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  • 1
    Online Resource
    Online Resource
    Supervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial
    Oxford University Press (OUP) ; 2021
    In:  EP Europace Vol. 23, No. 10 ( 2021-10-09), p. 1548-1558
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 23, No. 10 ( 2021-10-09), p. 1548-1558
    Abstract: Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, randomized data are sparse. Thus, this study aimed to investigate the influence of weight reduction on AF ablation outcomes. Methods and results SORT-AF is an investigator-sponsored, prospective, randomized, multicentre, and clinical trial. Patients with symptomatic AF (paroxysmal or persistent) and body mass index (BMI) 30–40 kg/m2 underwent AF ablation and were randomized to either weight-reduction (group 1) or usual care (group 2), after sleep–apnoea–screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF burden between 3 and 12 months after AF ablation. Overall, 133 patients (60 ± 10 years, 57% persistent AF) were randomized to group 1 (n = 67) and group 2 (n = 66), respectively. Complications after AF-ablation were rare (one stroke and no tamponade). The intervention led to a significant reduction of BMI (34.9 ± 2.6–33.4 ± 3.6) in group 1 compared to a stable BMI in group 2 (P  & lt; 0.001). Atrial fibrillation burden after ablation decreased significantly (P  & lt; 0.001), with no significant difference regarding the primary endpoint between the groups (P = 0.815, odds ratio: 1.143, confidence interval: 0.369–3.613). Further analyses showed a significant correlation between BMI and AF recurrence for patients with persistent AF compared with paroxysmal AF patients (P = 0.032). Conclusion The SORT-AF study shows that AF ablation is safe and successful in obese patients using continuous monitoring via ILR. Although the primary endpoint of AF burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF ablation in this setting. Trial registration number NCT02064114.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab122
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002579-8
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  • 2
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    Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation
    Oxford University Press (OUP) ; 2016
    In:  Europace
    Details
    In: Europace, Oxford University Press (OUP)
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euw307
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 2002579-8
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  • 3
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    Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography
    Wiley ; 2017
    In:  Journal of Cardiovascular Electrophysiology Vol. 28, No. 10 ( 2017-10), p. 1127-1136
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 28, No. 10 ( 2017-10), p. 1127-1136
    Abstract: The need for transesophageal echocardiography (TEE) before catheter ablation of atrial fibrillation (CA‐AF) is still being questioned. The aim of this study is to analyze patients’ (patients) risk factors of left atrial appendage thrombus (LAAT) prior to CA‐AF in daily clinical practice, according to oral anticoagulation (OAC) strategies recommended by current guidelines. Methods and results All patients scheduled for CA‐AF from 01/2015 to 12/2016 in our center were included and either treated with NOACs (novel‐OAC; paused 24‐hours preablation) or continuous vitamin K antagonists (INR 2.0–3.0). All patients received a preprocedural TEE at the day of ablation. Two groups were defined: (1) patients without LAAT, (2) patients with LAAT. The incidence of LAAT was 0.78% (13 of 1,658 patients). No LAAT was detected in patients with a CHA 2 DS 2 ‐VASc score of ≤1 (n = 640 patients) irrespective of the underlying AF type. Independent predictors for LAAT are: higher CHA 2 DS 2 ‐VASc scores (odds ratio [OR] 1.54, 95%‐confidence interval [CI] : 1.07–2.23, P = 0.0019), a history of nonparoxysmal AF (OR 7.96, 95%‐CI: 1.52–146.64, P = 0.049), hypertrophic cardiomyopathy (HCM; OR 9.63, 95% CI: 1.36–43.05, P = 0.007), and a left ventricular ejection fraction (LVEF) 〈 30% (OR 8.32, 95% CI: 1.18–36.29, P = 0.011). The type of OAC was not predictive (P = 0.70). Conclusions The incidence of LAAT in patients scheduled for CA‐AF is low. Therefore, periprocedural OAC strategies recommended by current guidelines seem feasible. Preprocedural TEE may be dispensed in patients with a CHA 2 DS 2 ‐VASc score ≤1. However, a CHA 2 DS 2 ‐VASc score ≥2, reduced LVEF, HCM, or history of nonparoxysmal AF are independently associated with an increased risk for LAAT.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.2017.28.issue-10
