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Schiavone M, Gasperetti A, Vogler J, Compagnucci P, Laredo M, Breitenstein A, Gulletta S, Martinek M, Kaiser L, Tundo F, Palmisano P, Rovaris G, Curnis A, Kuschyk J, Biffi M, Tilz R, Di Biase L, Tondo C, Forleo GB. Sex differences among subcutaneous defibrillator (S-ICD) recipients: a propensity-matched, multicenter, international analysis from the i-SUSI project. Europace 2024:euae115. [PMID: 38696701 DOI: 10.1093/europace/euae115] [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] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND AND AIMS Women have been historically underrepresented in implantable cardioverter defibrillator (ICD) trials. No data on sex differences regarding subcutaneous-ICDs (S-ICD) carriers have been described. Aim of our study was to investigate sex-related differences among unselected S-ICD recipients. METHODS Consecutive patients enrolled in the multicenter, international i-SUSI registry were analyzed. Comparisons between sexes were performed using a 1:1 propensity matching adjusted analysis for age, body mass index (BMI), left ventricular function and substrate. The primary outcome was the rate of appropriate shocks during follow-up. Inappropriate shocks and other device-related complications were deemed secondary outcomes. RESULTS A total of 1698 patients were extracted from the iSUSI registry; 399 (23.5%) were females. After propensity matching, two cohorts of 374 patients presenting similar baseline characteristics were analyzed. Despite similar periprocedural characteristics and a matched BMI, women resulted at lower risk of conversion failure as per PRAETORIAN score (73.4% vs 81.3%, p = 0.049). Over a median follow-up time of 26.5 [12.7-42.5] months, appropriate shocks were more common in the male cohort (rate/year 3.4%vs1.7%; log-rank p = 0.049), while no significant differences in device-related complications (rate/year: 6.3% vs 5.8%; log-rank p = 0.595) and inappropriate shocks (rate/year: 4.3%vs3.1%; log-rank p = 0.375) were observed. After controlling for confounders, sex remained significantly associated with the primary outcome (aHR 1.648; CI 0.999-2.655, p = 0.048), while not resulting predictor of inappropriate shocks and device-related complications. CONCLUSION In a propensity-matched cohort of S-ICD recipients, women are less likely to experience appropriate ICD therapy, while not showing higher risk of device related-complications.
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Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan-Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome-Italy
| | | | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lubeck-Germany
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona-Italy
| | - Mikael Laredo
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris-France
| | | | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan-Italy
| | - Martin Martinek
- Ordensklinikum Linz Elisabethinen Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Linz-Austria
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg-Germany
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan-Italy
| | | | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza-Italy
| | | | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim-Germany
| | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna-Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lubeck-Germany
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, New York-USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan-Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan-Italy
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2
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Elsner C, Bettin S, Tilz R, Häckl D. Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure. Curr Heart Fail Rep 2024:10.1007/s11897-024-00664-y. [PMID: 38662154 DOI: 10.1007/s11897-024-00664-y] [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] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a major public health problem worldwide, affecting more than 64 million people [1]. The complex and severe nature of HF presents challenges in providing cost-effective care as patients often require multiple hospitalizations and treatments. This review of relevant studies with focus on the last 10 years summarizes the health and economic implications of various HF treatment options in Europe and beyond. Although the main cost drivers in HF treatment are clinical (re)admission and decompensation of HF, an assessment of the economic impacts of various other device therapy options for HF care are included in this review. This includes: cardiovascular implantable electronic devices (CIEDs) such as cardiac-resynchronisation-therapy devices that include pacemaking (CRT-P), cardiac-resynchronisation-therapy devices that include defibrillation (CRT-D), implantable cardioverter/defibrillators (ICDs) and various types of pacemakers. The impact of (semi)automated (tele)monitoring as a relevant factor for increasing both the quality and economic impact of care is also taken into consideration. Quality of life adjusted life years (QALYs) are used in the overall context as a composite metric reflecting quantity and quality of life as a standardized measurement of incremental cost-effectiveness ratios (ICER) of different device-based HF interventions. RECENT FINDINGS In terms of the total cost of different devices, CRT-Ds were found in several studies to be more expensive than all other devices in regards to runtime and maintenance costs including (re)implantation. In the case of CRT combined with an implantable cardioverter-defibrillator (CRT-D) versus ICD alone, CRT-D was found to be the most cost-effective treatment in research work over the past 10 years. Further comparison between CRT-D vs. CRT-P does not show an economic advantage of CRT-D as a minority of patients require shock therapy. Furthermore, a positive health economic effect and higher survival rate is seen in CRT-P full ventricular stimulation vs. right heart only stimulation. Telemedical care has been found to provide a positive health economic impact for selected patient groups-even reducing patient mortality. For heart failure both in ICD and CRT-D subgroups the given telemonitoring benefit seems to be greater in higher-risk populations with a worse HF prognosis. In patients with HF, all CIED therapies are in the range of commonly accepted cost-effectiveness. QALY and ICER calculations provide a more nuanced understanding of the economic impact these therapies create in the healthcare landscape. For severe cases of HF, CRT-D with telemedical care seems to be the better option from a health economic standpoint, as therapy is more expensive, but costs per QALY range below the commonly accepted threshold.
