133 results on '"Breithardt OA"'
Search Results
2. P1032Regional distribution of post-systolic motion in patients after myocardial infarction - direct comparison between echocardiography and magnetic resonance imaging
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Gerlach, A, Rost, C, Schmid, M, Rost, MC, Flachskampf, FA, Daniel, WG, and Breithardt, OA
- Published
- 2011
3. P385Usefulness of a new ultra-portable echocardiographic hand-held device for the assessment of cardiac function and morphology.
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Breithardt, OA, Schiessl, S, Schmid, M, Seltmann, M, Klinghammer, L, Zeissler, C, Kuechle, M, and Daniel, WG
- Published
- 2011
4. Stress-Echokardiografie
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Breithardt Oa and von Roeder M
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medicine.medical_specialty ,Heart disease ,business.industry ,Cardiomyopathy ,General Medicine ,medicine.disease ,Coronary artery disease ,Hyperaemia ,Coronary circulation ,medicine.anatomical_structure ,Internal medicine ,medicine ,Stress Echocardiography ,Cardiology ,Dobutamine ,Treadmill ,medicine.symptom ,business ,medicine.drug - Abstract
Stress echocardiography (SE) is a powerful functional imaging technique to assess cardiac performance under work conditions. The main indication is the detection of myocardial ischemia due to coronary artery disease (CAD), however it can also be used in patients with structural heart disease (e. g. valvular disease, hypertrophic obstructive cardiomyopathy). Dynamic or pharmacological (dobutamine / adenosine) modalities are available to induce cardiac stress, basically depending on the clinical problem and the patient's ability to exercise. Exercise on a treadmill or a semi-supine bicycle is the most physiological way to induce stress. Dobutamine stimulation is useful in patients who are unable to exercise and for detection of viable myocardium in hypo- or akinetic segments. Adenosin-induced hyperaemia causes steal effects in myocardial segments with significant CAD. Main limitations of SE are the need for an appropriate acoustic window and the user-dependent variability with regard to the interpretation of the results.
- Published
- 2015
5. Die Echokardiographie: Untersuchungsablauf
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Wasmeier Gh, Breithardt Oa, and Frank A. Flachskampf
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medicine.medical_specialty ,business.industry ,medicine ,MEDLINE ,General Medicine ,Radiology ,business - Published
- 2008
6. Die Echokardiographie: Beurteilung der globalen systolischen linksventrikulären Funktion
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Flachskampf Fa and Breithardt Oa
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medicine.medical_specialty ,business.industry ,Internal medicine ,Heart failure ,medicine ,Cardiology ,General Medicine ,Linksventrikulare funktion ,business ,medicine.disease - Published
- 2008
7. Echokardiographie zur Optimierung der Patienten-auswahl für eine Resynchronisationstherapie
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Daniel Wg, Frank A. Flachskampf, and Breithardt Oa
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Left ventricular contraction ,medicine.medical_specialty ,Ventricular function ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Hemodynamics ,General Medicine ,Cardiac mortality ,medicine.disease ,QRS complex ,Heart failure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,business - Abstract
An uncoordinated left ventricular contraction sequence contributes significantly to the impaired hemodynamic function in patients with chronic heart failure. Cardiac resynchronization therapy with biventricular pacing may improve heart failure symptoms and exercise tolerance and reduce cardiac mortality in patients with severe chronic heart failure, depressed systolic left ventricular function (EF 120 ms. However, about one third of patients with implanted pacemakers do not respond favorably to resynchronisation therapy. This may be related to the limited diagnostic value of QRS duration for the identification of mechanical dyssynchrony. Echocardiography allows identification of mechanical dyssynchrony with a high diagnostic sensitivity and may improve the selection of patients suitable for biventricular pacing. This article discusses proposed echocrdiographic approaches for quantification of dyssynchrony.
- Published
- 2007
8. Established and evolving indications for cardiac resynchronisation
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Breithardt Oa, Khandheria Bk, and Nesser Hj
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medicine.medical_specialty ,Ventricular Dysfunction, Left ,Internal medicine ,Journal Article ,medicine ,Humans ,In patient ,cardiovascular diseases ,Cardiac Surgical Procedures ,Cheyne-Stokes Respiration ,Randomized Controlled Trials as Topic ,Heart Failure ,Medical treatment ,business.industry ,Cardiac Pacing, Artificial ,Mitral Valve Insufficiency ,Arrhythmias, Cardiac ,medicine.disease ,Myocardial imaging ,Sleep Apnea, Central ,Heart failure ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Randomised trials involving large number of patients have demonstrated the benefits of cardiac resynchronisation therapy (CRT) in patients with heart failure who have failed optimal medical treatment. Echocardiography plays an important role in defining dyssynchrony which is key to optimal patient selection. The electrocardiographic criteria for patient selection is supplemented by the finding of dyssynchrony on Doppler myocardial imaging, and echocardiography with Doppler myocardial imaging may eventually replace the electrocardiographic criteria for selection of patients who derive benefit from CRT.
- Published
- 2004
9. Detektion atrio-ventrikulärer und interventrikulärer Dyssynchronie mittels Tissue Doppler Imaging (TDI) am fetalen Herzen
- Author
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Steinhard, J, primary, Heinig, J, additional, Schmitz, R, additional, Breithardt, OA, additional, and Kiesel, L, additional
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- 2006
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10. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure.
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Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, Stellbrink C, Breithardt, Ole A, Sinha, Anil M, Schwammenthal, Ehud, Bidaoui, Nadim, Markus, Kai U, Franke, Andreas, and Stellbrink, Christoph
- Abstract
Objectives: We studied the acute effects of cardiac resynchronization therapy (CRT) on functional mitral regurgitation in heart failure (HF) patients with left bundle branch block (LBBB).Background: Both an decrease [corrected] in left ventricular (LV) closing force and mitral valve tethering have been implicated as mechanisms for functional mitral regurgitation (FMR) in dilated hearts. We hypothesized that an increase in LV closing force achieved by CRT could act to reduce FMR.Methods: Twenty-four HF patients with LBBB and FMR were studied after implantation of a biventricular CRT system. Acute changes in FMR severity between intrinsic conduction (OFF) and CRT were quantified according to the proximal isovelocity surface area method by measuring the effective regurgitant orifice area (EROA). Results were compared with the changes in estimated maximal rate of left ventricular systolic pressure rise (LV+dP/dt(max)) and transmitral pressure gradients (TMP), both measured by Doppler echocardiography.Results: Cardiac resynchronization therapy was associated with a significant reduction in FMR severity. Effective regurgitant orifice area decreased from 25 +/- 19 mm(2) (OFF) to 13 +/- 8 mm(2) (CRT). The change in EROA was directly related to the increase in LV+dP/dt(max) (r = -0.83, p < 0.0001). Compared with OFF, TMP increased more rapidly during CRT, and a higher maximal TMP was observed (OFF 73 +/- 24 mm Hg vs. CRT 85 +/- 26 mm Hg, p < 0.01).Conclusions: Functional mitral regurgitation is reduced by CRT in patients with HF and LBBB. This effect is directly related to the increased closing force (LV+dP/dt(max)). The results support the hypothesis that an increase in TMP, mediated by a rise in LV+dP/dt(max) due to more coordinated LV contraction, may facilitate effective mitral valve closure. [ABSTRACT FROM AUTHOR]- Published
- 2003
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11. Non-contrast second harmonic imaging improves interobserver agreement and accuracy of dobutamine stress echocardiography in patients with impaired image quality.
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Franke A, Hoffmann R, Kühl HP, Lepper W, Breithardt OA, Schormann M, Hanrath P, Franke, A, Hoffmann, R, Kühl, H P, Lepper, W, Breithardt, O A, Schormann, M, and Hanrath, P
- Abstract
Objective: To examine the influence of second harmonic imaging during dobutamine echocardiography on regional endocardial visibility, interobserver agreement in the interpretation of wall motion abnormalities, and diagnostic accuracy in patients with reduced image quality.Design: Blinded comparison.Setting: Tertiary care centre.Patients: 103 consecutive patients with suspected coronary artery disease and impaired transthoracic image quality (>/= 2 segments with poor endocardial delineation).Methods: Fundamental and second harmonic imaging were performed at each stage of a dobutamine stress echocardiography. Coronary angiography was undertaken within three weeks of dobutamine echocardiography in 75 patients.Main Outcome Measures: Evaluation of regional endocardial visibility (scoring from 0 = poor to 2 = good) and of segmental wall motion abnormalities for both modalities separately. A second blinded examiner analysed 70 studies to determine interobserver agreement.Results: Mean (SD) visibility score for all segments was 1.2 (0.4) using fundamental imaging and 1.7 (0.2) using second harmonic imaging at rest (p < 0.001), and 1.1 (0.4) v 1.6 (0.3), respectively, at peak dobutamine dose (p < 0.001). The average number of segments with poor endocardial visibility was lower for second harmonic than for fundamental imaging (0.6 (1.1) v 3.8 (2.6) at rest, p < 0.001; 0.9 (1.3) v 4.3 (2.9) at peak dose, p < 0.001). Improvement was most pronounced in all lateral and anterior segments. The kappa value for identical study interpretation increased from 0. 40 to 0.69 (p < 0.05). Sensitivity for the diagnosis of coronary artery disease was 64% using fundamental imaging versus 92% using harmonic imaging (p < 0.001), while specificity remained unchanged at 75% for both imaging modalities.Conclusions: Second harmonic imaging enhances endocardial visibility during dobutamine echocardiography. Consequently, interobserver agreement on stress echocardiography interpretation and diagnostic accuracy are significantly improved compared to fundamental imaging. Thus, in difficult to image patients, dobutamine echocardiography should be performed using second harmonic imaging. [ABSTRACT FROM AUTHOR]- Published
- 2000
12. A heart within the heart: double-chambered left ventricle.
- Author
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Breithardt OA, Ropers D, Seeliger T, Schmid A, von Erffa J, Garlichs C, Daniel WG, and Achenbach S
- Abstract
We describe a rare congenital anomaly in a 49-year-old woman who presented with palpitations and slightly reduced exercise capacity. A double-chambered left ventricle was suspected on echocardiography and confirmed by cardiac computed tomography scanning, cardiac magnet resonance imaging, and invasive angiography. [ABSTRACT FROM AUTHOR]
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- 2008
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13. Quest for the best candidate: how much imaging do we need before prescribing cardiac resynchronization therapy?
