Stephanie Fichtner

Arrhythmia Type After Persistent Atrial Fibrillation Ablation Predicts Success of the Repeat Procedure

Background— The aim of the study was to investigate whether the type of arrhythmia recurrence after ablation of persistent atrial fibrillation (AF) has an impact on the maintenance of sinus rhythm after the repeat ablation procedure. Methods and Results— Included were 78 consecutive patients (82% men; mean age, 61±10 years; mean left atrial diameter, 47±4 mm) with persistent AF who underwent ≥1 repeat ablation. The initial ablation procedure had consisted of pulmonary vein isolation with additional substrate modification (ablation of complex fractionated atrial electrograms [n=63] or linear lesions [n=15]). Patients presented for reablation either with persistent atrial tachycardia (AT) (group 1, n=36), persistent AF (group 2, n=37), or paroxysmal AF (group 3, n=5). The primary end point was freedom from any arrhythmia off antiarrhythmic drugs 6 and 9 months after the reablation procedure. Estimated proportions of patients reaching the primary end point were 59% for group 1, 28% for group 2, and 100% for group 3 at 6 months and 51%, 23%, and 100%, for groups 1, 2, and 3, respectively, at 9 months (P=0.002). Conclusions— In patients presenting for a repeat procedure after ablation of persistent AF, the occurrence of AT is associated with a significantly better outcome compared with recurrent persistent AF. These results suggest that AT might be considered as a step toward sinus rhythm.

Prospective assessment of short- and long-term quality of life after ablation for atrial fibrillation.

Quality of Life After Ablation for Atrial Fibrillation. Background : This study prospectively assesses different aspects of short‐ and long‐term quality of life (QoL) after catheter ablation for atrial fibrillation (AF). An analysis of 7 validated generic and tailored questionnaires was performed with regard to the relation of QoL to ablation success.

Safety of Implantable Pacemakers and Cardioverter Defibrillators in the Magnetic Field of a Novel Remote Magnetic Navigation System

Safety of Pacemakers and ICDs.u2002Introduction: Electromagnetic interference with pacemaker and implantable cardioverter defibrillator (ICD) systems may cause temporary or permanent system malfunction of implanted devices. The aim of this study was to evaluate potential interference of a novel magnetic navigation system with implantable rhythm devices.

Very late relapse of atrial fibrillation after pulmonary vein isolation: incidence and results of repeat ablation.

Background: u2002There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population.

Association of ST-elevation and non-ST-elevation presentation on ECG with transmurality and size of myocardial infarction as assessed by contrast-enhanced magnetic resonance imaging

BACKGROUNDnIt is the general perception, that ST-elevation myocardial infarction is associated with transmural ischemia while Non-ST elevation myocardial infarction is found in non-transmural subendocardial ischemia. This association, however, derives primarily from post mortem studies.nnnMETHODSnA total of 220 patients with acute myocardial infarction (MI) who had PCI on admission and contrast-enhanced cardiac magnetic resonance imaging (CMR) within one week were included into the study. Size and transmural extent of MI was quantified by CMR and correlated with the ECG on admission.nnnRESULTSnBased on the ECG findings, 57% were classified as STEMI and 43% as NSTEMI. CMR infarct size was significantly larger in STEMI than NSTEMI (23.2 vs. 14.2 LV%, p<0.001). As assessed by CMR, STEMI patients were transmural in 63% as compared to 27% of patients with NSTEMI (p<0.001). In a multivariable logistic regression model, total infarct size was significantly associated with presence of STEMI (OR: 1.045, 95% CI [1.014-1.077], p=0.004) whereas the number of transmural segments did not significantly add further information for a STEMI/NSTEMI classification (p=0.054, change of c-index from 0.69 to 0.70).nnnCONCLUSIONSnThe electrocardiographic STEMI/NSTEMI classification does rather characterize the total size of MI than the transmural extent as assessed by CMR.

Forces on cardiac implantable electronic devices during remote magnetic navigation

BackgroundRemote magnetic navigation systems are used for catheter navigation in cardiac electrophysiological ablation procedures. In this setting, ferromagnetic particles will be moved by changes in the magnetic field. It is unknown to what extent cardiac implantable electronic devices (CIED) are affected by the magnetic field when using magnetic navigation, and whether these forces may exceed the limit of 5xa0N that is set forth by German and European norms for implanted electrodes.MethodsA total of 121 rhythm devices were examined in a magnetic field of 0.1xa0T using the NIOBE II® Magnetic Navigation System (Stereotaxis, St. Louis, USA). Forces acting on the devices were measured with the force measurement tool Futek LRF 400 (Futek Advanced Sensor Technology Inc., Irvine, CA, USA). A standardized protocol of different movements of the magnetic field including all three dimensions was performed and maximal forces on the CIED were assessed.ResultsOut of 121 devices, 78 different pacemakers (54 different model families from 11 manufacturers) and 43 different cardioverter-defibrillators (26 different model families from 6) were examined. The mean force that could be observed was 0.33xa0±xa00.13xa0N for pacemakers (range 0.16–1.12xa0N) and 1.05xa0±xa00.11xa0N for cardioverter-defibrillators (range 0.86–1.38xa0N) when exposed to the magnetic field.ConclusionExposure of pacemakers or implantable cardioverter-defibrillators to a magnetic field of 0.1xa0T does not result in a force exceeding the regulatory demanded 5xa0N that could damage the connected leads.

