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Englert F, Bahlke F, Erhard N, Krafft H, Popa MA, Risse E, Lennerz C, Lengauer S, Telishevska M, Reents T, Kottmaier M, Kolb C, Hessling G, Deisenhofer I, Bourier F. VT ablation based on CT imaging substrate visualization: results from a large cohort of ischemic and non-ischemic cardiomyopathy patients. Clin Res Cardiol 2023:10.1007/s00392-023-02321-1. [PMID: 38112744 DOI: 10.1007/s00392-023-02321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The eradication of ventricular tachycardia (VT) isthmus sites constitutes the minimal procedural endpoint for VT ablation procedures. Contemporary high-resolution computed tomography (CT) imaging, in combination with computer-assisted analysis and segmentation of CT data, facilitates targeted elimination of VT isthmi. In this context, inHEART offers digitally rendered three-dimensional (3D) cardiac models which allow preoperative planning for VT ablations in ischemic and non-ischemic cardiomyopathies. To date, almost no data have been collected to compare the outcomes of VT ablations utilizing inHEART with those of traditional ablation approaches. METHODS The presented data are derived from a retrospective analysis of n = 108 patients, with one cohort undergoing VT ablation aided by late-enhancement CT and subsequent analysis and segmentation by inHEART, while the other cohort received ablation through conventional methods like substrate mapping and activation mapping. The ablations were executed utilizing a 3D mapping system (Carto3), with the mapping generated via the CARTO® PENTARAY™ NAV catheter and subsequently merged with the inHEART model, if available. RESULTS Results showed more successful outcome of ablations for the inHEART group with lower VT recurrence (27% vs. 42%, p < 0.06). Subsequent analyses revealed that patients with ischemic cardiomyopathies appeared to derive a significant benefit from inHEART-assisted VT ablation procedures, with a higher rate of successful ablation (p = 0.05). CONCLUSION Our findings indicate that inHEART-guided ablation is associated with reduced VT recurrence compared to conventional procedures. This suggests that employing advanced imaging and computational modeling in VT ablation may be valuable for VT recurrences.
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Affiliation(s)
- F Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - N Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - H Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M-A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - C Kolb
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Lazarettstr. 36, 80636, Munich, Germany.
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Bahlke F, Wachter A, Erhard N, Englert F, Krafft H, Popa M, Risse E, Kottmaier M, Telishevska M, Lengauer S, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. The influence of electrode-tissue-coverage on RF lesion formation and local impedance: Insights from an ex vivo model. Pacing Clin Electrophysiol 2023; 46:1170-1181. [PMID: 37616376 DOI: 10.1111/pace.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model. METHODS AND RESULTS An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC. CONCLUSIONS ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Andreas Wachter
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
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3
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Martini E, Kantenwein V, Haller B, Telishevska M, Bourier F, Reents T, Kottmaier M, Popa M, Risse E, Lengauer S, Lennerz C, Hessling G, Deisenhofer I, Kolb C. Long term outcome after ablation of persistent atrial fibrillation in patients with postprocedurally unmasked sinus node disease. Europace 2022. [DOI: 10.1093/europace/euac053.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
About three percent of patients with persistent atrial fibrillation [AF] additionally suffer from a concealed sinus node disease [SND]. We sought to determine the ablation success one year after ablation of persistent AF in patients with postprocedurally unmasked SND.
Methods and Results
In total 2239 patients with an ablation of persistent AF at our center were screened for a postprocedurally unmasked SND, which made cardiac pacing necessary within one week after ablation. In a propensity score matched case control study, the longterm ablation success of 51 patients (mean age 73±8years, 58% male) with postprocedurally unmasked SND after ablation of persistent AF was compared to that of 102 patients without SND after ablation of persistent AF. Controls were matched to cases based on the propensity score considering age, body mass index, left ventricular ejection fraction, gender, blood pressure, diabetes mellitus, atrial low voltage, previous number of ablations and method of ablation.
One year after ablation of persistent AF, 20 (39%) patients with postprocedurally unmasked SND and 61 (60%) patients without postprocedurally unmasked SND were in sinus rhythm (p=0.025). The number of repeat ablation procedures within the follow up year did not differ significantly between cases and controls (0.60±0.68 vs 0.53±0.80, p=0.574).
Conclusion
In patients with a postprocedurally unmasked SND after ablation of persistent AF, longterm ablation success seems to be worse compared to patients without postprocedurally unmasked SND.