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Breithardt OA and Breithardt G
- Published
- 2006
14. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area
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Domingos, JS, Augustine, DX, Leeson, P, Noble, JA, Doan, H-L, Boubrit, L, Cheikh-Khalifa, R, Laveau, F, Djebbar, M, Pousset, F, Isnard, R, Hammoudi, N, Lisi, M, Cameli, M, Di Tommaso, C, Curci, V, Reccia, R, Maccherini, M, Henein, M Y, Mondillo, S, Leitman, M, Vered, Z, Rashid, H, Yalcin, M U, Gurses, K M, Kocyigit, D, Evranos, B, Yorgun, H, Sahiner, L, Kaya, B, Aytemir, K, Ozer, N, Bertella, E, Petulla', M, Baggiano, A, Mushtaq, S, Russo, E, Gripari, P, Innocenti, E, Andreini, D, Tondo, C, Pontone, G, Necas, J, Kovalova, S, Hristova, K, Shiue, I, Bogdanva, V, Teixido Tura, G, Sanchez, V, Rodriguez-Palomares, J, Gutierrez, L, Gonzalez-Alujas, T, Garcia-Dorado, D, Forteza, A, Evangelista, A, Timoteo, A T, Aguiar Rosa, S, Cruz Ferreira, R, Campbell, R, Carrick, D, Mccombe, C, Tzemos, N, Berry, C, Sonecki, P, Noda, M, Setoguchi, M, Ikenouchi, T, Nakamura, T, Yamamoto, Y, Murakami, T, Katou, Y, Usui, M, Ichikawa, K, Isobe, M, Kwon, BJ, Roh, JW, Kim, HY, Ihm, SH, Barron, A J, Francis, DP, Mayet, J, Wensel, R, Kosiuk, J, Dinov, B, Bollmann, A, Hindricks, G, Breithardt, OA, Rio, P, Moura Branco, L, Galrinho, A, Cacela, D, Pinto Teixeira, P, Afonso Nogueira, M, Pereira-Da-Silva, T, Abreu, J, Teresa Timoteo, A, Cruz Ferreira, R, Pavlyukova, EN, Tereshenkova, EK, Karpov, RS, Piatkowski, R, Kochanowski, J, Opolski, G, Barbier, P, Mirea, O, Guglielmo, M, Savioli, G, Cefalu, C, Pudil, R, Horakova, L, Rozloznik, M, Balestra, C, P37/03, PRVOUK, Rimbas, RC, Enescu, OA, Calin, S, Vinereanu, D, POSDRU/159/1.5/S/141531, Grant, Karsenty, C, Hascoet, S, Hadeed, K, Semet, F, Dulac, Y, Alacoque, X, Leobon, B, Acar, P, Dharma, S, Sukmawan, R, Soesanto, AM, Vebiona, KPP, Firdaus, I, Danny, SS, Driessen, M M P, Sieswerda, GTJ, Post, MC, Snijder, RJ, Van Dijk, APJ, Leiner, T, Meijboom, FJ, Chrysohoou, C, Tsitsinakis, G, Tsiachris, D, Aggelis, A, Herouvim, E, Vogiatzis, I, Pitsavos, C, Koulouris, G, Stefanadis, C, Erdei, T, Edwards, J, Braim, D, Yousef, Z, Fraser, AG, Cardiff, Investigators, MEDIA, Avenatti, E, Magnino, C, Omede', P, Presutti, D, Moretti, C, Iannaccone, A, Ravera, A, Gaita, F, Milan, A, Veglio, F, Barbier, P, Scali, MC, Simioniuc, A, Guglielmo, M, Savioli, G, Cefalu, C, Mirea, O, Fusini, L, Dini, F, Okura, H, Murata, E, Kataoka, T, Mikaelpoor, A, Ojaghi Haghighi, SH, Ojaghi Haghighi, SZ, Alizadeasl, A, Sharifi-Zarchi, A, Zaroui, A, Ben Halima, M, Mourali, MS, Mechmeche, R, Rodriguez Palomares, J F, Gutierrez, LG, Maldonado, GM, Garcia, GG, Otaegui, IO, Garcia Del Blanco, BGB, Teixido, GT, Gonzalez Alujas, MTGA, Evangelista, AE, Garcia Dorado, DGD, Godinho, A R, Correia, AS, Rangel, I, Rocha, A, Rodrigues, J, Araujo, V, Almeida, PB, Macedo, F, Maciel, MJ, Rekik, B, Mghaieth, F, Aloui, H, Boudiche, S, Jomaa, M, Ayari, J, Tabebi, N, Farhati, A, Mourali, S, Dekleva, M, Markovic-Nikolic, N, Zivkovic, M, Stankovic, A, Boljevic, D, Korac, N, Beleslin, B, Arandjelovic, A, Ostojic, M, Galli, E, Guirette, Y, Auffret, V, Daudin, M, Fournet, M, Mabo, P, Donal, E, Chin, C W L, Luo, E, Hwan, J, White, A, Newby, D, Dweck, M, Carstensen, H G, Larsen, L H, Hassager, C, Kofoed, K F, Jensen, J S, Mogelvang, R, Kowalczyk, M, Debska, M, Kolesnik, A, Dangel, J, Kawalec, W, Migliore, RA, Adaniya, ME, Barranco, MA, Miramont, G, Gonzalez, S, Tamagusuku, H, Davidsen, E S, Kuiper, K K J, Matre, K, Gerdts, E, Igual Munoz, B, Maceira Gonzalez, AMG, Erdociain Perales, MEP, Estornell Erill, JEE, Valera Martinez, FVM, Miro Palau, VMP, Piquer Gil, MPG, Sepulveda Sanchez, PSS, Cervera Zamora, ACZ, Montero Argudo, AMA, Placido, R, Silva Marques, J, Magalhaes, A, Guimaraes, T, Nobre E Menezes, M, Goncalves, S, Ramalho, A, Robalo Martins, S, Almeida, AG, Nunes Diogo, A, Abid, L, Ben Kahla, S, Charfeddine, S, Abid, D, Kammoun, S, Tounsi, A, Abid, LEILA, Abid, DORRA, Charfeddine, SALMA, Hammami, RANIA, Triki, FETEN, Akrout, MALEK, Mallek, SOUAD, Hentati, MOURAD, Kammoun, SAMIR, Sirbu, C F, Berrebi, A, Huber, A, Folliguet, T, Yang, L-T, Shih, JY, Liu, YW, Li, YH, Tsai, LM, Luo, CY, Tsai, WC, Babukov, R, Bartosh, F, Bazilev, V, Muraru, D, Cavalli, G, Addetia, K, Miglioranza, MH, Veronesi, F, Mihaila, S, Tadic, M, Cucchini, U, Badano, L, Lang, RM, Miyazaki, S, Slavich, M, Miyazaki, T, Figini, F, Lativ, A, Chieffo, A, Montrfano, M, Alfieri, O, Colombo, A, Agricola, E, Liu, D, Hu, K, Herrmann, S, Stoerk, S, Kramer, B, Ertl, G, Bijnens, B, Weidemann, F, Brand, M, Butz, T, Tzikas, S, Van Bracht, M, Roeing, J, Wennemann, R, Christ, M, Grett, M, Trappe, H-J, Scherzer, S, Geroldinger, AG, Krenn, L, Roth, C, Gangl, C, Maurer, G, Rosenhek, R, Neunteufl, T, Binder, T, Bergler-Klein, J, Martins, E, Pinho, T, Leite, S, Azevedo, O, Belo, A, Campelo, M, Amorim, S, Rocha-Goncalves, F, Goncalves, L, Silva-Cardoso, J, Ahn, HS, Kim, KT, Jeon, HK, Youn, HJ, Haland, T, Saberniak, J, Leren, IS, Edvardsen, T, Haugaa, KH, Ziolkowska, L, Boruc, A, Kowalczyk, M, Turska-Kmiec, A, Zubrzycka, M, Kawalec, W, Monivas Palomero, V, Mingo Santos, S, Goirigolzarri Artaza, J, Rodriguez Gonzalez, E, Rivero Arribas, B, Castro Urda, V, Dominguez Rodriguez, F, Mitroi, C, Gracia Lunar, I, Fernadez Lozano, I, Palecek, T, Masek, M, Kuchynka, P, Fikrle, M, Spicka, I, Rysava, R, Linhart, A, Saberniak, J, Hasselberg, NE, Leren, IS, Haland, T, Borgquist, R, Platonov, PG, Edvardsen, T, Haugaa, KH, Ancona, R, Comenale Pinto, S, Caso, P, Coopola, MG, Arenga, F, Rapisarda, O, D'onofrio, A, Sellitto, V, Calabro, R, Rosca, M, Popescu, BA, Calin, A, Mateescu, A, Beladan, CC, Jalba, M, Rusu, E, Zilisteanu, D, Ginghina, C, Pressman, G, Cepeda-Valery, B, Romero-Corral, A, Moldovan, R, Saenz, A, Orban, M, Samuel, SP, Fijalkowski, M, Fijalkowska, M, Gilis-Siek, N, Blaut, K, Galaska, R, Sworczak, K, Gruchala, M, Fijalkowski, M, Nowak, R, Gilis-Siek, N, Fijalkowska, M, Galaska, R, Gruchala, M, Ikonomidis, I, Triantafyllidi, H, Trivilou, P, Tzortzis, S, Papadopoulos, C, Pavlidis, G, Paraskevaidis, I, Lekakis, J, Padiyath, A, Li, L, Xiao, Y, Danford, DA, Kutty, S, Kaymaz, C, Aktemur, T, Poci, N, Ozturk, S, Akbal, O, Yilmaz, F, Tokgoz Demircan, HC, Kirca, N, Tanboga, IH, Ozdemir, N, Investigators, EUPHRATES, Greiner, S, Jud, A, Aurich, M, Hess, A, Hilbel, T, Hardt, S, Katus, HA, D'ascenzi, F, Cameli, M, Alvino, F, Lisi, M, Focardi, M, Solari, M, Bonifazi, M, Mondillo, S, Konopka, M, Krol, W, Klusiewicz, A, Burkhard, K, Chwalbinska, J, Pokrywka, A, Dluzniewski, M, Braksator, W, King, G J, Coen, K, Gannon, S, Fahy, N, Kindler, H, Clarke, J, Iliuta, L, Rac-Albu, M, Placido, R, Robalo Martins, S, Guimaraes, T, Nobre