A Prospective Randomized Study Comparing Isolation of the Arrhythmogenic Vein Versus All Veins in Paroxysmal Atrial Fibrillation

Ablation procedures in patients with paroxysmal atrial fibrillation (PAF) includes isolation of all pulmonary veins (PVs). We hypothesized that an approach using an algorithm to detect arrhythmogenic PVs (aPVs) might lead to shorter procedure duration (PD) and fewer proarrhythmic effects (PE).

Diagnostic value of standard and extended ECG leads for the detection of acute myocardial infarction as compared to contrast-enhanced magnetic resonance imaging

acute myocardial infarction as compared to contrast-enhanced magnetic resonance imaging Nikolaus Sarafoff ⁎, Ruth Vochem , Stephanie Fichtner , Stefan Martinoff , Markus Schwaiger , Albert Schomig , Tareq Ibrahim a a Klinik fur Herzund Kreislauferkrankungen, Deutsches Herzzentrum, Technische Universitat Munchen, Germany b Klinik fur Radiologie und Nuklearmedizin, Deutsches Herzzentrum, Technische Universitat Munchen, Germany c Nuklearmedizinische Klinik im Klinikum Rechts der Isar, Technische Universitat Munchen

Visualization of multiple catheters in left atrial ablation procedures. Comparison of two different 3D mapping systems.

BackgroundVisualization of intracardiac catheters placed in predefined anatomic locations is a cornerstone for successful atrial fibrillation (AF) ablation. The 3D mapping system Carto3™ (Biosense Webster, Diamond Bar, CA, USA) released in 2009 provides the possibility to visualize more than one intracardiac catheter at a time. The aim of the study was to evaluate the feasibility and safety of the system, to show the learning curve, and to compare it to the established Ensite NavX™ system regarding procedural handling parameters.MethodsA total of 100xa0patients were enrolled in the study. The Carto3™ system was used by a team of four specialized operators in 50xa0patients (mean age 62±9xa0years, paroxysmal AF n=28, persistent AF n=17, left atrial flutter n=5). Patients were consecutively enrolled and matched (regarding type of ablated arrhythmias, ablation strategy, left atrial size, age, and gender) with patients ablated during the same time period with the EnSite NavX™ system. In patients with paroxysmal AF, ostial pulmonary vein isolation (PVI) was performed. Patients with persistent AF underwent PVI plus additional ablation of complex fractionated atrial electrograms (CFAE) and patients with left atrial flutter were treated with specific lines.ResultsIn 50xa0case-control pairs, all procedures were performed as planned without complications in both groups except onexa0cardiac tamponade in 1xa0patient in the Ensite NavX™ control group. The learning curve using the Carto3™ system was fast regarding x-ray time and procedural duration and reached the level of the EnSite NavX™ system after 15xa0and 25xa0patients, respectively.ConclusionThe Carto3™ system with its feature of visualizing several catheters is feasible and safe compared to an established system, e.g., Ensite NavX™. The learning curve is steep regarding reduction of x-ray time and procedural duration.ZusammenfassungHintergrundDie Visualisierung von Ablationskathetern in Herzhöhlen ist ein Meilenstein bei der Ablation von Vorhofflimmern. Das 3D-Mappingsystem Carto3™ (Biosense Webster, Diamond Bar, USA) mit Markteinführung im Jahr 2009 bietet die Möglichkeit, mehr als einen Katheter gleichzeitig zu visualisieren. Ziel der Studie war die Anwendbarkeit und die Sicherheit von Carto3™ im Vergleich zum etablierten 3D-Mappingsystem Ensite NavX™ zu untersuchen.Material und Methoden100xa0Patienten wurden in die Studie eingeschlossen. Vier erfahrene Untersucher verwendeten das Carto3™-System bei 50 konsekutiven Patienten (mittleres Alter 62±9xa0Jahre, paroxysmales Vorhofflimmern n=28, persistierendes Vorhofflimmern n=17, linksatriales Vorhofflattern n=5). Diese 50xa0Patienten (Carto3™-Gruppe) wurden hinsichtlich der abladierten Vorhofrhythmusstörung, der Ablationsstrategie, der Größe des linken Atriums, des Alters sowie des Geschlechts mit Patienten verglichen, bei denen im selben Zeitraum das EnSite-NavX™-System benutzt worden war. Bei Patienten mit paroxysmalem Vorhofflimmern wurde eine ostiale Pulmonalvenenisolation durchgeführt, bei Patienten mit persistierendem Vorhofflimmern zusätzlich eine potenzialorientierte Substratmodifikation mittels Ablation von komplex-fraktionierten atrialen Signalen (CFAE). Bei Patienten mit linksatrialem Vorhofflattern wurden spezifische Linien gezogen.ErgebnisseBei allen Patienten wurden die Ablationsprozeduren wie vorgesehen ohne Komplikationen durchgeführt, ausgenommen einer Perikardtamponade bei einem Patienten in der Ensite-NavX™-Gruppe. Die Lernkurve des Carto3™-Systems war hinsichtlich der Durchleuchtungs- und der Prozedurzeit steil und erreichte nach 15 bzw. 25xa0Patienten das gleiche Niveau wie bei den Patienten der Ensite-NavX™-Gruppe.SchlussfolgerungDas Carto3™-System mit der neuen Funktion mehrere Katheter gleichzeitig zu visualisieren ist im Vergleich zum etablierten EnSite NavX™-System anwendbar und sicher. Die Lernkurve hinsichtlich Durchleuchtungs- und Prozedurzeit ist steil.

