Alexander Wutzler

Association of 5-HT1B Receptor Polymorphisms With the Loudness Dependence of Auditory Evoked Potentials in a Community-Based Sample of Healthy Volunteers

The terminal autoreceptor 5‐HT1B is centrally involved in the regulation of the brain serotonergic system and in several psychiatric disorders including depression, addiction, and obsessive‐compulsive disorder. The loudness dependence of the auditory evoked N1/P2‐component (LDAEP; primary auditory cortex) is currently considered as one of best‐validated indicators of serotonergic neurotransmission, especially for synaptically released serotonin. Since the 5‐HT1B receptor is involved in the release of serotonin at terminal endings of cortical neurons, this study addressed the question whether single nucleotide polymorphism (SNP) in the gene coding for this receptor (HTR1B) are related to LDAEP of the primary auditory cortex (tangential dipole) investigating a community‐based sample of 127 healthy subjects randomly selected from the general population. In this carefully recruited sample, a G‐G haplotype (rs1213368‐rs6296) and the respective G‐alleles were found to be related to a strong LDAEP response of the left tangential dipole, indicating low serotonergic activity. Apart from the fact that this is the first study which relates HTR1B SNPs to a measure of serotonergic function, it can be speculated that LDAEP may reflect parts of the release mechanism of serotonin at cortical synapses, although the lateralized finding cannot be entirely explained. Carriers of the G‐alleles may be characterized by a particularly strong feedback inhibition of serotonin release at cortical terminals in the primary auditory cortex, possibly mediated by higher sensitivity of 5‐HT1B receptors associated with low serotonergic activity.

Pain Reactions during Pulmonary Vein Isolation under Deep Sedation: Cryothermal versus Radiofrequency Ablation

Left atrial ablation can be accompanied by discomfort or pain. The purpose of this study was to systematically compare pain reactions during ablation of atrial fibrillation under deep sedation with cryothermal and radiofrequency energy.

Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience

PurposeCatheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels.MethodsFrom January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator.ResultsProcedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637u2009±u2009611 μGy/m2; beginner 44.1u2009±u200979.5xa0μGy/m2, pu2009=u20090.002; 1st year fellow 24.3u2009±u200946.4.5xa0μGy/m2, pu2009=u20090.001; 2nd year fellow 130.3u2009±u2009233.3xa0μGy/m2, pu2009=u20090.003; expert 9.3u2009±u200937.4xa0μGy/m2, Pu2009<u20090.001). Procedure duration, acute success, and complications were not significantly different between the groups.ConclusionOur results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.

Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study)

The prevalence of patients with implanted cardioverter defibrillators (ICDs) and the frequency of surgery on these patients are steadily on the rise. Guidelines recommend preoperative ICD reprogramming, although this is sometimes difficult in clinical practice. Placing a magnet on the ICD is a practical alternative and even no inactivation is possible in selected cases.

Autonomic dysfunction of gastric motility in major depression

BACKGROUNDnPatients suffering from major depressive disorder (MDD) often complain about somatic symptoms. Cardiac complaints have been examined predominantly. However, gastrointestinal complaints are also reported frequently and are associated with worse outcomes. The research concerning changes in gastric motility of these patients is rather sparse. The aim of our study was to determine dysfunction of gastric motility and gastrointestinal symptoms in MDD. The duration and severity of MDD were examined regarding its influence over gastric emptying.nnnMETHODSnGastric emptying was determined by a 13C-acetate breath test in patients with MDD (n = 29) and healthy control subjects (n = 51). Prior to this, depressive illness was operationalized using external and self-assessment scales (HAMD-21, MADRS, BDI, CGI). Whether the severity or duration of MDD influenced the gastric emptying parameters was examined using Spearmans correlation. In addition, autonomic complaints were recorded by means of an ANS score. Each ANS score item was determined using a Mann-Whitney U or Kruskal-Wallis test concerning the gastric emptying parameters.nnnRESULTSnThere was a significant difference in the parameters of the maximum gastric emptying rate (Tmax) and gastric half emptying time T1/2b between patients with MDD and healthy control subjects (Tmax 66.21min vs 53.35min, p < 0.006, T1/2b 207.59min vs 133.27min, p < 0.005). There was a significant negative correlation between Tmax and the severity of MDD determined with the depression rating scales BDI (Spearmans rank - 0.521, p = 0.013) and HAMD-21 (r - 0.384, p = 0.048). No correlation was found between the duration of MDD and the maximum gastric emptying rate (r - 0.125, p = 0.519) and gastric half emptying time (r - 0.62, p = 0.749).nnnCONCLUSIONnGastrointestinal motility is significantly impaired in patients with MDD compared to healthy control subjects. Autonomic complaints were indicated frequently in MDD patients. The duration of MDD had no influence over the time of gastric emptying. There was a significant negative correlation between the severity of MDD and Tmax, indicating that the Tmax was reached earlier with the progression of MDD. The slowing of gastric motility in MDD patients is likely a result of a dysfunction of the autonomic nervous system.