E Menezes, M, Cortez-Dias, N, Francisco, A, Silva, G, Goncalves, S, Almeida, AG, Nunes Diogo, A, Kyu, K, Kong, WKF, Songco, GG, Galupo, MJ, Castro, MD, Shin Hnin, W, Ronald Lee, CH, Poh, KK, Milazzo, V, Di Stefano, C, Tosello, F, Leone, D, Ravera, A, Sabia, L, Sobrero, G, Maule, S, Veglio, F, Milan, A, Jamiel, A M, Ahmed, A M, Farah, I, Al-Mallah, M H, Petroni, R, Magnano, R, Bencivenga, S, Di Mauro, M, Petroni, S, Altorio, SF, Romano, S, Penco, M, Kumor, M, Lipczynska, M, Klisiewicz, A, Wojcik, A, Konka, M, Kozuch, K, Szymanski, P, Hoffman, P, Rimbas, RC, Rimbas, M, Enescu, OA, Mihaila, S, Calin, S, Vinereanu, D, 112/2011, Grant CNCSIS, 159/1.5/S/141531, Grant POSDRU, Donal, E, Reynaud, A, Lund, LH, Persson, H, Hage, C, Oger, E, Linde, C, Daubert, JC, investigators, KaRen, Maria Oliveira Lima, M, Costa, H, Gomes Da Silva, M, Noman Alencar, MC, Carmo Pereira Nunes, M, Costa Rocha, MO, Abid, L, Charfeddine, S, Ben Kahla, S, Abid, D, Siala, A, Hentati, M, Kammoun, S, Kovalova, S, Necas, J, Ozawa, K, Funabashi, N, Takaoka, H, Kobayashi, Y, Matsumura, Y, Wada, M, Hirakawa, D, Yasuoka, Y, Morimoto, N, Takeuchi, H, Kitaoka, H, Sugiura, T, Lakkas, L, Naka, KK, Ntounousi, E, Gkirdis, I, Koutlas, V, Bechlioulis, A, Pappas, K, Katsouras, CS, Siamopoulos, K, Michalis, LK, Naka, KK, Evangelou, D, Kalaitzidis, R, Bechlioulis, A, Lakkas, L, Gkirdis, I, Tzeltzes, G, Nakas, G, Katsouras, CS, Michalis, LK, Generati, G, Bandera, F, Pellegrino, M, Labate, V, Alfonzetti, E, Guazzi, M, Zagatina, A, Zhuravskaya, N, Al-Mallah, M, Alsaileek, A, Qureshi, W, Karsenty, C, Hascoet, S, Peyre, M, Hadeed, K, Alacoque, X, Amadieu, R, Leobon, B, Dulac, Y, Acar, P, Yamanaka, Y, Sotomi, Y, Iwakura, K, Inoue, K, Toyoshima, Y, Tanaka, K, Oka, T, Tanaka, N, Orihara, Y, Fujii, K, Soulat-Dufour, L, Lang, S, Boyer-Chatenet, L, Van Der Vynckt, C, Ederhy, S, Adavane, S, Haddour, N, Boccara, F, Cohen, A, Huitema, MP, Boerman, S, Vorselaars, VMM, Grutters, JC, Post, MC, Gopal, A S, Saha, SK, Toole, RS, Kiotsekoglou, A, Cao, JJ, Reichek, N, Meyer, C G, Altiok, E, Al Ateah, G, Lehrke, M, Becker, M, Lotfi, S, Autschbach, R, Marx, N, Hoffmann, R, Frick, M, Nemes, A, Sepp, R, Kalapos, A, Domsik, P, Forster, T, Caro Codon, J, Blazquez Bermejo, Z, Lopez Fernandez, T, Valbuena Lopez, S C, Iniesta Manjavacas, A M, De Torres Alba, F, Dominguez Melcon, F, Pena Conde, L, Moreno Yanguela, M, Lopez-Sendon, J L, Nemes, A, Lengyel, C, Domsik, P, Kalapos, A, Orosz, A, Varkonyi, TT, Forster, T, Rendon, J, Saldarriaga, C I, Duarte, N, Nemes, A, Domsik, P, Kalapos, A, Forster, T, Nemes, A, Domsik, P, Kalapos, A, Sepp, R, Foldeak, D, Borbenyi, Z, Forster, T, Hamdy, AM, Fereig, HM, Nabih, MA, Abdel-Aziz, A, Ali, AA, Broyd, CJ, Wielandts, J-Y, De Buck, S, Michielsen, K, Louw, R, Garweg, C, Nuyts, J, Ector, J, Maes, F, Heidbuchel, H, Gillis, K, Bala, G, Tierens, S, Cosyns, B, Maurovich-Horvat, P, Horvath, T, Jermendy, A, Celeng, C, Panajotu, A, Bartykowszki, A, Karolyi, M, Tarnoki, AD, Jermendy, G, and Merkely, B
- Abstract
Purpose: 3D echocardiography (3DE) enables fast 3D acquisition but subsequent manual navigation to find 2D diagnostic planes can be time consuming. We have developed and validated an automated machine learning-based technique to find apical 2-, 3- and 4-chamber (A2C, A3C, A4C) views that enables fast volume navigation and analysis. Methods: 3DE volumes were acquired (Philips iE33: X3-1 and X5-1 probes) from 30 healthy volunteers and 36 clinical patients with suspected valve disease and coronary heart disease. 66 end diastolic volumes were used to assess the accuracy of apical standard view finding by our method against manual plane finding. To do this, dedicated software was developed with a machine learning approach and a 3-fold cross validation of results was performed. Results: Automatic A4C view detection was possible in 60/66 (91%) of volumes; detection failures were due to suboptimal myocardium wall integrity or lack of right ventricle in the scan. A2C and A3C views were extracted from the A4C view using the known geometrical relationships between apical standard views (A2C to A3C: 30°~40° and A2C to A4C: 90° of rotation over the left ventricle long axis, as shown in the Figure). In average, our method accurately found the heart apex and mitral valve centre with a 7.1 ± 5.7 mm and 7.2 ± 5.3 mm error, respectively. Conclusions: In order to automate clinical workflow, we have developed a new and fully automatic machine learning strategy for apical standard view finding which performed well (91% detection accuracy) on volunteer and clinical 3D echocardiograms.
Figure - Published
- 2014
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15. Predicting response to CRT. The value of two- and three-dimensional echocardiography.
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Marsan NA, Breithardt OA, Delgado V, Bertini M, Tops LF, Marsan, Nina Ajmone, Breithardt, Ole A, Delgado, Victoria, Bertini, Matteo, and Tops, Laurens F
- Abstract
Recently, it has been suggested that a direct assessment of left ventricular (LV) mechanical dyssynchrony may improve the selection of candidates to cardiac resynchronization therapy (CRT). In fact, when the established clinical and electrocardiographic selection criteria are applied, response to CRT may vary widely and up to one-third of the patients fail to benefit from CRT. Echocardiography has been extensively applied to assess LV dyssynchrony and to predict favourable response to CRT, using different two- and three-dimensional modalities. In this review, the value of these echocardiographic modalities will be discussed, highlighting the advantages and drawbacks of each technique and evaluating the clinical implications and future perspectives of LV dyssynchrony assessment. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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16. Follow-up in Tako-tsubo cardiomyopathy by real-time three-dimensional echocardiography.
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Breithardt OA, Becker M, Kälsch T, Haghi D, Breithardt, O-A, Becker, M, Kälsch, T, and Haghi, D
- Published
- 2008
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17. A Randomized, Multicenter, Single-Blinded Trial Comparing Paclitaxel-Coated Balloon Angioplasty With Plain Balloon Angioplasty in Drug-Eluting Stent Restenosis: The PEPCAD-DES Study.
- Author
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Rittger H, Brachmann J, Sinha AM, Waliszewski M, Ohlow M, Brugger A, Thiele H, Birkemeyer R, Kurowski V, Breithardt OA, Schmidt M, Zimmermann S, Lonke S, von Cranach M, Nguyen TV, Daniel WG, and Wöhrle J
- Published
- 2012
18. Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.