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Affiliation(s)
- Christian Elsner
- Center for Artificial Intelligence, University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Simon Bettin
- Department for ENT, University of Lübeck, Lübeck, Germany
| | - Roland Tilz
- German Center for Cardiovascular Research (DZHK), Partner Site, Lübeck, Germany
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3
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Tilz R, Feher M, Vogler J, Bode K, Duta A, Ortolan A, Lopez LD, Küchler M, Mamaev R, Lyan E, Sommer P, Braun M, Sciacca V, Demming T, Maslova V, Kuck KH, Heeger CH, Eitel C, Popescu SS. Venous Vascular Closure System Versus Figure-of-Eight Suture Following Atrial Fibrillation Ablation - The STYLE-AF Study. Europace 2024:euae105. [PMID: 38647070 DOI: 10.1093/europace/euae105] [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] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Simplified ablation technologies for pulmonary vein isolation (PVI) are increasingly performed worldwide. One of the most common complications following PVI are vascular access-related complications. Lately, venous closure systems (VCS) were introduced into clinical practice, aiming to reduce the time of bedrest, to increase the patients' comfort and to reduce vascular access-related complications. AIMS To compare the safety and efficacy of using a VCS to achieve haemostasis following single shot PVI to the actual standard of care (figure-of-eight suture and manual compression (MC)). METHODS This is a prospective, multicentre, randomized, controlled, open-label trial performed at 3 German centres. Patients were randomized 1:1 to undergo haemostasis either by means of VCS (VCS group) or of a figure-of-eight suture and MC (F8 group). The primary efficacy endpoint was the time to ambulation, while the primary safety endpoint was the incidence of major periprocedural adverse events until hospital discharge. RESULTS A total of 125 patients were randomized. The baseline characteristics were similar between the groups. The VCS group showed a shorter time to ambulation (109.0 (82.0, 160.0) vs. 269.0 (243.8, 340.5) min; p<0.001), shorter time to haemostasis (1 (1, 2) vs. 5 (2, 10) min; p<0.001) and shorter time to discharge eligibility (270 (270, 270) vs. 340 (300, 458) min; p<0.001). No major vascular access related complication was reported in either group. A trend towards a lower incidence of minor vascular access related complications on the day of procedure was observed in the VCS group (7 (11.1%) vs. 15 (24.2%); p=0.063) as compared to the control group. CONCLUSION Following AF ablation, the use of a VCS results in a significantly shorter time to ambulation, time to haemostasis and time to discharge eligibility. No major vascular access related complications were identified. The use of MC and a figure-of-eight suture showed a trend towards a higher incidence of minor vascular access related complications.