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Affiliation(s)
- E Martini
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - V Kantenwein
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - B Haller
- Hospital Rechts der Isar of the TU Munich, Institute of Medical Statistics and Epidemiology, Munich, Germany
| | - M Telishevska
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - F Bourier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - T Reents
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Kottmaier
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - M Popa
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - E Risse
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - S Lengauer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Lennerz
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - G Hessling
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - I Deisenhofer
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
| | - C Kolb
- German Heart Center, Clinic for Heart and Circulatory Diseases, Munich, Germany
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Kantenwein V, Telishevska M, Bourier F, Kottmaier M, Brkic A, Risse E, Popa M, Lengauer S, Kolb C, Deisenhofer I, Hessling G, Reents T. Feasibility and safety of left atrial access for ablation of atrial fibrillation in patients with persistent left superior vena cava. Pacing Clin Electrophysiol 2022; 45:357-364. [PMID: 35015906 DOI: 10.1111/pace.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure. METHODS AND RESULTS In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33,3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48,2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3,7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred. CONCLUSION In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marta Telishevska
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Felix Bourier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marc Kottmaier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Amir Brkic
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Elena Risse
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Miruna Popa
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Sarah Lengauer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
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Bartkowiak M, Kottmaier M, Reents T, Bourier FJ, Telishevska M, Koch-Buettner K, Risse E, Maurer S, Krafft H, Popa MA, Otgonbayar U, Lennerz C, Hessling G, Deisenhofer I. Safety of high power and short duration ablation (70 watts over 5–7 seconds) in patients with persistent atrial fibrillation undergoing pulmonary vein isolation and additional substrate modification. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In paroxysmal atrial fibrillation (AF), pulmonary vein isolation using HPSD has shown a promising success rate compared to ablation using conventional power settings, as well as a significant reduction in procedural and ablation time. In persistent atrial fibrillation, left atrial substrate modification seems to be a promising additional ablation approach besides pulmonary vein isolation (PVI). However, results after additional substrate ablation are not consistently positive, which may be related to non-transmural lesions and tissue oedema. An extended time of the procedure may also influence safety. Recent publications showed that HPSD ablation provides more sufficient lesions due to acute cell necrosis instead of cell oedema.
Purpose
The aim of this study is to evaluate the safety of HPSD ablation in patients undergoing ablation of persistent atrial fibrillation with PVI and additional substrate modification.
Methods
We studied and compared n=300 patients from our register undergoing the first ablation of persistent atrial fibrillation with HPSD settings (n=150) between May 2018 and January 2019 and standard settings (n=150) between July 2017 and January 2018. Patients were followed up for three months to report procedure-related adverse events. In all patients, a modified stepwise approach using PVI followed by electrogram-guided substrate modification and linear-ablation, if necessary, was performed. A HPSD ablation was performed with 70 watts with a maximum duration of 5–7 seconds. Catheter irrigation was set to 20 ml/min using the Flexability™ ablation catheter and the Ampere™ generator. The patients were compared with a historical cohort that underwent PVI using a conventional power protocol with 30–40 watts over 20–40 seconds, using the same ablation catheter. A transthoracic echocardiogram was performed in all patients after the ablation-procedure and on the following day. Duplex sonography or clinical control were performed to assess groin complications.
Results
Baseline characteristics and procedural data are shown in table 1. No significant difference in the complication rates in both groups was observed by a significant procedure-time reduction in HPSD-Group (2:13h vs 2:31h p<0,001) and overall low risk of the procedure. No deaths, thromboembolic complications or atrioesophageal fistula were registered. Complication rates with statistical relevancy are shown in table 2.