- Author
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Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, Gorcsan J 3rd, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, Yu CM, Bax, Jeroen J, and Abraham, Theodore
- Abstract
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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19. Cardiac resynchronization therapy: Part 1--issues before device implantation.
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Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, Gorcsan J 3rd, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, Yu CM, Bax, Jeroen J, and Abraham, Theodore
- Abstract
Cardiac resynchronization therapy (CRT) has been used extensively over the last years in the therapeutic management of patients with end-stage heart failure. Data from 4,017 patients have been published in eight large, randomized trials on CRT. Improvement in clinical end points (symptoms, exercise capacity, quality of life) and echocardiographic end points (systolic function, left ventricular size, mitral regurgitation) have been reported after CRT, with a reduction in hospitalizations for decompensated heart failure and an improvement in survival. However, individual results vary, and 20% to 30% of patients do not respond to CRT. At present, the selection criteria include severe heart failure (New York Heart Association functional class III or IV), left ventricular ejection fraction <35%, and wide QRS complex (>120 ms). Assessment of inter- and particularly intraventricular dyssynchrony as provided by echocardiography (predominantly tissue Doppler imaging techniques) may allow improved identification of potential responders to CRT. In this review a summary of the clinical and echocardiographic results of the large, randomized trials is provided, followed by an extensive overview on the currently available echocardiographic techniques for assessment of LV dyssynchrony. In addition, the value of LV scar tissue and venous anatomy for the selection of potential candidates for CRT are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2005
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20. Twelve-month efficacy of second-generation cryoballoon ablation for atrial fibrillation performed at community hospitals: results of the German register on cryoballoon ablation in local hospitals (regional).
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Michaelsen J, Parade U, Bauerle H, Winter KD, Rauschenbach U, Mischke K, Schaefer C, Gutleben KJ, Rana OR, Willich T, Schlößer M, Rötzer A, Breithardt OA, Middendorf S, Grove R, Mosa J, Krug J, Imnadze G, Saygili E, and Hoffmann R
- Subjects
- Humans, Hospitals, Community, Treatment Outcome, Recurrence, Atrial Fibrillation surgery, Atrial Flutter surgery, Cryosurgery methods, Pulmonary Veins surgery, Catheter Ablation methods
- Abstract
Background: The 12-month follow-up (F/U) efficacy of CBA PVI performed at community hospitals for treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF) is unknown. This study determined the 12-month efficacy of pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) performed at community hospitals with limited annual case numbers., Methods: This registry study included 983 consecutive patients (pts) from 19 hospitals, each with an annual procedural volume of < 100 PVI procedures/year. Pts underwent CBA PVI for paroxysmal AF (n = 520), persistent AF (n = 423), or redo PVI (n = 40). The primary endpoint was frequency of documented recurrent AF, the occurrence of atrial flutter or tachycardia following a 90-day period after the index ablation and up to 12 months. The frequency of repeat ablation was determined., Results: Isolation of all PVs was documented in 98% of pts at the end of the procedure. Twelve-month F/U data could be obtained in 916 pts. A 24-h ECG registration was performed in 641 pts (70.0%); in 107 pts (16.7%) of them, recurrent AF was documented. The primary endpoint was met in 193 F/U pts (21.1%). It occurred in 80/486 F/U pts with paroxysmal AF (16.4%), and in 107/390 F/U pts with persistent AF (27.4%). Redo PVI was performed in 71 pts (7.8%), and atrial flutter ablation was performed in 12 pts (1.4%)., Conclusions: CBA PVI for paroxysmal or persistent AF can be performed at community hospitals with adequate rates of 12-month symptom freedom and arrhythmia recurrence. The study was registered at the German register of clinical studies (DRKS00016504)., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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21. How-to: Focus Cardiac Ultrasound in acute settings.
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Soliman-Aboumarie H, Breithardt OA, Gargani L, Trambaiolo P, and Neskovic AN
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- Clinical Decision-Making, Humans, Echocardiography, Point-of-Care Systems
- Abstract
Focus cardiac ultrasound (FoCUS) provides vital information at at the bedside which has the potential of improving outcomes in the acute settings. FoCUS could help the clinicians in their daily clinical decision-making while applied within the clinical context as an extension of bedside clinical examination. FoCUS practitioners should be aware of their own limitations with the importance of the timely referral for comprehensive Echocardiography whenever required., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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22. Safety and acute efficacy of cryoballoon ablation for atrial fibrillation at community hospitals.
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Hoffmann R, Parade U, Bauerle H, Winter KD, Rauschenbach U, Mischke K, Schaefer C, Gutleben KJ, Rana OR, Willich T, Schlößer M, Rötzer A, Breithardt OA, Middendorf S, Waldecker B, Grove R, Mosa J, Krug J, Imnadze G, Saygili E, and Michaelsen J
- Subjects
- Hospitals, Community, Humans, Recurrence, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation methods, Cryosurgery adverse effects, Cryosurgery methods, Pulmonary Veins surgery
- Abstract
Aims: Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is an established procedure for treating symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI performed at community hospitals are unknown. We aimed to determine the safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers., Methods and Results: This registry study included 1004 consecutive patients who had PVI performed for symptomatic paroxysmal (n = 563) or persistent AF (n = 441) from January 2019 to September 2020 at 20 hospitals. Each hospital performed fewer than 100 CBA-PVI procedures/year according to local standards. Procedural data, efficacy, and complication rates were determined. The mean number of CBA procedures performed/year at each centre was 59 ± 25. The average procedure time was 90.1 ± 31.6 min and the average fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins was documented in 97.9% of patients. The most frequent reason for not achieving complete isolation was development of phrenic nerve palsy. No hospital deaths were observed. Two patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in six patients (0.6%), two of whom (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), two of whom (0.2%) required vascular surgery. Phrenic nerve palsy occurred in 48 patients (4.8%) and persisted up to hospital discharge in six patients (0.6%)., Conclusion: Pulmonary vein isolation procedures for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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23. Level 1 of Entrustable Professional Activities in adult echocardiography: a position statement from the EACVI regarding the training and competence requirements for selecting and interpreting echocardiographic examinations.
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Stankovic I, Muraru D, Fox K, Di Salvo G, Hasselberg NE, Breithardt OA, Hansen TB, Neskovic AN, Gargani L, Cosyns B, and Edvardsen T
- Subjects
- Adult, Cardiac Imaging Techniques, Clinical Competence, Humans, Cardiology education, Echocardiography
- Abstract
The goal of Level 1 training in echocardiography is to enable the trainee to select echocardiography appropriately for the evaluation of a specific clinical question, and then to interpret the report. It is not the goal of Level 1 training to teach how to perform the examination itself-that is the goal of higher levels of training. However, understanding the principles, indications, and findings of this crucial technique is valuable to many medical professionals including outside cardiology. This should be seen as part of a general understanding of cardiac imaging modalities. The purpose of this position statement is to define the scope and outline the general requirements for Level 1 training and competence in echocardiography. Moreover, the document aims to make a clear distinction between Level 1 competence in echocardiography and focus cardiac ultrasound (FoCUS)., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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24. Outcome in patients undergoing upgrade to cardiac resynchronization therapy: predictors of outcome after upgrade to CRT.
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Kosiuk J, Krause M, Doering M, Weber A, Breithardt OA, Dinov B, Darma A, Lucas J, Muessigbrodt A, Bode K, Kuehl M, Dagres N, Hindricks G, Bollmann A, and Richter S
- Subjects
- Aged, Cause of Death, Defibrillators, Implantable, Electric Countershock adverse effects, Electric Countershock mortality, Female, Heart Failure diagnosis, Heart Failure mortality, Heart Failure physiopathology, Humans, Male, Middle Aged, Recovery of Function, Retrospective Studies, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Cardiac Pacing, Artificial adverse effects, Cardiac Pacing, Artificial mortality, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy mortality, Cardiac Resynchronization Therapy Devices, Device Removal, Electric Countershock instrumentation, Heart Failure therapy, Pacemaker, Artificial
- Abstract
The advantages of upgrade to cardiac resynchronisation therapy (CRT) have not been explored as carefully as the outcomes of de novo CRT implantations. Furthermore selection criteria for patients with the potential to benefit the most from this therapy are unknown. Therefore, we analyzed the long term outcome and its predictors in a real-world cohort receiving a CRT upgrade from previous pacemaker (PM) and defibrillator devices (ICD). We analyzed 86 patients (mean age 68 ± 9 years; 89% male) undergoing CRT upgrade procedures. Response to CRT as well as long term patient outcome was analyzed. NYHA class improved in majority of the patients during short term period (61%), and this trend remained constant during long term follow-up (54%). The observed all-cause mortality was 54% with mean survival of 49 ± 4 months. 11 patients underwent left ventricular assist device implantation or heart transplantation. In the multivariate analysis, only kidney function assessed by GFR (HR 0.97; 95% CI 0.95-0.99; p = 0.009) and LVEF (HR 0.92; 95% CI 0.87-0.97; p = 0.002) remain predictors for mortality. Patients who undergo an upgrade procedure to CRT demonstrate a significant response rate assessed by improvement in NYHA class, with initial baseline parameters such as LVEF and kidney function remaining significant predictors for mortality.
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- 2020
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25. Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study.