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Affiliation(s)
- R Tilz
- Department of Rhythmology, University Heart Center, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - M Feher
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - J Vogler
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - K Bode
- Heart Center of Leipzig, Leipzig, Germany
| | - A Duta
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - A Ortolan
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | | | - M Küchler
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - R Mamaev
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - E Lyan
- University Medical Center of Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - Philipp Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - M Braun
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - V Sciacca
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - T Demming
- University Medical Center of Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - V Maslova
- University Medical Center of Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - K H Kuck
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - C-H Heeger
- Department of Rhythmology, University Heart Center, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - C Eitel
- Department of Rhythmology, University Heart Center, Luebeck, Germany
| | - S S Popescu
- Department of Rhythmology, University Heart Center, Luebeck, Germany
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4
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Gasperetti A, Schiavone M, Milstein J, Compagnucci P, Vogler J, Laredo M, Breitenstein A, Gulletta S, Martinek M, Casella M, Kaiser L, Santini L, Rovaris G, Curnis A, Biffi M, Kuschyk J, Di Biase L, Tilz R, Tondo C, Forleo GB. Differences in underlying cardiac substrate among S-ICD recipients and its impact on long-term device-related outcomes: Real-world insights from the iSUSI registry. Heart Rhythm 2024; 21:410-418. [PMID: 38246594 DOI: 10.1016/j.hrthm.2023.12.007] [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: 10/18/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. OBJECTIVE The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. METHODS Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC). The main outcome of our study was to compare the rates of appropriate and inappropriate shocks and device-related complications. RESULTS Among 1698 patients, the most common underlying substrate was ischemic (31.7%), followed by dilated cardiomyopathy (20.5%), BrS (10.8%), hypertrophic cardiomyopathy (8.5%), and ARVC (4.4%). S-ICD for primary prevention was more common in the nonischemic cohort (70.9% vs 65.4%; P = .037). Over a median (interquartile range) follow-up of 26.5 (12.6-42.8) months, no differences were observed in appropriate shocks between ischemic and nonischemic patients (4.8%/y vs 3.9%/y; log-rank, P = .282). ARVC (9.0%/y; hazard ratio [HR] 2.492; P = .001) and BrS (1.8%/y; HR 0.396; P = .008) constituted the groups with the highest and lowest rates of appropriate shocks, respectively. Device-related complications did not differ between groups (ischemic: 6.4%/y vs nonischemic: 6.1%/y; log-rank, P = .666), nor among underlying substrates (log-rank, P = .089). Nonischemic patients experienced higher rates of inappropriate shocks than did ischemic S-ICD recipients (4.4%/y vs 3.0%/y; log-rank, P = .043), with patients with ARVC (9.9%/y; P = .001) having the highest risk, even after controlling for confounders (adjusted HR 2.243; confidence interval 1.338-4.267; P = .002). CONCLUSION Most S-ICD recipients were primary prevention nonischemic cardiomyopathy patients. Among those, patients with ARVC tend to receive the most frequent appropriate and inappropriate shocks and patients with BrS the least frequent appropriate shocks.
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Affiliation(s)
- Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jenna Milstein
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Mikael Laredo
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France
| | | | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Martin Martinek
- Ordensklinikum Linz Elisabethinen Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Linz, Austria
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany
| | - Luca Santini
- Cardiology Unit, Ospedale G.B. Grassi, Ostia, Rome, Italy
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, New York
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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5