    DOI: 10.1111/jce.13279
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 4
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    Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients—Results from the CORONA Germany Study
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 17 ( 2021-09-02), p. 3982-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 17 ( 2021-09-02), p. 3982-
    Abstract: Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients. Objective: The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients. Methods: From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event. Results: In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94–3.2), p = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9–8]). Age (OR 1.1, CI: (0.66–1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74–6.8)), systolic blood-pressure (OR 0.7, CI: (0.53–0.96)), potassium (OR 1.3, CI: (0.99–1.73)) and C-reactive-protein (1.4, CI (1.04–1.76)) were associated with CV-events. Conclusion: Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10173982
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 5
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    Comparison of machine learning methods with logistic regression analysis in creating predictive models for risk of critical in-hospital events in COVID-19 patients on hospital admission
    Springer Science and Business Media LLC ; 2022
    In:  BMC Medical Informatics and Decision Making Vol. 22, No. 1 ( 2022-11-28)
    Details
    In: BMC Medical Informatics and Decision Making, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-11-28)
    Abstract: Machine learning (ML) algorithms have been trained to early predict critical in-hospital events from COVID-19 using patient data at admission, but little is known on how their performance compares with each other and/or with statistical logistic regression (LR). This prospective multicentre cohort study compares the performance of a LR and five ML models on the contribution of influencing predictors and predictor-to-event relationships on prediction model´s performance. Methods We used 25 baseline variables of 490 COVID-19 patients admitted to 8 hospitals in Germany (March–November 2020) to develop and validate (75/25 random-split) 3 linear (L1 and L2 penalty, elastic net [EN]) and 2 non-linear (support vector machine [SVM] with radial kernel, random forest [RF]) ML approaches for predicting critical events defined by intensive care unit transfer, invasive ventilation and/or death (composite end-point: 181 patients). Models were compared for performance (area-under-the-receiver-operating characteristic-curve [AUC] , Brier score) and predictor importance (performance-loss metrics, partial-dependence profiles). Results Models performed close with a small benefit for LR (utilizing restricted cubic splines for non-linearity) and RF (AUC means: 0.763–0.731 [RF–L1]); Brier scores: 0.184–0.197 [LR–L1] ). Top ranked predictor variables (consistently highest importance: C-reactive protein) were largely identical across models, except creatinine, which exhibited marginal (L1, L2, EN, SVM) or high/non-linear effects (LR, RF) on events. Conclusions Although the LR and ML models analysed showed no strong differences in performance and the most influencing predictors for COVID-19-related event prediction, our results indicate a predictive benefit from taking account for non-linear predictor-to-event relationships and effects. Future efforts should focus on leveraging data-driven ML technologies from static towards dynamic modelling solutions that continuously learn and adapt to changes in data environments during the evolving pandemic. Trial registration number : NCT04659187.