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Kircher S, Arya A, Altmann D, Rolf S, Bollmann A, Sommer P, Dagres N, Richter S, Breithardt OA, Dinov B, Husser D, Eitel C, Gaspar T, Piorkowski C, and Hindricks G
- Subjects
- Aged, Anti-Arrhythmia Agents therapeutic use, Disease-Free Survival, Electrocardiography, Ambulatory methods, Electrophysiologic Techniques, Cardiac methods, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pulmonary Veins surgery, Recurrence, Treatment Outcome, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Catheter Ablation methods, Postoperative Complications diagnosis, Postoperative Complications therapy
- Abstract
Aims: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF)., Methods and Results: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type. Bipolar voltage mapping was performed during stable sinus rhythm. An LVA consisted of ≥ 3 adjacent mapping points that each had a peak-to-peak amplitude ≤0.5 mV. After a mean follow-up of 12 ± 3 months, significantly more patients in the LVA ablation group were free from atrial arrhythmia recurrence >30 s off antiarrhythmic drugs (AADs) after a single procedure (primary endpoint) compared with control group patients [40/59 (68%) vs. 25/59 (42%), log-rank P = 0.003]. Arrhythmia-free survival on or off AADs was found in 33/59 control group patients (56%) and in 41/59 LVA ablation group patients (70%) (adjusted log-rank P = 0.10). During the 7 day Holter monitoring period at 12 months, significantly more patients in the LVA ablation group were free from arrhythmia recurrence on or off AADs [45/50 (90%) vs. 33/46 (72%), P = 0.04]. No between-group differences were observed regarding procedure duration, fluoroscopy time, and major complications., Conclusion: In this single-centre study, individually tailored substrate modification guided by voltage mapping was associated with a significantly higher arrhythmia-free survival rate compared with a conventional approach applying linear ablation according to AF type.
- Published
- 2018
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26. Characterizing left ventricular mechanical and electrical activation in patients with normal and impaired systolic function using a non-fluoroscopic cardiovascular navigation system.
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Piorkowski C, Arya A, Markovitz CD, Razavi H, Jiang C, Rosenberg S, Breithardt OA, Rolf S, John S, Kosiuk J, Huo Y, Döring M, Richter S, Ryu K, Gaspar T, Prinzen FW, Hindricks G, and Sommer P
- Subjects
- Aged, Atrial Fibrillation diagnosis, Cardiac Resynchronization Therapy methods, Catheter Ablation methods, Electrocardiography, Ambulatory methods, Female, Heart Ventricles diagnostic imaging, Humans, Male, Middle Aged, Monitoring, Intraoperative methods, Myocardial Contraction physiology, Patient Selection, Recovery of Function, Reference Values, Treatment Outcome, Ventricular Function, Left physiology, Atrial Fibrillation surgery, Electrophysiologic Techniques, Cardiac, Epicardial Mapping methods, Image Interpretation, Computer-Assisted, Stroke Volume physiology
- Abstract
Purpose: Cardiac disease frequently has a degenerative effect on cardiac pump function and regional myocardial contraction. Therefore, an accurate assessment of regional wall motion is a measure of the extent and severity of the disease. We sought to further validate an intra-operative, sensor-based technology for measuring wall motion and strain by characterizing left ventricular (LV) mechanical and electrical activation patterns in patients with normal (NSF) and impaired systolic function (ISF)., Methods: NSF (n = 10; ejection fraction = 62.9 ± 6.1%) and ISF (n = 18; ejection fraction = 35.1 ± 13.6%) patients underwent simultaneous electrical and motion mapping of the LV endocardium using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, Abbott). Motion trajectories, strain profiles, and activation times were calculated over the six standard LV walls., Results: NSF patients had significantly greater motion and systolic strains across all LV walls than ISF patients. LV walls with low-voltage areas showed less motion and systolic strain than walls with normal voltage. LV electrical dyssynchrony was significantly smaller in NSF and ISF patients with narrow-QRS complexes than ISF patients with wide-QRS complexes, but mechanical dyssynchrony was larger in all ISF patients than NSF patients. The latest mechanical activation was most often the lateral/posterior walls in NSF and wide-QRS ISF patients but varied in narrow-QRS ISF patients., Conclusions: This intra-operative technique can be used to characterize LV wall motion and strain in patients with impaired systolic function. This technique may be utilized clinically to provide individually tailored LV lead positioning at the region of latest mechanical activation for patients undergoing cardiac resynchronization therapy., Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01629160.
- Published
- 2018
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27. Mapping-guided characterization of mechanical and electrical activation patterns in patients with normal systolic function using a sensor-based tracking technology.
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Piorkowski C, Breithardt OA, Razavi H, Nabutovsky Y, Rosenberg SP, Markovitz CD, Arya A, Rolf S, John S, Kosiuk J, Olson E, Eitel C, Huo Y, Döring M, Richter S, Ryu K, Gaspar T, Prinzen FW, Hindricks G, and Sommer P
- Subjects
- Aged, Echocardiography, Electrophysiologic Techniques, Cardiac, Equipment Design, Feasibility Studies, Female, Heart Rate, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Ambulatory methods, Pilot Projects, Predictive Value of Tests, Prospective Studies, Stroke Volume, Systole, Telemetry methods, Time Factors, Action Potentials, Electromagnetic Phenomena, Monitoring, Ambulatory instrumentation, Telemetry instrumentation, Transducers, Ventricular Function, Left
- Abstract
Aims: In times of evolving cardiac resynchronization therapy, intra-procedural characterization of left ventricular (LV) mechanical activation patterns is desired but technically challenging with currently available technologies. In patients with normal systolic function, we evaluated the feasibility of characterizing LV wall motion using a novel sensor-based, real-time tracking technology., Methods and Results: Ten patients underwent simultaneous motion and electrical mapping of the LV endocardium during sinus rhythm using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, SJM). Epicardial motion data were also collected simultaneously at corresponding locations from accessible coronary sinus branches. Displacements at each mapping point and times of electrical and mechanical activation were combined over each of the six standard LV wall segments. Mechanical activation timing was compared with that from electrical activation and preoperative 2D speckle tracking echocardiography (echo). MediGuide-based displacement data were further analysed to estimate LV chamber volumes that were compared with echo and magnetic resonance imaging (MRI). The lateral and septal walls exhibited the largest (12.5 [11.6-15.0] mm) and smallest (10.2 [9.0-11.3] mm) displacement, respectively. Radial displacement was significantly larger endocardially than epicardially (endo: 6.7 [5.0-9.1] mm; epi: 3.8 [2.4-5.6] mm), while longitudinal displacement was significantly larger epicardially (endo: 8.0 [5.0-10.6] mm; epi: 10.3 [7.4-13.8] mm). Most often, the anteroseptal/anterior and lateral walls showed the earliest and latest mechanical activations, respectively. 9/10 patients had concordant or adjacent wall segments of latest mechanical and electrical activation, and 6/10 patients had concordant or adjacent wall segments of latest mechanical activation as measured by MediGuide and echo. MediGuide's LV chamber volumes were significantly correlated with MRI (R2= 0.73, P < 0.01) and echo (R2= 0.75, P < 0.001)., Conclusion: The feasibility of mapping-guided intra-procedural characterization of LV wall motion was established., Clinical Trial Registration: http://www.clinicaltrials.gov; Unique identifier: CT01629160., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)
- Published
- 2017
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28. Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes.
- Author
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Nedios S, Koutalas E, Sommer P, Arya A, Rolf S, Husser D, Bollmann A, Hindricks G, and Breithardt OA
- Subjects
- Aged, Atrial Fibrillation complications, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation physiopathology, Diastole, Echocardiography, Transesophageal, Female, Heart Atria diagnostic imaging, Heart Atria physiopathology, Humans, Linear Models, Male, Middle Aged, Multidetector Computed Tomography, Recovery of Function, Recurrence, Risk Factors, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left etiology, Atrial Fibrillation surgery, Atrial Function, Left, Atrial Remodeling, Catheter Ablation adverse effects, Heart Atria surgery, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left
- Abstract
Aims: The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes., Methods and Results: In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts. The ratio of LA-A and LAV was defined as the LA asymmetry index (ASI). According to the current guidelines, the presence of DD was evaluated by echocardiography. Regression analysis was used to identify predictors of asymmetry changes and long-term success. Univariate linear regression revealed that ASI is associated with LAV, the presence of DD, and mitral regurgitation. Asymmetry index was higher in patients with DD (n = 35, 62 ± 5 vs. 59 ± 6%, P = 0.013) or mitral regurgitation (n = 67, 61 ± 6 vs. 58 ± 5%, P = 0.025). Multiple linear regression analysis showed that DD (B = 2.6, β = 0.207, 95% confidence interval, CI: 0.167-5.011, P = 0.036) and LAV (B = 0.037, β = 0.211, 95% CI: 0.003-0.071, P = 0.033) were the only factors independently associated with ASI (adjusted r2 = 0.92, F = 6.2, P = 0.003). Regression analysis showed that AF recurrence (33% after 24 months) is associated with asymmetric LA changes, while DD is not., Conclusions: Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)
- Published
- 2017
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29. [Malignant bileaflet mitral valve prolapse syndrome in otherwise idiopathic ventricular fibrillation].