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Migliore F, Schiavone M, Pittorru R, Forleo GB, De Lazzari M, Mitacchione G, Biffi M, Gulletta S, Kuschyk J, Dall'Aglio PB, Rovaris G, Tilz R, Mastro FR, Iliceto S, Tondo C, Di Biase L, Gasperetti A, Tarzia V, Gerosa G. Left ventricular assist device in the presence of subcutaneous implantable cardioverter defibrillator: Data from a multicenter experience. Int J Cardiol 2024; 400:131807. [PMID: 38272130 DOI: 10.1016/j.ijcard.2024.131807] [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: 10/31/2023] [Revised: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure (HF). Subcutaneous implantable cardioverter defibrillator (S-ICD) might be a viable alternative to conventional ICDs with a lower risk of short- and long-term of device-related complications and infections.The aim of this multicenter study was to evaluate the outcomes and management of S-ICD recipients who underwent LVAD implantation. METHODS The study population included patients with a preexisting S-ICD who underwent LVAD implantation for advanced HF despite optimal medical therapy. RESULTS The study population included 30 patients (25 male; median age 45 [38-52] years).The HeartMate III was the most common LVAD type. Median follow-up in the setting of concomitant use of S-ICDs and LVADs was 7 months (1-20).There were no reports of inability to interrogate S-ICD systems in this population. Electromagnetic interference (EMI) occurred in 21 (70%) patients. The primary sensing vector was the one most significantly involved in determining EMI. Twenty-seven patients (90%) remained eligible for S-ICD implantation with at least one optimal sensing vector. The remaining 3 patients (10%) were ineligible for S-ICD after attempts of reprogramming of sensing vectors. Six patients (20%) experienced inappropriate shocks (IS) due to EMI. Six patients (20%) experienced appropriate shocks. No S-ICD extraction because of need for antitachycardia pacing, ineffective therapy or infection was reported. CONCLUSIONS Concomitant use of LVAD and S-ICD is feasible in most patients. However, the potential risk of EMI oversensing, IS and undersensing in the post-operative period following LVAD implantation should be considered. Careful screening for EMI should be performed in all sensing vectors after LVAD implantation.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Jurgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Mannheim, Germany
| | - Pietro Bernardo Dall'Aglio
- Department of Cardiology and Angiology, Faculty of Medicine, Heart, Center Freiburg University, University of Freiburg, Germany
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lubeck, Lubeck, Germany
| | - Florinda Rosaria Mastro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine at Montefiore Health System, Bronx, NY, USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
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6
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Schiavone M, Gasperetti A, Compagnucci P, Vogler J, Laredo M, Montemerlo E, Gulletta S, Breitenstein A, Ziacchi M, Martinek M, Casella M, Palmisano P, Kaiser L, Lavalle C, Calò L, Seidl S, Saguner AM, Rovaris G, Kuschyk J, Biffi M, Di Biase L, Dello Russo A, Tondo C, Della Bella P, Tilz R, Forleo GB. Impact of ventricular tachycardia ablation in subcutaneous implantable cardioverter defibrillator carriers: a multicentre, international analysis from the iSUSI project. Europace 2024; 26:euae066. [PMID: 38584394 PMCID: PMC10999646 DOI: 10.1093/europace/euae066] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Catheter ablation (CA) of ventricular tachycardia (VT) has become an important tool to improve clinical outcomes in patients with appropriate transvenous implantable cardioverter defibrillator (ICD) shocks. The aim of our analysis was to test whether VT ablation (VTA) impacts long-term clinical outcomes even in subcutaneous ICD (S-ICD) carriers. METHODS AND RESULTS International Subcutaneous Implantable Cardioverter Defibrillator (iSUSI) registry patients who experienced either an ICD shock or a hospitalization for monomorphic VT were included in this analysis. Based on an eventual VTA after the index event, patients were divided into VTA+ vs. VTA- cohorts. Primary outcome of the study was the occurrence of a combination of device-related appropriate shocks, monomorphic VTs, and cardiovascular mortality. Secondary outcomes were addressed individually. Among n = 1661 iSUSI patients, n = 211 were included: n = 177 experiencing ICD shocks and n = 34 hospitalized for VT. No significant differences in baseline characteristics were observed. Both the crude and the yearly event rate of the primary outcome (5/59 and 3.8% yearly event rate VTA+ vs. 41/152 and 16.4% yearly event rate in the VTA-; log-rank: P value = 0.0013) and the cardiovascular mortality (1/59 and 0.7% yearly event rate VTA+ vs. 13/152 and 4.7% yearly event rate VTA-; log-rank P = 0.043) were significantly lower in the VTA + cohort. At multivariate analysis, VTA was the only variable remaining associated with a lower incidence of the primary outcome [adjusted hazard ratio 0.262 (0.100-0.681), P = 0.006]. CONCLUSION In a real-world registry of S-ICD carriers, the combined study endpoint of arrhythmic events and cardiovascular mortality was lower in the patient cohort undergoing VTA at long-term follow-up. CLINICALTRIALS.GOV IDENTIFIER NCT0473876.
