Thomas Meinertz

Event‐Recorder Monitoring in the Diagnosis of Atrial Fibrillation in Symptomatic Patients: Subanalysis of the SOPAT Trial

In the SOPAT (suppression of paroxysmal atrial tachyarrhythmias) trial, a high number of asymptomatic atrial fibrillation (AF) episodes were registered in patients with symptomatic AF. This subanalysis was performed to answer three questions: (1) Does antiarrhythmic therapy influence the ratio of symptomatic to asymptomatic AF? (2) Are symptoms during AF dependent on the heart rate (HR)? (3) Do symptoms correlate with an episode of AF? Within 60 months 1,033 patients with symptomatic AF were randomized to either quinidine plus verapamil (Q+V) 480/240 mg/day, Q+V 320/160 mg/day, sotalol 320 mg/day, or placebo, and followed up by daily and symptom‐triggered ECG event recording. Over 188,634 ECGs were analyzed (87% SR, 7% AF). Symptoms were reported in only 46% of AF‐ECGs. Quinidine plus verapamil reduced the ratio of symptomatic to asymptomatic AF, whereas sotalol had no effect (median [%] (25/75% quartile): Q+V 480/240: 33 (0/79), Q+V 320/160: 45 (1/82), sotalol: 56 (7/93), placebo: 63 (8/92)). The HR during AF directly correlates with the occurrence of symptoms (P < 0.001) and was significantly lower during asymptomatic AF in all groups (mean ± SD: sympt.: 113 ± 27/minute, asympt.: 103 ± 27/minute, P < 0.001). Both antiarrhythmics reduced the mean HR compared to placebo (P < 0.001). Analyzing all symptom‐triggered ECGs, AF was diagnosed in only 37%, whereas the majority were SR. Taken together, in contrast to sotalol, Q+V reduces the ratio of symptomatic to asymptomatic AF compared with placebo, at least in part by decreasing the heart rate. Furthermore, patients symptoms are not a reliable surrogate parameter for the prevalence of AF.

Tissue Doppler imaging identifies myocardial dysfunction in adults with Marfan syndrome.

Successful prevention of aortic complications has lead to improved survival of Marfan syndrome (MFS). With increasing age, however, ventricular arrhythmia and heart failure are emerging as life‐threatening manifestations of myocardial dysfunction.

Pattern of Isthmus Conduction Recovery Using Open Cooled and Solid Large‐Tip Catheters for Radiofrequency Ablation of Typical Atrial Flutter

Introduction: Open cooled‐tip and solid 8‐mm‐tip catheters have demonstrated safety and effectiveness for radiofrequency current (RFC) ablation of typical atrial flutter (AFL). However, data from prospective and randomized studies in this setting are lacking.

Mapping of the Coronary Sinus and Great Cardiac Vein Using a 2-French Electrode Catheter and a Right Femoral Approach

Coronary Sinus Mapping. Introduction: Local electrogranis recorded from the coronary sinus and great cardiac vein provide important information for the diagnosis of various arrhythmias and identification of target sites for ablation of left‐sided accessory pathways. One limitation of present techniques is the inability, in many cases, to probe the great cardiac vein at the anterior mitral annulus. We tested the feasibility of a new technique for catheterization of the coronary sinus and great cardiac vein by means of a small‐diameter electrode catheter advanced via a right femoral approach through an angiography catheter.

Predicting Recurrence of Vasovagal Syncope: A Simple Risk Score for the Clinical Routine

Background: Predictors for recurrence of syncope are lacking in patients with vasovagal syncope. The aim of this study was to identify risk factors for recurrence of syncope and develop a simple prognostic risk score of clinical value.

Favorable Outcome Using an Abbreviated Procedure for Catheter Ablation of AVNRT: Results from a Prospective Randomized Trial

Introduction: Radiofrequency catheter ablation aiming slow pathway modulation is a widely established procedure with high success and low recurrence rates in patients with atrioventricular nodal reentry tachycardia (AVNRT). However, the necessity of a waiting period following successful slow pathway modulation to increase the long‐term success rates has not been systematically evaluated thus far.

Slow Wall Motion Rather Than Electrical Conduction Delay Underlies Mechanical Dyssynchrony in Postinfarction Patients With Narrow QRS Complex

Post‐MI Narrow QRS Dyssynchrony.u2002Introduction: The mechanism of mechanical dyssynchrony in postinfarction patients with a narrow QRS complex is not defined but essential for cardiac resynchronization therapy (CRT).

Effects of Continuous and Triggered Atrial Overdrive Pacing on Paroxysmal Atrial Fibrillation in Pacemaker Patients

Background: The aim of the study was to compare the effects of different pacing strategies to prevent paroxysmal atrial fibrillation (AF): triggered atrial overdrive pacing versus the combination of triggered and continuous overdrive pacing.

Intraoperative Comparison of a Subthreshold Test Pulse with the Standard High-Energy Shock Approach for the Measurement of Defibrillation Lead Impedance

There are two methods to measure shocking lead impedance: delivery of high‐energy shocks that require patient sedation, and the painless measurement of impedance from subthreshold test pulses. The aim of this study was to compare the two methods.

Early Detection of Symptomatic Paroxysmal Cardiac Arrhythmias by Trans-Telephonic ECG Monitoring: Impact on Diagnosis and Treatment of Atrial Fibrillation

Diagnosis of infrequent cardiac arrhythmias (CA) is often unsuccessful using resting or Holter ECG. As early detection and treatment of CA, especially atrial fibrillation (AF), has implications on patients’ treatment and outcome, we investigated, whether self‐guided, trans‐telephonic event‐recorder monitoring (Tele‐ECG) improves diagnosis and influences treatment options.