First data on cardiac mapping and outcome of pulmonary vein isolation using a novel ablation catheter with tip mini electrodes

AIMSnPulmonary vein isolation (PVI) is a standard treatment of atrial fibrillation (AF). AF recurrence after PVI occurs in a substantial number of cases. A novel ablation catheter equipped with mini-electrodes (ME) may facilitate PVI. Our study evaluated outcome after PVI with the ME catheter compared to a standard catheter.nnnMETHODSnPatients undergoing PVI with the ME catheter were compared to a control group ablated with a standard contact force sensing catheter. Freedom of AF after 12u202fmonths was the study endpoint. Additionally, low voltage areas (LVA) <0.5u202fmV were identified with a circular mapping catheter (CMC) and the ablation catheter in each group. LVA were compared between the maps obtained with the CMC and the ME or standard catheter, respectively.nnnRESULTSnA total of 110 patients underwent PVI with ME catheter (nu202f=u202f59) or the standard catheter (nu202f=u202f51). Procedure duration (117.4u202f±u202f43 vs. 103.1u202f±u202f32.8u202fmin, pu202f=u202f0.15), radiation dose (1135.6u202f±u202f1125.7 vs. 1078.8u202f±u202f951.4u202fμGy/m2, pu202f=u202f0.91), incidence of complications and 12-month success rate (64.4 vs 72.5%, pu202f=u202f0.36) were not significantly different between the groups. LVA were significantly smaller when obtained with the standard catheter compared to the CMC (14u202f±u202f13 vs. 58.5u202f±u202f22.1u202fcm2, pu202f<u202f0.001), while no such difference was seen for mapping with the ME compared to the CMC (37u202f±u202f30.3 vs. 33.4u202f±u202f39u202fcm2, pu202f=u202f0.4).nnnCONCLUSIONnClinical outcomes are comparable between ME catheter and a standard contact force sensing catheter. Furthermore, better LVA detection points to improved mapping capabilities of the ME catheter.

Strahlenreduktion in der interventionellen Elektrophysiologie

BACKGROUNDnRadiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether axa0reduction of radiation exposure with the use of near-zero fluoroscopy protocols is possible when applied by less experienced operators.nnnMETHODSnConsecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) axa0near near-zero fluoroscopy protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed axa0growing number of procedures with the near-zero fluoroscopy protocol.nnnRESULTSnIn all, 290xa0procedures were analyzed. After implementation of axa0radiation-reduced protocol, axa0significant reduction of radiation exposure was observed (standard 850u202f±u2009831.7 vs. initial phase 197.2u202f±u2009481.8 μGy/m2, pu202f<u20090.001, and vs. routine use 283u202f±u2009493.8 μGy/m2, pu202f<u20090.001). No significant difference was observed between the initial phase and routine phase (pu202f=u20091). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; pu202f<u20090.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; pu202f=u20090.002). Complication rates were not significantly different.nnnCONCLUSIONSnImplementation of axa0radiation-reduced protocol leads to axa0significant reduction of radiation exposure even in less experienced operators during training.ZusammenfassungHintergrundDie Strahlenexposition im Katheterlabor ist mit signifikanten Gesundheitsrisiken verbunden. Unklar ist, ob eine Reduktion der Strahlenbelastung mit „Near-zero-fluoroscopy“-Protokollen auch bei weniger erfahreneren Untersuchern möglich ist.MethodenEs wurden konsekutive Ablationsprozeduren mit Verwendung eines 3‑D-Mapping-Systems analysiert. Hierbei wurden 3xa0Zeiträume betrachtet. Im ersten Zeitraum (Standard) wurde ohne Strahlenreduktionsprotokoll gearbeitet. Im zweiten Zeitraum wurde ein „Near-zero-fluoroscopy“-Protokoll eingeführt (Initialphase Strahlenreduktion), allerdings wurde der Großteil der Untersuchungen von einem Experten durchgeführt. Im dritten Zeitraum übernahmen zunehmend zwei weniger erfahrene Untersucher (Fellow und Anfänger) die Prozeduren als Erstuntersucher.ErgebnisseInsgesamt wurden 290 Untersuchungen analysiert. Nach Einführung des Strahlenreduktionsprotokolls wurde eine signifikante Reduktion des mittleren Flächendosisproduktes gegenüber dem Standardprotokoll beobachtet (Standard 850u202f±u2009831,7 vs. Initialphase 197,2u202f±u2009481,8 μGy/m2, pu202f<u20090,001, und vs. Routinephase 283u202f±u2009493,8 μGy/m2, pu202f<u20090,001). Zwischen Initialphase und Routinephase ergab sich kein signifikanter Unterschied (pu202f=u20091). Über die 3 untersuchten Zeiträume stieg der Anteil der weniger erfahrenen Untersucher an den komplexen (Fellow: 0u202f% vs. 10u202f% vs. 30u202f%; pu202f<u20090,001), sowie den nichtkomplexen (Fellow: 30u202f% vs. 39u202f% vs. 49u202f%; Anfänger: 15u202f% vs. 38u202f% vs. 34u202f%; pu202f=u20090,002) Prozeduren signifikant an. Komplikationsraten unterschieden sich nicht signifikant.SchlussfolgerungDie Einführung des hier beschriebenen Strahlenreduktionsprotokolls führt bei Untersuchern unterschiedlicher Erfahrung zu einer signifikanten Reduktion der Strahlenbelastung und ist auch im Verlauf der Ausbildung sinnvoll.AbstractBackgroundRadiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether axa0reduction of radiation exposure with the use of “near-zero fluoroscopy” protocols is possible when applied by less experienced operators.MethodsConsecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) axa0near “near-zero fluoroscopy” protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed axa0growing number of procedures with the “near-zero fluoroscopy” protocol.ResultsIn all, 290xa0procedures were analyzed. After implementation of axa0radiation-reduced protocol, axa0significant reduction of radiation exposure was observed (standard 850u202f±u2009831.7 vs. initial phase 197.2u202f±u2009481.8 μGy/m2, pu202f<u20090.001, and vs. routine use 283u202f±u2009493.8 μGy/m2, pu202f<u20090.001). No significant difference was observed between the initial phase and routine phase (pu202f=u20091). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; pu202f<u20090.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; pu202f=u20090.002). Complication rates were not significantly different.ConclusionsImplementation of axa0radiation-reduced protocol leads to axa0significant reduction of radiation exposure even in less experienced operators during training.