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Affiliation(s)
- Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy
- Department of Cardiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21218, USA
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Mikael Laredo
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France
| | | | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Martin Martinek
- Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | | | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Sebastian Seidl
- Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Ardan M Saguner
- Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland
| | | | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Montefiore-Einstein Center, Bronx, NY, USA
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Paolo Della Bella
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Giovanni B Forleo
- Cardiology Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, Milan 20157, Italy
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Krieger K, Park I, Althoff T, Busch S, Chun KRJ, Estner H, Iden L, Maurer T, Rillig A, Sommer P, Steven D, Tilz R, Duncker D. [Perioperative management for cardiovascular implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2024; 35:83-90. [PMID: 38289503 PMCID: PMC10879261 DOI: 10.1007/s00399-023-00989-6] [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] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
Cardiovascular implantable electronic devices (CIED) are an important part of modern cardiology and careful perioperative planning of these procedures is necessary. All information relevant to the indication, the procedure, and the education of the patient must be available prior to surgery. This provides the basis for appropriate device selection. Preoperative antibiotic prophylaxis and perioperative anticoagulation management are essential to prevent infection. After surgery, postoperative monitoring, telemetric control, and device-based diagnostics are required before discharge. These processes need to be adapted to the increasing trend towards outpatient care. This review summarises perioperative management based on practical considerations.
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Affiliation(s)
- Konstantin Krieger
- Klinik für Kardiologie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland.
| | - Innu Park
- Klinik für Kardiologie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
| | - Till Althoff
- Klinik für Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland, Charitéplatz 1, 10117
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien, C. de Villarroel, 170, 08036
| | - Sonia Busch
- Abteilung für Elektrophysiologie, Herz-Zentrum Bodensee, Konstanz, Deutschland, Luisenstraße 9A, 78464
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt am Main, Deutschland, Im Prüfling 23, 60389
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland, Ziemssenstraße 5, 80336
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland, Am Kurpark 1, 23795
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland, Lohmühlenstraße 5, 20099
| | - Andreas Rillig
- Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland, Martinistraße 52, 20251
| | - Philipp Sommer
- Med. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland, Georgstraße 11, 32545
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland, Kerpener Straße 62, 50937
| | - Roland Tilz
- Klinik für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland, Ratzeburger Allee 160, 23562
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland, Carl-Neuberg-Straße 1, 30625
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de Waha S, Desch S, Tilz R, Vogler J, Uhlemann M, Marín-Cuartas M, Raschpichler M, Borger M. Erratum zu: ESC-Leitlinien 2023 zum Management der Endokarditis. Herz 2024; 49:155. [PMID: 38418606 DOI: 10.1007/s00059-024-05236-3] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Suzanne de Waha
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Steffen Desch
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Roland Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Julia Vogler
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Madlen Uhlemann
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Mateo Marín-Cuartas
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Matthias Raschpichler
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Michael Borger
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
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de Waha S, Desch S, Tilz R, Vogler J, Uhlemann M, Marín-Cuartas M, Raschpichler M, Borger M. [ESC guidelines 2023 on the management of endocarditis : What is new?]. Herz 2024; 49:33-42. [PMID: 38092975 DOI: 10.1007/s00059-023-05225-y] [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] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/26/2024]
Abstract
In August 2023 the new European guidelines on the management of infective endocarditis were published by the European Society of Cardiology (ESC). Numerous recommendations were revised and supplemented by new ones. This review article outlines the essential modifications of the current ESC guidelines focusing on the prevention including antibiotic prophylaxis, the role of the endocarditis team, the revision of the diagnostic criteria, the paradigm shift towards oral antibiotic treatment, the timing and the indications for surgical treatment as well as the relevance of infections of cardiovascular implantable electronic devices.
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Affiliation(s)
- Suzanne de Waha
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.