Conclusion
Complex ablation using PVI and additional substrate modification in persistent atrial fibrillation using HPSD seems to be equally as safe regarding procedure-related outcomes as standard power settings ablation and can significantly reduce the time of the overall procedure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - T Reents
- German Heart Centre Munich, Munich, Germany
| | | | | | | | - E Risse
- German Heart Centre Munich, Munich, Germany
| | - S Maurer
- German Heart Centre Munich, Munich, Germany
| | - H Krafft
- German Heart Centre Munich, Munich, Germany
| | - M A Popa
- German Heart Centre Munich, Munich, Germany
| | | | - C Lennerz
- German Heart Centre Munich, Munich, Germany
| | - G Hessling
- German Heart Centre Munich, Munich, Germany
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Bourier F, Popa M, Kottmaier M, Maurer S, Bahlke F, Telishevska M, Lengauer S, Koch-Büttner K, Kornmayer M, Risse E, Brkic A, Reents T, Hessling G, Deisenhofer I. RF electrode-tissue coverage significantly influences steam pop incidence and lesion size. J Cardiovasc Electrophysiol 2021; 32:1594-1599. [PMID: 33928696 DOI: 10.1111/jce.15063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Steam pops are a rare complication associated with radiofrequency (RF) ablation and are hard to predict. The aim of this study was to assess the influence of coverage between the RF ablation electrode and cardiac tissue on steam pop incidence and lesion size. METHODS AND RESULTS An ex vivo model using porcine cardiac preparations and contact force sensing catheters was designed to perform RF ablations at different coverage levels between the RF electrode and cardiac tissue. During coverage level I, only the distal part of the ablation electrode was in contact with tissue. During coverage level II half of the ablation electrode, and during coverage level III the entire ablation electrode was embedded in tissue. RF applications (n = 60) at different coverage levels I-III were systematically performed using the same standardized ablation protocol. Ablations during coverage level III resulted in a significantly higher rate of steam pops (100%) when compared to ablations during coverage level II (10%) and coverage level I (0%), log rank p < .001. Coverage level I ablations resulted in significantly smaller lesion depths, diameters, and impedance drops when compared to higher coverage level ablations, p < .001. In the controlled ex vivo model, there was no difference in applied contact force or energy between different coverage levels. CONCLUSIONS The level of coverage between RF electrode, cardiac tissue, and the surrounding fluid significantly influenced the incidence of steam pops in an ex vivo setup. Larger coverage between RF electrode and tissue resulted in significantly larger lesion dimensions.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Susanne Maurer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
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7
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Kalinsek TP, Kottmaier M, Telishevska M, Berger F, Semmler V, Popa M, Brkic A, Lengauer S, Otgonbayar U, Koch-Büttner K, Bartowiak M, Kornmayer M, Brooks S, Risse E, Kathan S, Hofmann M, Grebmer C, Reents T, Hessling G, Deisenhofer I, Bourier F. Early recurrence after pulmonary vein isolation is associated with inferior long-term outcomes: Insights from a retrospective cohort study. Pacing Clin Electrophysiol 2020; 43:1156-1164. [PMID: 32895960 DOI: 10.1111/pace.14060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long-term outcomes and to identify clinical variables associated with ER. METHODS We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan-Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long-term outcomes. RESULTS ER was observed in 13% of patients. Kaplan-Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14-day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30-day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. CONCLUSIONS ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long-term outcomes.
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Affiliation(s)
- Tine Prolic Kalinsek
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Florian Berger
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Ulamnemekh Otgonbayar
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marcin Bartowiak
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Stephanie Brooks
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Susanne Kathan
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Monika Hofmann
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
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8
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Perl RM, Risse E, Hetzel J, Bösmüller H, Kloth C, Fritz J, Horger M. The effect of intraparenchymal blood patching on the rate of pneumothorax in patients undergoing percutaneous CT-guided core biopsy of the lung. Eur J Radiol 2019; 116:14-20. [PMID: 31153555 DOI: 10.1016/j.ejrad.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.
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Affiliation(s)
- R M Perl
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany.
| | - E Risse
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - J Hetzel
- Department of Internal Medicine II, Eberhard Karls University, Tübingen, Germany
| | - H Bösmüller
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, Eberhard Karls University, Tübingen, Germany
| | - C Kloth
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - J Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Caroline Street, JHOC 3140A, Baltimore, MD, 21287, United States
| | - M Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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9
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Kottmaier M, Bourier F, Wünscher S, Kornmayer M, Semmler V, Lengauer S, Telishevska M, Koch-Büttner K, Risse E, Brooks S, Hessling G, Deisenhofer I, Reents T. Repeat ablation for paroxysmal atrial fibrillation - Does adenosine play a role in predicting pulmonary vein reconnection patterns? Indian Pacing Electrophysiol J 2018; 18:203-207. [PMID: 30290206 PMCID: PMC6302775 DOI: 10.1016/j.ipej.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. METHODS We included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. RESULTS Fifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). CONCLUSIONS In repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.
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Affiliation(s)
- M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany.