- Author
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Vollmann D, Hansen C, Lüthje L, and Breithardt OA
- Subjects
- Adult, Cardiac Complexes, Premature diagnosis, Cardiac Complexes, Premature physiopathology, Cardiac Complexes, Premature therapy, Defibrillators, Implantable, Echocardiography, Female, Heart Conduction System physiopathology, Humans, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency therapy, Mitral Valve Prolapse physiopathology, Mitral Valve Prolapse therapy, Systole physiology, Ventricular Fibrillation physiopathology, Ventricular Fibrillation therapy, Ventricular Premature Complexes physiopathology, Ventricular Premature Complexes therapy, Electrocardiography, Mitral Valve Prolapse diagnosis, Ventricular Fibrillation diagnosis, Ventricular Premature Complexes diagnosis
- Abstract
A 32-year-old, otherwise healthy woman was admitted after successful out-of-hospital resuscitation due to ventricular fibrillation. Established cardiac, pulmonary, metabolic, and toxicological causes were excluded. However, persisting (biphasic) negative T waves in the inferior ECG leads and premature ventricular contractions (PVC) were noted. PVC morphology indicated a focus alternating between the posterior papillary muscle/the left posterior fascicle and the left ventricular outflow tract region/anterior papillary muscle. Echocardiography revealed a bileaflet mitral prolapse with mild mitral valve regurgitation. This case is a typical presentation of the recently described malignant bileaflet mitral valve prolapse syndrome. The patient was discharged without overt neurological deficit after implantation of a cardioverter-defibrillator.
- Published
- 2017
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30. Too weak to withstand the strain: another piece in the CRT puzzle.
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Kosiuk J, Koutalas E, and Breithardt OA
- Subjects
- Heart Ventricles, Humans, Prognosis, Cardiac Resynchronization Therapy, Heart Failure
- Published
- 2017
- Full Text
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31. Association between ventricular arrhythmias and myocardial mechanical dispersion assessed by strain analysis in patients with nonischemic cardiomyopathy.
- Author
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Kosiuk J, Dinov B, Bollmann A, Koutalas E, Mussigbrodt A, Sommer P, Arya A, Richter S, Hindricks G, and Breithardt OA
- Subjects
- Aged, Female, Humans, Incidence, Male, Middle Aged, Risk, Tachycardia, Ventricular epidemiology, Time Factors, Ventricular Fibrillation epidemiology, Cardiomyopathies physiopathology, Echocardiography methods, Tachycardia, Ventricular physiopathology, Ventricular Fibrillation physiopathology
- Abstract
Background: Mechanical dispersion (MD), defined as the standard deviation of time to maximum myocardial shortening assessed by 2D speckle tracking echocardiographic strain imaging (2DS), has been recently proposed as a predictor for ventricular tachycardia or fibrillation (VT/VF) in patients with ischemic cardiomyopathy and long QT syndrome. However, the role of MD in patients with non-ischemic cardiomyopathy (NICM) has not yet been studied., Methods and Results: In 20 patients with NICM (mean age 62 ± 11 years, 75 % male, mean EF 32 ± 6 %, mean QRS duration 102 ± 14 ms), we measured longitudinal strain by 2DS in a 16-segment left ventricular model and calculated the MD. Patients were divided into two groups, defined by the presence or absence of documented VT/VF. In 11 patients (55 %), VT/VF was documented. The median time from VT/VF to echocardiographic examination was 26 (IQR 15-58) months. There were no significant differences in baseline characteristics between patients with and without index events. MD was significantly greater in patients with VT/VF as compared to those without arrhythmias (84 ± 31 ms vs. 53 ± 16 ms, p = 0.017). The analysis of the ROC curve (AUC 0.81, 95 % CI 0.63-1.00, p = 0.017) revealed that dispersion >50 ms is associated with twelve times higher risk of VT/VF in patients with NICM (OR 12.5, 95 % CI 1.1-143.4, p = 0.024)., Conclusions: In this small cohort of NICM patients, greater MD was associated with a higher incidence of VT/VF.
- Published
- 2015
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32. Patient discomfort following catheter ablation and rhythm device surgery.
- Author
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Bode K, Breithardt OA, Kreuzhuber M, Mende M, Sommer P, Richter S, Doering M, Dinov B, Rolf S, Arya A, Dagres N, Hindricks G, and Bollmann A
- Subjects
- Aged, Analgesics therapeutic use, Female, Humans, Male, Pain Measurement drug effects, Pain, Postoperative diagnosis, Treatment Outcome, Catheter Ablation adverse effects, Defibrillators, Implantable adverse effects, Pacemaker, Artificial adverse effects, Pain, Postoperative drug therapy, Pain, Postoperative etiology, Prosthesis Implantation adverse effects
- Abstract
Aims: Proper management of post-interventional pain relieves unwarranted patient distress and enhances patient satisfaction. There have been only a limited number of investigations into patient discomfort following electrophysiological interventions. This study aims to quantify pain after interventional procedures, including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT), as well as implant or explant of pacemakers or implantable cardioverter defibrillators., Methods and Results: One-hundred and two consecutive patients (mean age 66 years, 70 men) were asked to quantify post-interventional pain on a numeric rating scale (NRS 0-10) every 2 h during a period of 24 h after their intervention (49 ablations in deep propofol sedation, 53 device surgeries in local anaesthesia with mepivacaine 1%) and to specify the type of pain. Pain was classified as moderate to severe in case of NRS > 3. Post-operative pain medication included non-opioid and opioid analgesics as per the treating physicians' discretion. Sixty-one patients (60%) suffered from moderate-to-severe pain within the first 24 h after the procedure, despite the use of analgesics in 47 patients (46%). Pain was present in an early period (0-6 h) in 54% and in a late period (8-24 h) in 40% of patients. Patients complained of back pain (44%), pain at the site of the device pocket (39%), pain at the groin after puncture (7%), and pericarditic pain (5%). Multivariate analysis identified female gender (P = 0.046) associated with early post-interventional pain while age, diabetes mellitus, body mass index, type of intervention, and procedure time were not related to early or late post-interventional pain., Conclusion: The findings highlight the high prevalence and the poor predictability of moderate-to-severe post-interventional pain within the first 24 h after catheter ablation and cardiac device surgery procedures, despite the use of peri-interventional analgesics. These findings highlight the need for more careful pain assessment and management programmes., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2015
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33. [How to do a stress echocardiography?].
- Author
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von Roeder M and Breithardt OA
- Subjects
- Adenosine, Cardiomyopathy, Hypertrophic, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease physiopathology, Coronary Circulation physiology, Dobutamine, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Humans, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia physiopathology, Echocardiography, Stress methods, Heart Diseases diagnostic imaging, Heart Diseases physiopathology
- Abstract
Stress echocardiography (SE) is a powerful functional imaging technique to assess cardiac performance under work conditions. The main indication is the detection of myocardial ischemia due to coronary artery disease (CAD), however it can also be used in patients with structural heart disease (e. g. valvular disease, hypertrophic obstructive cardiomyopathy). Dynamic or pharmacological (dobutamine / adenosine) modalities are available to induce cardiac stress, basically depending on the clinical problem and the patient's ability to exercise. Exercise on a treadmill or a semi-supine bicycle is the most physiological way to induce stress. Dobutamine stimulation is useful in patients who are unable to exercise and for detection of viable myocardium in hypo- or akinetic segments. Adenosin-induced hyperaemia causes steal effects in myocardial segments with significant CAD. Main limitations of SE are the need for an appropriate acoustic window and the user-dependent variability with regard to the interpretation of the results., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2015
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34. Results of catheter ablation of atrial fibrillation in hypertrophied hearts - Comparison between primary and secondary hypertrophy.
- Author
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Müssigbrodt A, Kosiuk J, Koutalas E, Pastromas S, Dagres N, Darma A, Lucas J, Breithardt OA, Sommer P, Dinov B, Eitel C, Rolf S, Döring M, Richter S, Arya A, Husser D, Bollmann A, and Hindricks G
- Subjects
- Aged, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation etiology, Cardiomyopathy, Hypertrophic complications, Case-Control Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation methods, Hypertrophy, Left Ventricular complications
- Abstract
Background and Purpose: Approximately 20-25% of the patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation (AF) during the clinical course of the disease, a percentage significantly larger than that of the general population. The purpose of the present study was to report on the procedural results of patients with AF and either primary or secondary left ventricular hypertrophy (LVH)., Methods and Subjects: Twenty-two consecutive HCM patients (55% male, mean age 57±8 years) with symptomatic AF, having undergone AF ablation procedures between September 2009 and July 2012 were compared with respect to procedural outcome and follow-up characteristics with 22 matched controls with secondary cardiac hypertrophy (64% male, 63±10 years) from our prospective AF catheter ablation registry., Results and Conclusion: Radiofrequency catheter ablation (RFCA) was successful in restoring long-term sinus rhythm in patients with LVH due to HCM and due to secondary etiology. However, patients with HCM needed more RFCA procedures and frequently additional antiarrhythmic drug therapy in order to maintain sinus rhythm., (Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)
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- 2015
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35. Hand-held ultrasound-the real stethoscope.
- Author
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Breithardt OA
- Subjects
- Female, Humans, Male, Echocardiography instrumentation, Point-of-Care Systems, Rheumatic Heart Disease diagnostic imaging
- Published
- 2015
- Full Text
- View/download PDF
36. Sensor-based electromagnetic navigation to facilitate implantation of left ventricular leads in cardiac resynchronization therapy.