| | - Steffen Desch
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Roland Tilz
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Julia Vogler
- Klinik für Rhythmologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Madlen Uhlemann
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Mateo Marín-Cuartas
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Matthias Raschpichler
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
| | - Michael Borger
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland
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10
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reinsch N, Reddy VY. Impact of Left Atrial Posterior Wall Ablation During Pulsed-Field Ablation for Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00030-6. [PMID: 38430087 DOI: 10.1016/j.jacep.2024.01.017] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) alone is insufficient to treat many patients with persistent atrial fibrillation (PersAF). Adjunctive left atrial posterior wall (LAPW) ablation with thermal technologies has revealed lack of efficacy, perhaps limited by the difficulty in achieving lesion durability amid concerns of esophageal injury. OBJECTIVES This study aims to compare the safety and effectiveness of PVI + LAPW ablation vs PVI in patients with PersAF using pulsed-field ablation (PFA). METHODS In a retrospective analysis of the MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-approval Clinical Use of Pulsed Field Ablation) registry, we studied consecutive PersAF patients undergoing post-approval treatment with a pentaspline PFA catheter. The primary effectiveness outcome was freedom from any atrial arrhythmia of ≥30 seconds. Safety outcomes included the composite of acute and chronic major adverse events. RESULTS Of the 547 patients with PersAF who underwent PFA, 131 (24%) received adjunctive LAPW ablation. Compared to PVI-alone, patients receiving adjunctive LAPW ablation were younger (65 vs 67 years of age, P = 0.08), had a lower CHA2DS2-VASc score (2.3 ± 1.6 vs 2.6 ± 1.6, P = 0.08), and were more likely to receive electroanatomical mapping (48.1% vs 39.0%, P = 0.07) and intracardiac echocardiography imaging (46.1% vs 17.1%, P < 0.001). The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmias was not statistically different between groups in the full (PVI + LAPW: 66.4%; 95% CI: 57.6%-74.4% vs PVI: 73.1%; 95% CI: 68.5%-77.2%; P = 0.68) and propensity-matched cohorts (PVI + LAPW: 71.7% vs PVI: 68.5%; P = 0.34). There was also no significant difference in major adverse events between the groups (2.2% vs 1.4%, respectively, P = 0.51). CONCLUSIONS In patients with PersAF undergoing PFA, as compared to PVI-alone, adjunctive LAPW ablation did not improve freedom from atrial arrhythmia at 12 months.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France; I2MC, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic; Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France; Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | | | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Pessac, France
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nico Reinsch
- Department of Medicine, Witten/Herdecke University, Witten, Germany; Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czech Republic.
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11
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Reddy VY. Clinical Outcomes by Sex After Pulsed Field Ablation of Atrial Fibrillation. JAMA Cardiol 2023; 8:1142-1151. [PMID: 37910101 PMCID: PMC10620676 DOI: 10.1001/jamacardio.2023.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/10/2023] [Indexed: 11/03/2023]
Abstract
Importance Previous studies evaluating the association of patient sex with clinical outcomes using conventional thermal ablative modalities for atrial fibrillation (AF) such as radiofrequency or cryoablation are controversial due to mixed results. Pulsed field ablation (PFA) is a novel AF ablation energy modality that has demonstrated preferential myocardial tissue ablation with a unique safety profile. Objective To compare sex differences in patients undergoing PFA for AF in the Multinational Survey on the Methods, Efficacy, and Safety on the Postapproval Clinical Use of Pulsed Field Ablation (MANIFEST-PF) registry. Design, Setting, and Participants This was a retrospective cohort study of MANIFEST-PF registry data, which included consecutive patients undergoing postregulatory approval treatment with PFA to treat AF between March 2021 and May 2022 with a median follow-up of 1 year. MANIFEST-PF is a multinational, retrospectively analyzed, prospectively enrolled patient-level registry including 24 European centers. The study included all consecutive registry patients (age ≥18 years) who underwent first-ever PFA for paroxysmal or persistent AF. Exposure PFA was performed on patients with AF. All patients underwent pulmonary vein isolation and additional ablation, which was performed at the discretion of the operator. Main Outcomes and Measures The primary effectiveness outcome was freedom from clinically documented atrial arrhythmia for 30 seconds or longer after a 3-month blanking period. The primary safety outcome was the composite of acute (<7 days postprocedure) and chronic (>7 days) major adverse events (MAEs). Results Of 1568 patients (mean [SD] age, 64.5 [11.5] years; 1015 male [64.7%]) with AF who underwent PFA, female patients, as compared with male patients, were older (mean [SD] age, 68 [10] years vs 62 [12] years; P < .001), had more paroxysmal AF (70.2% [388 of 553] vs 62.4% [633 of 1015]; P = .002) but had fewer comorbidities such as coronary disease (9% [38 of 553] vs 15.9% [129 of 1015]; P < .001), heart failure (10.5% [58 of 553] vs 16.6% [168 of 1015]; P = .001), and sleep apnea (4.7% [18 of 553] vs 11.7% [84 of 1015]; P < .001). Pulmonary vein isolation was performed in 99.8% of female (552 of 553) and 98.9% of male (1004 of 1015; P = .90) patients. Additional ablation was performed in 22.4% of female (124 of 553) and 23.1% of male (235 of 1015; P = .79) patients. The 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was similar in male and female patients (79.0%; 95% CI, 76.3%-81.5% vs 76.3%; 95% CI, 72.5%-79.8%; P = .28). There was also no significant difference in acute major AEs between groups (male, 1.5% [16 of 1015] vs female, 2.5% [14 of 553]; P = .19). Conclusion and Relevance Results of this cohort study suggest that after PFA for AF, there were no significant sex differences in clinical effectiveness or safety events.