    Type of Medium: Online Resource
    ISSN: 1472-6947
    URL: Article
    DOI: 10.1186/s12911-022-02057-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2046490-3
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  • 6
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    Pulsed‐field ablation combined with ultrahigh‐density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations
    Wiley ; 2022
    In:  Journal of Cardiovascular Electrophysiology Vol. 33, No. 3 ( 2022-03), p. 345-356
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 33, No. 3 ( 2022-03), p. 345-356
    Abstract: Pulsed‐field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited. Objective This study sought to investigate PFA lesion creation with ultrahigh‐density (UHDx) mapping. Methods Consecutive AF patients underwent PFA‐based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA‐lesions and decrease of LA‐voltage were assessed with pre‐ and post PFA UHDx‐mapping (Orion™ catheter and Rhythmia™ 3D‐mapping system, Boston Scientific). Results In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx‐mapping subsequent to PVI revealed early PV‐reconnection in five case (5/80, 6.25%). Gaps were located at the anterior‐superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p   〈  .0001) with almost no complex electrogram‐fractionation at the lesion border zones. PFA‐catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites. Conclusion For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.v33.3
    DOI: 10.1111/jce.15349
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 7
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    A novel wide‐band dielectric imaging system to guide radiofrequency ablation for pulmonary vein isolation
    Wiley ; 2022
    In:  Journal of Cardiovascular Electrophysiology Vol. 33, No. 12 ( 2022-12), p. 2467-2472
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 33, No. 12 ( 2022-12), p. 2467-2472
    Abstract: Recently, the wide‐band dielectric mapping system Kodex‐EPD was introduced. This study reports the first clinical experience using a novel system to guide pulmonary vein isolation (PVI) with radiofrequency (RF) ablation. Methods and Results The study included 20 consecutive patients undergoing de‐novo PVI for symptomatic paroxysmal or persistent atrial fibrillation guided by Kodex‐EPD. The primary efficacy endpoint was successful PVI. Secondary endpoints included procedural parameters and complications. In all 20 patients (mean age 68 ± 8 years, 12 male patients, paroxysmal fibrillation in 14/20 [70%] patients), PVI was successfully completed. One patient underwent additional cavo‐tricuspid isthmus ablation for concomitant typical atrial flutter and one patient required additional ablation of a focal atrial tachycardia. A conventional three‐dimensional image of the left atrium as well as the innovative endocardial panoramic view were used to guide catheter manipulation and ablation. Median procedure time was 115 [1st; 3rd quartile 93,75; 140] min and median total fluoroscopy time was 9.9 [9.7; 11.2] min, of which a median of 0.8 [0.6; 0.9] min was required to create left atrial maps. Complete left atrial imaging using Kodex‐EPD was achieved within a median of 7.1 [5.7; 8.3] min. Median RF ablation time was 45.1 [34.6; 58.7] min. No major complications were observed. Conclusion RF ablation PVI guided by Kodex‐EPD seems safe and feasible. The system provides effective three‐dimensional guidance for PVI.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.v33.12
    DOI: 10.1111/jce.15705
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 8
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    Atrial fibrillation progression and the importance of early treatment for improving clinical outcomes
    Oxford University Press (OUP) ; 2022
    In:  EP Europace Vol. 24, No. Supplement_2 ( 2022-06-06), p. ii22-ii28
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 24, No. Supplement_2 ( 2022-06-06), p. ii22-ii28
    Abstract: Over time, atrial fibrillation (AF) naturally progresses from initially paroxysmal to persistent/permanent AF caused by structural and electrical remodelling with a complex underlying pathogenesis. It has been demonstrated that this progression of AF itself is linked to negative cardiovascular outcomes (stroke, systemic embolism, and hospitalization due to heart failure). Consequently, there is a profound rationale for early treatment of AF as a cornerstone of AF management. Recent randomized trials produced evidence that early rhythm control is effective in maintaining sinus rhythm, lower the risk of cardiovascular outcomes, and that catheter ablation of AF is effective to delay AF progression. This review will illuminate current evidence regarding the hypothesis of early AF treatment to prevent AF progression and improve clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab257
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 9
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    Update Vorhofflimmern – Was ist neu?