Visualization of multiple catheters in left atrial ablation procedures

BackgroundVisualization of intracardiac catheters placed in predefined anatomic locations is a cornerstone for successful atrial fibrillation (AF) ablation. The 3D mapping system Carto3™ (Biosense Webster, Diamond Bar, CA, USA) released in 2009 provides the possibility to visualize more than one intracardiac catheter at a time. The aim of the study was to evaluate the feasibility and safety of the system, to show the learning curve, and to compare it to the established Ensite NavX™ system regarding procedural handling parameters.MethodsA total of 100xa0patients were enrolled in the study. The Carto3™ system was used by a team of four specialized operators in 50xa0patients (mean age 62±9xa0years, paroxysmal AF n=28, persistent AF n=17, left atrial flutter n=5). Patients were consecutively enrolled and matched (regarding type of ablated arrhythmias, ablation strategy, left atrial size, age, and gender) with patients ablated during the same time period with the EnSite NavX™ system. In patients with paroxysmal AF, ostial pulmonary vein isolation (PVI) was performed. Patients with persistent AF underwent PVI plus additional ablation of complex fractionated atrial electrograms (CFAE) and patients with left atrial flutter were treated with specific lines.ResultsIn 50xa0case-control pairs, all procedures were performed as planned without complications in both groups except onexa0cardiac tamponade in 1xa0patient in the Ensite NavX™ control group. The learning curve using the Carto3™ system was fast regarding x-ray time and procedural duration and reached the level of the EnSite NavX™ system after 15xa0and 25xa0patients, respectively.ConclusionThe Carto3™ system with its feature of visualizing several catheters is feasible and safe compared to an established system, e.g., Ensite NavX™. The learning curve is steep regarding reduction of x-ray time and procedural duration.ZusammenfassungHintergrundDie Visualisierung von Ablationskathetern in Herzhöhlen ist ein Meilenstein bei der Ablation von Vorhofflimmern. Das 3D-Mappingsystem Carto3™ (Biosense Webster, Diamond Bar, USA) mit Markteinführung im Jahr 2009 bietet die Möglichkeit, mehr als einen Katheter gleichzeitig zu visualisieren. Ziel der Studie war die Anwendbarkeit und die Sicherheit von Carto3™ im Vergleich zum etablierten 3D-Mappingsystem Ensite NavX™ zu untersuchen.Material und Methoden100xa0Patienten wurden in die Studie eingeschlossen. Vier erfahrene Untersucher verwendeten das Carto3™-System bei 50 konsekutiven Patienten (mittleres Alter 62±9xa0Jahre, paroxysmales Vorhofflimmern n=28, persistierendes Vorhofflimmern n=17, linksatriales Vorhofflattern n=5). Diese 50xa0Patienten (Carto3™-Gruppe) wurden hinsichtlich der abladierten Vorhofrhythmusstörung, der Ablationsstrategie, der Größe des linken Atriums, des Alters sowie des Geschlechts mit Patienten verglichen, bei denen im selben Zeitraum das EnSite-NavX™-System benutzt worden war. Bei Patienten mit paroxysmalem Vorhofflimmern wurde eine ostiale Pulmonalvenenisolation durchgeführt, bei Patienten mit persistierendem Vorhofflimmern zusätzlich eine potenzialorientierte Substratmodifikation mittels Ablation von komplex-fraktionierten atrialen Signalen (CFAE). Bei Patienten mit linksatrialem Vorhofflattern wurden spezifische Linien gezogen.ErgebnisseBei allen Patienten wurden die Ablationsprozeduren wie vorgesehen ohne Komplikationen durchgeführt, ausgenommen einer Perikardtamponade bei einem Patienten in der Ensite-NavX™-Gruppe. Die Lernkurve des Carto3™-Systems war hinsichtlich der Durchleuchtungs- und der Prozedurzeit steil und erreichte nach 15 bzw. 25xa0Patienten das gleiche Niveau wie bei den Patienten der Ensite-NavX™-Gruppe.SchlussfolgerungDas Carto3™-System mit der neuen Funktion mehrere Katheter gleichzeitig zu visualisieren ist im Vergleich zum etablierten EnSite NavX™-System anwendbar und sicher. Die Lernkurve hinsichtlich Durchleuchtungs- und Prozedurzeit ist steil.