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Döring M, Sommer P, Rolf S, Lucas J, Breithardt OA, Hindricks G, and Richter S
- Subjects
- Aged, Aged, 80 and over, Clinical Competence, Coronary Angiography, Coronary Sinus diagnostic imaging, Equipment Design, Feasibility Studies, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Radiation Dosage, Radiographic Image Interpretation, Computer-Assisted, Radiography, Interventional, Software, Treatment Outcome, Workflow, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy Devices, Electromagnetic Phenomena, Heart Failure therapy, Heart Ventricles physiopathology, Magnets, Transducers, Ventricular Function, Left
- Abstract
Introduction: Implantation of cardiac resynchronization therapy (CRT) devices can be challenging, time consuming, and fluoroscopy intense. To facilitate placement of left ventricular (LV) leads, a novel electromagnetic navigation system (MediGuide™, St. Jude Medical, St. Paul, MN, USA) has been developed, displaying real-time 3-D location of sensor-embedded delivery tools superimposed on prerecorded X-ray cine-loops of coronary sinus venograms. We report our experience and advanced progress in the use of this new electromagnetic tracking system to guide LV lead implantation., Methods and Results: Between January 2012 and December 2013, 71 consecutive patients (69 ± 9 years, 76% male) were implanted with a CRT device using the new electromagnetic tracking system. Demographics, procedural data, and periprocedural adverse events were gathered. The impact of the operator's experience, optimized workflow, and improved software technology on procedural data were analyzed. LV lead implantation was successfully achieved in all patients without severe adverse events. Total procedure time measured 87 ± 37 minutes and the median total fluoroscopy time (skin-to-skin) was 4.9 (2.5-7.8) minutes with a median dose-area-product of 476 (260-1056) cGy*cm(2) . An additional comparison with conventional CRT device implantations showed a significant reduction in fluoroscopy time from 8.0 (5.8; 11.5) to 4.5 (2.8; 7.3) minutes (P = 0.016) and radiation dose from 603 (330; 969) to 338 (176; 680) cGy*cm(2) , respectively (P = 0.044 )., Conclusion: Use of the new navigation system enables safe and successful LV lead placement with improved orientation and significantly reduced radiation exposure during CRT implantation., (© 2014 Wiley Periodicals, Inc.)
- Published
- 2015
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- View/download PDF
37. Precordial QRS amplitude ratio predicts long-term outcome after catheter ablation of electrical storm due to ventricular tachycardias in patients with arrhythmogenic right ventricular cardiomyopathy.
- Author
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Müssigbrodt A, Dinov B, Bertagnoli L, Sommer P, Richter S, Breithardt OA, Rolf S, Bollmann A, Hindricks G, and Arya A
- Subjects
- Adult, Arrhythmogenic Right Ventricular Dysplasia etiology, Female, Humans, Longitudinal Studies, Male, Middle Aged, Outcome Assessment, Health Care methods, Reproducibility of Results, Sensitivity and Specificity, Tachycardia, Ventricular complications, Treatment Outcome, Arrhythmogenic Right Ventricular Dysplasia diagnosis, Arrhythmogenic Right Ventricular Dysplasia surgery, Catheter Ablation, Electrocardiography methods, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery
- Abstract
Background: Radiofrequency catheter ablation is currently considered as the therapeutic option of choice in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and recurrent ventricular tachycardia (VT)., Methods: This study intended to assess the long-term outcome of catheter ablation in patients with ARVC and electrical storm. The specific objective was to assess the relationship between precordial QRS amplitude ratio and outcome of catheter ablation in these patients., Results: Twenty-eight patients (19 men, age 52.3±14.2years) underwent 48 catheter ablation procedures (range 1-6, six epicardial). During a mean follow-up of 18.7±15.1months, 13 patients (46.5%) experienced VT recurrence. Age >50years and ∑QRSmvV1-V3/∑QRSmvV1-V6≤0.48 but not right ventricular size and acute ablation outcome were associated with VT recurrence during the follow up., Conclusion: Age >50years and ∑QRSmvV1-V3/∑QRSmvV1-V6≤0.48 predict recurrence of VT after successful radiofrequency catheter ablation of VT in patients with ARVC and electrical storm., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
38. Irrigated tip catheters for radiofrequency ablation in ventricular tachycardia.
- Author
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Müssigbrodt A, Grothoff M, Dinov B, Kosiuk J, Richter S, Sommer P, Breithardt OA, Rolf S, Bollmann A, Arya A, and Hindricks G
- Subjects
- Catheter Ablation methods, Catheters, Humans, Tachycardia, Ventricular pathology, Catheter Ablation instrumentation, Electrocardiography, Tachycardia, Ventricular radiotherapy
- Abstract
Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.
- Published
- 2015
- Full Text
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39. Correspondence on "Possible spontaneous PFO closure after thrombus trapped in PFO", Antonia Schulz et al., Clin Res Cardiol 2014; 103:333-335.
- Author
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Breithardt OA and Hindricks G
- Subjects
- Humans, Male, Foramen Ovale, Patent etiology, Thrombosis etiology
- Published
- 2014
- Full Text
- View/download PDF
40. Abnormal ECG findings in a young patient with presyncope.
- Author
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Rommel KP, Paech C, Grothoff M, Hindricks G, and Breithardt OA
- Subjects
- Echocardiography, Transesophageal, Heart Defects, Congenital complications, Humans, Magnetic Resonance Imaging, Male, Pericardium diagnostic imaging, Tomography, X-Ray Computed, Young Adult, Electrocardiography, Heart Defects, Congenital diagnosis, Pericardium abnormalities, Syncope etiology
- Published
- 2014
- Full Text
- View/download PDF
41. Comparison of Dabigatran and Uninterrupted Warfarin in Patients With Atrial Fibrillation Undergoing Cardiac Rhythm Device Implantations.
- Author
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Kosiuk J, Koutalas E, Doering M, Nedios S, Sommer P, Rolf S, Darma A, Breithardt OA, Dinov B, Hindricks G, Richter S, and Bollmann A
- Abstract
Background:The incidence of postoperative complications following pacemaker or implantable cardioverter-defibrillator implantations in patients treated with new oral anticoagulation agents has not been studied. Here we present a first comparison of complications after cardiac rhythm device (CRD) implantations in patients with atrial fibrillation (AF) treated with dabigatran or uninterrupted warfarin.Methods and Results:Using a case-control study design, we compared complications within 30 days after 236 CRD procedures performed under uninterrupted warfarin (n=118) or interrupted dabigatran (n=118).There were no significant differences in the baseline characteristics of both groups. In the warfarin group, 9 (8%) pocket hematomas were observed vs. 3 (3%) in the dabigatran group (P=0.075). Two complications in the warfarin group necessitated surgical intervention as opposed to none in the dabigatran group (P=0.156). The postprocedural blood loss expressed as a drop in hemoglobin was significantly greater in the warfarin group (-0.9±0.7 vs. -0.5±0.4 mmol/L, P=0.023). In the dabigatran group, 1 case of transient ischemic attack occurred. The mean time to hospital discharge was shorter in patients treated with dabigatran (2.5±2.3 vs. 3.8±4.1 days, P=0.02).Conclusions:The incidence and severity of bleeding complications may be lower in patients treated with periprocedurally discontinued dabigatran when compared with uninterrupted warfarin therapy. Further evaluation of peri-interventional complications and establishment of an optimal anticoagulation management protocol are needed.
- Published
- 2014
42. The predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction on short- and long-term outcomes of catheter ablation of atrial fibrillation.
- Author
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Kosiuk J, Breithardt OA, Bode K, Kornej J, Arya A, Piorkowski C, Gaspar T, Sommer P, Husser D, Hindricks G, and Bollmann A
- Subjects
- Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Chi-Square Distribution, Diastole, Electrocardiography, Ambulatory, Female, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Recurrence, Registries, Risk Factors, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left physiopathology, Atrial Fibrillation surgery, Catheter Ablation adverse effects, Echocardiography, Doppler, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Function, Left
- Abstract
Aims: Recurrence of atrial fibrillation (AF) is frequently observed after AF catheter ablation. However, the predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction (LVDD) has not been well studied., Methods and Results: In 124 consecutive patients (mean age 61 ± 10 years, 60% male) with paroxysmal (n = 70) or persistent AF (n = 54) undergoing AF catheter ablation, mitral early diastolic peak (E-wave) and late peak (A-wave) velocities, E/A ratio, deceleration time (DT) of mitral early velocity, early diastolic mitral annulus peak velocity (e'), and E/e' ratio were determined by transthoracic echocardiography. Early (ERAF) and late AF recurrence (LRAF) were monitored with 7-day Holter electrocardiograms directly after catheter ablation and after 6 and 12 months. Early AF recurrence occurred in 34% of the patients, while LRAF was observed in 27% of the patients. Patients with ERAF had higher E-wave (0.9 ± 0.2 vs. 0.8 ± 0.2 m/s, P = 0.035) and lower A-wave velocity (0.5 ± 0.2 vs. 0.6 ± 0.2 m/s, P = 0.038), higher E/A ratio (1.8 ± 0.9 vs. 1.5 ± 0.9, P = 0.089), and slower DT (214 ± 67 vs. 243 ± 68 ms, P = 0.073), while E/e', left atrial diameter, and left ventricular ejection fraction were similar. In multivariable regression analysis, the E/A ratio was the only independent predictor of ERAF (odds ratio 2.905, 95% confidence interval 1.072-7.870, P = 0.036). None of the echocardiographic parameters influenced the late therapy outcome., Conclusion: Early results of the catheter ablation, but not the late rhythm outcome, are influenced by an impaired mitral inflow pattern, which is associated with LVDD., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2014