    Georg Thieme Verlag KG ; 2021
    In:  DMW - Deutsche Medizinische Wochenschrift Vol. 146, No. 15 ( 2021-08), p. 982-987
    Details
    In: DMW - Deutsche Medizinische Wochenschrift, Georg Thieme Verlag KG, Vol. 146, No. 15 ( 2021-08), p. 982-987
    Abstract: Behandlungspfad im Management von Vorhofflimmerpatient*innen Die im vergangenen Jahr neu erschienen Vorhofflimmer-Leitlinien schlagen einen Diagnose- und Therapiealgorithmus vor, der eine strukturierte und erweiterte Charakterisierung ermöglichen soll und nach umfangreicher und „ganzheitlicher“ Einschätzung in einer gezielten Therapiestrategie mündet. Zentraler Bestandteil bleibt die Prävention thromboembolischer Komplikationen. Therapie von Begleiterkrankungen Eine konsequente Behandlung von Begleiterkrankungen, insbesondere klassischer kardiovaskulärer Risikofaktoren, wird in einem multimodalen Therapieansatz betont. Symptomkontrolle und die Rolle der Katheterablation Symptomatische Patient*innen sollten eine rhythmuserhaltende Therapie bekommen. Vor dem Hintergrund oft limitierter medikamentöser Optionen kommt der Katheterablation eine entscheidende Rolle zu. Prognostische Aspekte und das richtige Timing Mit der EAST-AFNET4-Studie konnte erstmals der prognostische Vorteil einer Rhythmuskontrolle bei Patient*innen mit Begleiterkrankungen gezeigt werden. Entscheidend scheint insbesondere der frühe Therapiebeginn nach Diagnosestellung. Aktuelle Studien demonstrieren die hohe Effektivität der Katheterablation auch als Erstlinienbehandlung. Bei Herzinsuffizienz geht die Katheterablation mit einer Prognoseverbesserung einher.
    Type of Medium: Online Resource
    ISSN: 0012-0472 , 1439-4413
    URL: Article
    DOI: 10.1055/a-1361-7362
    RVK:
    XA 39100
    RVK:
    XA 10000
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2035474-5
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  • 10
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    Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current
    Wiley ; 2020
    In:  Journal of Cardiovascular Electrophysiology Vol. 31, No. 5 ( 2020-05), p. 1051-1061
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 31, No. 5 ( 2020-05), p. 1051-1061
    Abstract: The aim of this study was to investigate electrophysiological findings in patients with arrhythmia recurrence undergoing a repeat ablation procedure using ultra–high‐density (UHDx) mapping following an index procedure using either contact–force (CF)‐guided radiofrequency current (RFC) pulmonary vein isolation (PVI) or second‐generation cryoballoon (CB) PVI for treatment of atrial fibrillation (AF). Methods and Results Fifty consecutive patients with recurrence of AF and/or atrial tachycardia (AT) following index CF‐RFC PVI (n = 21) or CB PVI (n = 29) were included. A 64‐pole mini‐basket mapping catheter in combination with an UHDx‐mapping system‐guided ablation was used. RFC was applied using a catheter tip with three incorporated mini‐electrodes. PV reconnection rates were higher after CF‐RFC PVI (CF‐RFC: 2.5 ± 1.3 PVs vs CB: 1.4 ± 0.9 PVs; P  = .0025) and left PVs were more frequently reconnected (CF‐RFC: 64% PVs vs CB: 35% PVs; P  = .0077). Fractionated signals along the antral index ablation line (FS) were found in 30% of CB‐PVI patients (CF‐RFC: 9.5% vs CB:30%; P  = .098) targeted for ablation. In five cases, FS were a critical part of maintaining consecutive AT. The main AT mechanism found during reablation (n = 45 ATs) was macroreentry (80% [36/45], CF‐RFC: 78.9% vs CB: 80.8%; P  = 1.0) with a variety of circuits throughout both atria. Conclusion UHDx mapping is sensitive in detecting conduction gaps along the index ablation line. Left PVs are more frequently reconnected after initial CF‐RFC PVI. FS are a common finding after CB PVI and can maintain certain forms of ATs. ATs after index PVI are mostly macroreentries with a broad spectrum of entities.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.v31.5
    DOI: 10.1111/jce.14413
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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