Ungewöhnliche Schrittmacherkomplikation bei Morbus Still

ZusammenfassungFallberichtEin Patient mit Morbus Still stellt sich mit Hautrötung über seiner Schrittmachernarbe vor. Im Rahmen eines Aggregatwechsels war 2012 statt einer zuvor subpektoralen Lage des Aggregats eine subkutane gewählt worden. Der lokale Befund verschlechtert sich, es entsteht ein Granulom. Bei sich schorfender Makula über der Narbe wird eine Revisionsoperation durchgeführt.TherapieIntraoperativ zeigt sich eine oberflächliche Lage der Schrittmacherelektroden. Die Schrittmacherkabel und das Aggregat werden mühsam aus derbem Granulationsgewebe gelöst. Das neue Material wird subpektoral implantiert. In den Verlaufskontrollen zeigt sich ein unauffälliger Befund.SchlussfolgerungNach Umpositionierung des Aggregats nach subkutan war die Haut des Patienten größerem mechanischem Stress ausgesetzt, der bei M.xa0Still zur Bildung eines Erythem und Hypergranulation führte. Bei M.xa0Still sollte deshalb eine oberflächliche Schrittmacherlage vermieden werden.AbstractCase reportA 49-year-old man with Still’s disease presented with axa0rash above his pacemaker scar. In 2012, there was axa0replacement of the generator in which the position was changed from subpectoral to subcutaneous. Axa0revision operation was performed after the local finding became worse, turning from axa0granuloma to axa0macula.TherapyDuring surgery, axa0superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into axa0subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing.ConclusionAfter repositioning of the generator to axa0subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Still’s disease. Axa0superficial position of axa0pacemaker should be avoided in patients affected by Still’s disease.CASE REPORTnA 49-year-old man with Stills disease presented with axa0rash above his pacemaker scar. In 2012, there was axa0replacement of the generator in which the position was changed from subpectoral to subcutaneous. Axa0revision operation was performed after the local finding became worse, turning from axa0granuloma to axa0macula.nnnTHERAPYnDuring surgery, axa0superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into axa0subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing.nnnCONCLUSIONnAfter repositioning of the generator to axa0subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Stills disease. Axa0superficial position of axa0pacemaker should be avoided in patients affected by Stills disease.

Mapping and ablation of a mechanically blocked concealed accessory pathway under repeated adenosine bolus infusions

ZusammenfassungIm Rahmen der Katheterablation einer akzessorischen Leitungsbahn kann es zur mechanischen Leitungsblockierung während der Mappingprozedur kommen. Adenosin wird als Substanz zur Detektion verborgener Erregungsleitung nach inkompletten Ablationsläsionen verwendet. In diesem Beitrag wird der Fall einer Patientin mit linksseitiger akzessorischer Leitungsbahn präsentiert, die nach mechanischer Blockierung erst unter wiederholten Adenosin-Bolusgaben, die jeweils mit einer temporären Wiedergewinnung der Erregungsleitung der akzessorischen Bahn einhergingen, erfolgreich abladiert werden konnte.AbstractDuring mapping and catheter ablation of an accessory pathway, a mechanically induced conduction block can occur. Adenosine is used to detect dormant conduction of incomplete ablation lesions. Presented in this article is the case of a patient with a left-sided accessory pathway, which was mechanically blocked during the mapping procedure and could only be successfully ablated after repeated adenosine bolus infusions, which resulted in intermittent restitution of conduction via the accessory pathway.During mapping and catheter ablation of an accessory pathway, a mechanically induced conduction block can occur. Adenosine is used to detect dormant conduction of incomplete ablation lesions. Presented in this article is the case of a patient with a left-sided accessory pathway, which was mechanically blocked during the mapping procedure and could only be successfully ablated after repeated adenosine bolus infusions, which resulted in intermittent restitution of conduction via the accessory pathway.