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Wünscher
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - V Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - K Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Brooks
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
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10
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Bourier F, Hofmann M, Kathan A, Reents T, Zeilberger M, Pracht L, Kottmaier M, Risse E, Brooks S, Koch-Buttner K, Telishevska M, Lengauer S, Kornmayr ML, Hessling G, Deisenhofer I. P3834Early recurrence of atrial fibrillation after pulmonary vein isolation is associated with poor outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Bourier
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Hofmann
- Technical University of Munich, German Heart Center, Munich, Germany
| | - A Kathan
- Technical University of Munich, German Heart Center, Munich, Germany
| | - T Reents
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Zeilberger
- Technical University of Munich, German Heart Center, Munich, Germany
| | - L Pracht
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Kottmaier
- Technical University of Munich, German Heart Center, Munich, Germany
| | - E Risse
- Technical University of Munich, German Heart Center, Munich, Germany
| | - S Brooks
- Technical University of Munich, German Heart Center, Munich, Germany
| | - K Koch-Buttner
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M Telishevska
- Technical University of Munich, German Heart Center, Munich, Germany
| | - S Lengauer
- Technical University of Munich, German Heart Center, Munich, Germany
| | - M L Kornmayr
- Technical University of Munich, German Heart Center, Munich, Germany
| | - G Hessling
- Technical University of Munich, German Heart Center, Munich, Germany
| | - I Deisenhofer
- Technical University of Munich, German Heart Center, Munich, Germany
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11
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Kottmaier M, Reents T, Bourier F, Reiter A, Semmler V, Telishevska M, Berger F, Koch-Buettner K, Brooks S, Kornmayer M, Risse E, Lengauer S, Hessling G, Deisenhofer I. P5757Mapping and ablation of complex left atrial tachycardia using an automated high resolution mapping algorithm. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - A Reiter
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevska
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - E Risse
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
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12
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Kottmaier M, Mayer S, Bourier F, Reents T, Semmler V, Telishevska M, Kornmayer M, Brooks S, Lengauer S, Berger F, Koch-Buettner K, Risse E, Hessling G, Deisenhofer I, Holdenrieder S. P989Association between circulating biomarkers of fibrosis and left atrial voltage in patients undergoing atrial fibrillation ablation. A pilot study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Mayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Bourier
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - T Reents
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - V Semmler
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Telishevska
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - M Kornmayer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Brooks
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Lengauer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - F Berger
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - K Koch-Buettner
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - E Risse
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - G Hessling
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - I Deisenhofer
- German Heart Center of Munich, Department of Electrophysiology, Munich, Germany
| | - S Holdenrieder
- German Heart Center of Munich, Institut of Laboratory Medicine, Munich, Germany
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13
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Bourier F, Schwarz B, Brkic A, Wolff L, Semmler V, Kottmaier M, Risse E, Telishevska M, Brooks S, Lengauer S, Kornmayer M, Koch-Büttner K, Berger F, Hessling G, Deisenhofer I, Reents T. EP radiofrequency generators: Significant offsets between selected and delivered power? J Cardiovasc Electrophysiol 2017; 29:330-334. [DOI: 10.1111/jce.13386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Bernhard Schwarz
- Department of Medical Technology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Amir Brkic
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Lara Wolff
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Verena Semmler
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marc Kottmaier
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Elena Risse
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marta Telishevska
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Stephanie Brooks
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Sarah Lengauer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Florian Berger
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Gabriele Hessling
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
| | - Tilko Reents
- Department of Electrophysiology, Technical University of Munich; German Heart Center Munich; Munich Germany
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14
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Ter-Avetisyan S, Schnürer M, Nickles PV, Sokollik T, Risse E, Kalashnikov M, Sandner W, Priebe G. The Thomson deflectometer: a novel use of the Thomson spectrometer as a transient field and plasma diagnostic. Rev Sci Instrum 2008; 79:033303. [PMID: 18377003 DOI: 10.1063/1.2901579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Laser accelerated proton beams have been used for field characterization in expanding plasmas. The Thomson parabola spectrometer, as a charged particles analyzer, also allows precise measurement of the charged particles' trajectories. The proton's deflections by fast changing plasma fields can be measured with the new design of the Thomson parabola spectrometer and, therefore, it can be applied for proton deflectometry. It is shown that from resulting spectrograms the plasma field dynamics can be reconstructed with high temporal resolution. In a proof-of-principle experiment, a weakly relativistic plasma expansion is studied as an example.
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Affiliation(s)
- S Ter-Avetisyan
- Max Born Institute, Max Born Str. 2a, D-12489 Berlin, Germany.
