rudic, Boris, additional, Würfel, Sarah, additional, Römer, Albrecht, additional, Böhmer, Andreas, additional, Honold, Jörg, additional, Georgopoulos, Stamatis, additional, Gleirscher, Lukas, additional, Lederle, Susanne, additional, Chaplygin, Artem, additional, Pauschinger, Matthias, additional, Brinker-Paschke, Andrea, additional, Kropacek, Jana, additional, Eckardt, Lars, additional, Ellermann, Christian, additional, Bode, Niklas, additional, Reinke, Florian, additional, Engelke, Hauke, additional, Höllriegel, Robert, additional, Woitek, Felix, additional, Winzer, Ephraim, additional, Ibrahim, Karim, additional, Pflücke, Christian, additional, Ende, Georg, additional, Speiser, Uwe, additional, Haußig, Stephan, additional, Wachter, Rolf, additional, Uhe, Tobias, additional, Konrad, Torsten, additional, Zitron, Edgar, additional, Destani, Jeton, additional, Fu, Fangyi, additional, Al Said, Samer, additional, Kaya, Ziya, additional, Schgör, Wilfried, additional, and Senoner, Thomas, additional

Published
2022
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47. Local Electrical Impedance Mapping of the Atria: Conclusions on Substrate Properties and Confounding Factors

Author

Unger, Laura Anna, Schicketanz, Leonie, Oesterlein, Tobias, Stritt, Michael, Haas, Annika, Martínez Antón, Carmen, Schmidt, Kerstin, Doessel, Olaf, and Luik, Armin

Subjects
Physiology, substrate mapping, local impedance, QP1-981, atrial fibrillation, ddc:620, electrophysiology, impedance mapping, atrial substrate, pulmonary vein isolation, Engineering & allied operations, Original Research
Abstract

The treatment of atrial fibrillation and other cardiac arrhythmias as a major cause of cardiovascular hospitalization has remained a challenge predominantly for patients with severely remodeled substrate. Individualized ablation strategies are extremely important both for pulmonary vein isolation and subsequent ablations. Current approaches to identifying arrhythmogenic regions rely on electrogram-based features such as activation time and voltage. Novel technologies now enable clinical assessment of the local impedance as tissue property. Previous studies demonstrated its use for ablation monitoring and indicated its potential to differentiate healthy substrate, scar, and pathological tissue. This study investigates the potential of local electrical impedance-based substrate mapping of the atria for human in-vivo data. The presented pipeline for impedance mapping particularly contains options for dealing with undesirable effects originating from cardiac motion, catheter motion, or proximity to other intracardiac devices. Bloodpool impedance was automatically determined as a patient-specific reference. Full-chamber, left atrial impedance maps were drawn up from interpolating the measured impedances to the atrial endocardium. Finally, the origin and magnitude of oscillations of the raw impedance recording were probed into. The most dominant reason for exclusion of impedance samples was the loss of endocardial contact. With median elevations above the bloodpool impedance between 29 and 46 Ω, the impedance within the pulmonary veins significantly exceeded the remaining atrial walls presenting median elevations above the bloodpool impedance between 16 and 20 Ω. Previous ablation lesions were distinguished from their surroundings by a significant drop in local impedance while the corresponding regions did not differ for the control group. The raw impedance was found to oscillate with median amplitudes between 6 and 17 Ω depending on the patient. Oscillations were traced back to an interplay of atrial, ventricular, and respiratory motion. In summary, local impedance measurements demonstrated their capability to distinguish pathological atrial tissue from physiological substrate. Methods to limit the influence of confounding factors that still hinder impedance mapping were presented. Measurements at different frequencies or the combination of multiple electrodes could lead to further improvement. The presented examples indicate that electrogram- and impedance-based substrate mapping have the potential to complement each other toward better patient outcomes in future.

Published
2022

50. Hybrid machine learning to localize atrial flutter substrates using the surface 12-lead electrocardiogram

Author

Luongo, Giorgio, primary, Vacanti, Gaetano, additional, Nitzke, Vincent, additional, Nairn, Deborah, additional, Nagel, Claudia, additional, Kabiri, Diba, additional, Almeida, Tiago P, additional, Soriano, Diogo C, additional, Rivolta, Massimo W, additional, Ng, Ghulam André, additional, Dössel, Olaf, additional, Luik, Armin, additional, Sassi, Roberto, additional, Schmitt, Claus, additional, and Loewe, Axel, additional

Published
2022
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