- Full Text
- View/download PDF
43. Relation of functional echocardiographic parameters to infarct scar transmurality by magnetic resonance imaging.
- Author
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Rost C, Rost MC, Breithardt OA, Schmid M, Klinghammer L, Stumpf C, Daniel WG, and Flachskampf FA
- Subjects
- Diagnosis, Differential, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Severity of Illness Index, Echocardiography, Doppler methods, Magnetic Resonance Imaging, Cine methods, Myocardial Infarction diagnosis, Myocardium pathology
- Abstract
Background: Identification of viable but dysfunctional myocardium after myocardial infarction is important for management, including the decision for revascularization. Assessment of infarct transmurality (TRM) by late contrast enhancement on magnetic resonance imaging (MRI) is frequently used for this task but has several limitations, particularly its availability. The goal of this study was to compare the value of several simple echocardiographic parameters measured at rest at the bedside for the identification of three degrees of infarct TRM, with contrast-enhanced MRI as the gold standard., Methods: In a prospective, single-center study, 41 patients (33 men; mean age, 62 ± 10 years; 32 with ST-segment elevation infarctions) underwent resting echocardiography and contrast-enhanced MRI <5 days after infarction. Wall motion score, preejection velocity by tissue Doppler, and longitudinal, circumferential, and radial peak systolic strain by speckle-tracking-based strain imaging were assessed, and the findings were compared with infarct TRM stratified by contrast-enhanced MRI (no scar, 0% TRM; nontransmural scar, 1%-50% TRM; and transmural scar, 51%-100% TRM)., Results: Four hundred segments showed no scar, 125 showed nontransmural scar, and 213 showed transmural scar on contrast-enhanced MRI. The sensitivity and specificity of visual wall motion scoring to detect any scar versus no scar were 71% and 81%, respectively, similar to values for circumferential strain (sensitivity and specificity both 81% with a cutoff of -14.5%). Longitudinal and radial strain performed less well, and the presence of preejection velocity performed distinctly worse (45% and 90%, respectively). The sensitivity and specificity for identifying nontransmural versus transmural infarction was better for circumferential strain (78% and 75%, respectively, with a cutoff of -10.5%) than for the other strain types, preejection velocity (52% and 67%, respectively), or visual wall motion scoring (50% and 81%, respectively, for a score > 2)., Conclusion: Visual wall motion analysis alone is able to detect infarcted myocardium but cannot differentiate sufficiently between transmural and nontransmural infarction. This is best achieved at the bedside using speckle-tracking-based circumferential strain., (Copyright © 2014 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
44. Treatment with novel oral anticoagulants in a real-world cohort of patients undergoing cardiac rhythm device implantations.
- Author
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Kosiuk J, Koutalas E, Doering M, Sommer P, Rolf S, Breithardt OA, Nedios S, Dinov B, Hindricks G, Richter S, and Bollmann A
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Benzimidazoles adverse effects, Dabigatran, Electric Countershock adverse effects, Female, Germany epidemiology, Hematoma chemically induced, Hematoma epidemiology, Hemorrhage chemically induced, Hemorrhage epidemiology, Humans, Incidence, Male, Middle Aged, Morpholines adverse effects, Prospective Studies, Prosthesis Design, Prosthesis Implantation adverse effects, Risk Factors, Rivaroxaban, Thiophenes adverse effects, Thromboembolism diagnosis, Thromboembolism epidemiology, Time Factors, Treatment Outcome, beta-Alanine administration & dosage, beta-Alanine adverse effects, Anticoagulants administration & dosage, Atrial Fibrillation therapy, Benzimidazoles administration & dosage, Cardiac Pacing, Artificial adverse effects, Defibrillators, Implantable, Electric Countershock instrumentation, Morpholines administration & dosage, Pacemaker, Artificial, Prosthesis Implantation instrumentation, Thiophenes administration & dosage, Thromboembolism prevention & control, beta-Alanine analogs & derivatives
- Abstract
Aims: The safety and efficacy of novel oral anticoagulants in patients with atrial fibrillation undergoing pacemaker or implantable cardioverter-defibrillator interventions have not been clearly defined. Therefore, we compared the incidence of bleeding and thrombo-embolic complications following cardiac rhythm device (CRD) implantations under dabigatran vs. rivaroxaban in a real-world cohort., Methods and Results: We analysed 176 consecutive procedures performed in 93 patients treated peri-interventionally with dabigatran and 83 patients with rivaroxaban, respectively. Post-operative bleeding complications and thrombo-embolic events occurring within 30 days were compared. There were no significant differences in baseline characteristics between patients in the dabigatran and the rivaroxaban group. Most of the patients in both the groups received dual chamber or cardiac resynchronization devices (71 vs. 78%) as opposed to single-chamber systems (29 vs. 22%). In the dabigatran group, two (2%) bleeding complications (two pocket haematomas) were observed in comparison with four (5%, three pocket haematomas and one pericardial effusion) in the rivaroxaban group (P = 0.330). Three complications in the rivaroxaban group necessitated surgical intervention as opposed to none in the dabigatran group (P = 0.064). One case of a transient ischaemic attack occurred in the dabigatran group (P = 0.343)., Conclusion: Bleeding and thrombo-embolic complications in patients treated with dabigatran or rivaroxban are rare. Further and larger studies are warranted to define the optimal anticoagulation management in patients with a need for oral anticoagulation and CRD interventions., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2014
- Full Text
- View/download PDF
45. [Cardiac pacing and cardiac resynchronization therapy].
- Author
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Breithardt OA and Richter S
- Subjects
- Female, Humans, Pregnancy, Arrhythmias, Cardiac therapy, Cardiac Resynchronization Therapy methods, Heart Failure therapy
- Published
- 2014
- Full Text
- View/download PDF
46. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy.
- Author
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, and Vardas PE
- Subjects
- Humans, Cardiac Pacing, Artificial standards, Cardiac Resynchronization Therapy standards
- Published
- 2014
- Full Text
- View/download PDF
47. Reversing heart failure by CRT: how long do the effects last?
- Author
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Breithardt OA
- Subjects
- Female, Humans, Male, Alzheimer Disease drug therapy, Cardiac Resynchronization Therapy methods, Cholinesterase Inhibitors therapeutic use, Heart Failure therapy, Myocardial Infarction prevention & control, Ventricular Dysfunction, Left therapy, Ventricular Remodeling physiology
- Published
- 2013
- Full Text
- View/download PDF
48. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).
- Author
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Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, and Wilson CM
- Subjects
- Algorithms, Aortic Valve surgery, Bicuspid Aortic Valve Disease, Cardiac Pacing, Artificial adverse effects, Cardiac Pacing, Artificial methods, Cardiac Resynchronization Therapy adverse effects, Cardiomyopathy, Hypertrophic complications, Catheter Ablation, Child, Contraindications, Defibrillators, Implantable, Emergency Treatment, Female, Heart Defects, Congenital complications, Heart Defects, Congenital surgery, Heart Transplantation, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation, Humans, Magnetic Resonance Imaging, Myocardial Infarction therapy, Postoperative Care, Pregnancy, Pregnancy Complications, Cardiovascular, Prosthesis-Related Infections surgery, Rare Diseases complications, Remote Consultation, Reoperation, Secondary Prevention, Stroke Volume physiology, Syncope prevention & control, Arrhythmias, Cardiac therapy, Cardiac Resynchronization Therapy methods, Heart Failure therapy
- Published
- 2013
- Full Text
- View/download PDF
49. Relevant ventricular septal defect caused by steam pop during ablation of premature ventricular contraction.
- Author
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Schönbauer R, Sommer P, Misfeld M, Dinov B, Fiedler L, Huo Y, Gaspar T, Breithardt OA, Hindricks G, and Arya A
- Subjects
- Cardiac Surgical Procedures, Electrocardiography, Female, Heart Septal Defects, Ventricular surgery, Humans, Middle Aged, Steam adverse effects, Treatment Outcome, Catheter Ablation adverse effects, Heart Septal Defects, Ventricular diagnosis, Heart Septal Defects, Ventricular etiology, Ventricular Premature Complexes surgery
- Published
- 2013
- Full Text
- View/download PDF
50. Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department.
- Author
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Bahrmann P, Bahrmann A, Breithardt OA, Daniel WG, Christ M, Sieber CC, and Bertsch T
- Subjects
- Aged, Aged, 80 and over, Biomarkers blood, Emergency Service, Hospital, Glycopeptides blood, Humans, Prognosis, Prospective Studies, Troponin I blood, Troponin T blood, Myocardial Infarction blood, Myocardial Infarction diagnosis
- Abstract
Background: Identifying older patients with non-ST- elevation myocardial infarction (NSTEMI) within the very large proportion with elevated high-sensitive cardiac troponin T (hs-cTnT) is a diagnostic challenge because they often present without clear symptoms or electrocardiographic features of acute coronary syndrome to the emergency department (ED). We prospectively investigated the diagnostic and prognostic performance of copeptin ultra-sensitive (copeptin-us) and hs-cTnT compared to hs-cTnT alone for NSTEMI at prespecified cut-offs in unselected older patients., Methods: We consecutively enrolled 306 non-surgical patients ≥70 years presenting to the ED. In addition to clinical examination, copeptin-us and hs-cTnT were measured at admission. Two cardiologists independently adjudicated the final diagnosis of NSTEMI after reviewing all available data. All patients were followed up for cardiovascular-related death within the following 12 months., Results: NSTEMI was diagnosed in 38 (12%) patients (age 81±6 years). The combination of copeptin-us ≥14 pmol/L and hs-cTnT ≥0.014 µg/L compared to hs-cTnT ≥0.014 µg/L alone had a positive predictive value of 21% vs. 19% to rule in NSTEMI. The combination of copeptin-us <14 pmol/L and hs-cTnT <0.014 µg/L compared to hs-cTnT <0.014 µg/L alone had a negative predictive value of 100% vs. 99% to rule out NSTEMI. Hs-cTnT ≥0.014 µg/L alone was significantly associated with outcome. When copeptin-us ≥14 pmol/L was added, the net reclassification improvement for outcome was not significant (p=0.809)., Conclusions: In unselected older patients presenting to the ED, the additional use of copeptin-us at predefined cut-offs may help to reliably rule out NSTEMI but may not help to increase predicted risk for outcome compared to hs-cTnT alone.
- Published
- 2013
- Full Text
- View/download PDF
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