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15
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Ter-Avetisyan S, Schnürer M, Nickles PV, Kalashnikov M, Risse E, Sokollik T, Sandner W, Andreev A, Tikhonchuk V. Quasimonoenergetic deuteron bursts produced by ultraintense laser pulses. Phys Rev Lett 2006; 96:145006. [PMID: 16712088 DOI: 10.1103/physrevlett.96.145006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Indexed: 05/09/2023]
Abstract
We report on the generation and laser acceleration of bunches of energetic deuterons with a small energy spread at about 2 MeV. This quasimonoenergetic peak within the ion energy spectrum was observed when heavy-water microdroplets were irradiated with ultrashort laser pulses of about 40 fs duration and high (10(-8)) temporal contrast, at an intensity of 10(19) W/cm(2). The results can be explained by a simple physical model related to spatial separation of two ion species within a finite-volume target. The production of quasimonoenergetic ions is a long-standing goal in laser-particle acceleration; it could have diverse applications such as in medicine or in the development of future compact ion accelerators.
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Affiliation(s)
- S Ter-Avetisyan
- Max-Born-Institut Berlin, Max-Born-Strasse 2a, D-12489 Berlin, Germany
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16
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17
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Kalashnikov MP, Risse E, Schönnagel H, Sandner W. Double chirped-pulse-amplification laser: a way to clean pulses temporally. Opt Lett 2005; 30:923-5. [PMID: 15865400 DOI: 10.1364/ol.30.000923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We demonstrate a double chirped-pulse-amplification (CPA) Ti: sapphire laser system that includes two CPA stages with intermediate nonlinear temporal pulse filtering. The method makes it possible to reduce substantially the background of amplified spontaneous emission (ASE), including prepulses and postpulses. An ASE temporal contrast of 10(10) was demonstrated at 20 mJ of output energy and 50-fs pulse duration. The demonstrated scheme is applicable to petawatt power-level laser systems.
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Affiliation(s)
- M P Kalashnikov
- Max-Born-Institut für Nichtlineare Optik und Kurzzeitspektroskopie, Max-Born-Strasse, 2a, 12489 Berlin, Germany.
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18
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Kalashnikov M, Risse E, Schönnagel H, Husakou A, Herrmann J, Sandner W. Characterization of a nonlinear filter for the front-end of a high contrast double-CPA Ti:sapphire laser. Opt Express 2004; 12:5088-5097. [PMID: 19484062 DOI: 10.1364/opex.12.005088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A nonlinear filter using rotation of the polarization ellipse in air is investigated. Scheme to enhance the temporal contrast is developed for a double-CPA multi-terawatt Ti:sapphire laser. It supports an energy level of millijoule and has a high efficiency. The method allows suppression of the ASE pedestal, pre- and post-pulses by 3 orders of magnitude and also steepens the pulse front. For the physical interpretation of the results, numerical simulation of the filtering is performed.
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19
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Ter-Avetisyan S, Schnürer M, Busch S, Risse E, Nickles PV, Sandner W. Spectral dips in ion emission emerging from ultrashort laser-driven plasmas. Phys Rev Lett 2004; 93:155006. [PMID: 15524895 DOI: 10.1103/physrevlett.93.155006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Indexed: 05/24/2023]
Abstract
Deep dips in MeV ion spectra are obtained from water droplet targets irradiated by intense [(0.5-1.2) x 10(19) W/cm(2)] and ultrashort (35 fs) laser pulses. The existence of these dips is ascribed to the generation of a multielectron-temperature plasma, which is confirmed by our experiments. An existing fluid model based on hot-electron components with significantly different temperatures is consistent with the behavior we observe in the ion spectra of the femtosecond laser-driven interaction. The model provides a good simulation of the observed spectral dips and allows us to establish important parameters such as hot- and cold-electron temperatures and the respective electron density ratios. The result may be of interest for spectral tailoring of proton spectra in future applications of laser-generated proton beams.
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Affiliation(s)
- S Ter-Avetisyan
- Max-Born-Institut, Max-Born-Strasse 2a, D-12489 Berlin, Germany
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20
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Kunst PWA, Sutedja G, Golding RP, Risse E, Kardos G, Postmus PE. Unusual pulmonary lesions: case 1. A juvenile bronchopulmonary fibrosarcoma. J Clin Oncol 2002; 20:2745-51. [PMID: 12039937 DOI: 10.1200/jco.2002.20.11.2745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P W A Kunst
- Vrije Universiteit Medical Center, Amsterdam, the Netherlands
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Losse H, Risse E, Wessels F. [Oral contraceptives and arterial hypertension]. Med Klin 1974; 69:2043-50. [PMID: 4374645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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22
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Heilmann E, Risse E. [Serum iron and total iron-binding capacity under administration of oral contraceptives]. Med Welt 1974; 25:797-8. [PMID: 4831461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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