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Affiliation(s)
- Mohit K. Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Boris Schmidt
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jim Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- I2MC Institute, INSERM UMR 1297, Toulouse, France
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
- Neuron Medical, Brno, Czech Republic
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
| | - Julian Chun
- Medizinisches Versorgungszentrum Cardioangiologisches Centrum Bethanien Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Medicine, Witten/Herdecke University, Witten, Germany
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
| | - Marc D. Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Bart A. Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine—University of Freiburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
- Universitair Ziekenhuis, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Catharina Hospital, Eindhoven, the Netherlands instead of Catharina Ziekenhuis Eindhoven, the Netherlands
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Cologne, Germany
| | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC—Institute Des Maladies Du Rythme Cardiaque, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Thomas Kueffer
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia
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Batra G, Aktaa S, Camm AJ, Costa F, Di Biase L, Duncker D, Fauchier L, Fragakis N, Frost L, Hijazi Z, Juhlin T, Merino JL, Mont L, Nielsen JC, Oldgren J, Polewczyk A, Potpara T, Sacher F, Sommer P, Tilz R, Maggioni AP, Wallentin L, Casadei B, Gale CP. Data standards for atrial fibrillation/flutter and catheter ablation: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart). Eur Heart J Qual Care Clin Outcomes 2023; 9:609-620. [PMID: 36243903 PMCID: PMC10495697 DOI: 10.1093/ehjqcco/qcac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 09/13/2023]
Abstract
AIMS Standardized data definitions are essential for monitoring and assessment of care and outcomes in observational studies and randomized controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology aimed to develop contemporary data standards for atrial fibrillation/flutter (AF/AFL) and catheter ablation. METHODS AND RESULTS We used the EuroHeart methodology for the development of data standards and formed a Working Group comprising 23 experts in AF/AFL and catheter ablation registries, as well as representatives from the European Heart Rhythm Association and EuroHeart. We conducted a systematic literature review of AF/AFL and catheter ablation registries and data standard documents to generate candidate variables. We used a modified Delphi method to reach a consensus on a final variable set. For each variable, the Working Group developed permissible values and definitions, and agreed as to whether the variable was mandatory (Level 1) or additional (Level 2). In total, 70 Level 1 and 92 Level 2 variables were selected and reviewed by a wider Reference Group of 42 experts from 24 countries. The Level 1 variables were implemented into the EuroHeart IT platform as the basis for continuous registration of individual patient data. CONCLUSION By means of a structured process and working with international stakeholders, harmonized data standards for AF/AFL and catheter ablation for AF/AFL were developed. In the context of the EuroHeart project, this will facilitate country-level quality of care improvement, international observational research, registry-based RCTs, and post-marketing surveillance of devices and pharmacotherapies.
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Affiliation(s)
- Gorav Batra
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Institute for Data Analytics, University of Leeds and Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | | | - Francisco Costa
- Cardiology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, 1449-005 Lisboa, Portugal
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York City, NY 10467, USA
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Laurent Fauchier
- Service de Cardiologie, Center Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, 37044 Tours, France
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, 54124 Thessaloniki, Greece
| | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, and Department of Clinical Medicine, Aarhus University, 8200 AarhusDenmark
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Tord Juhlin
- Department of Cardiology, Skåne University Hospital, 221 85 Lund, Sweden
| | - José L Merino
- Arrhythmia and Robotic Electrophysiology Unit, Hospital Universitario La Paz, IdiPaz, Universidad Autonoma, 28046 Madrid, Spain
| | - Lluis Mont
- Hospital Clinic, Universitat de Barcelona, Institut de Recerca Biomèdica August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain; CIBER cardiovascular, 28029 Madrid, Spain
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Jonas Oldgren
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Anna Polewczyk
- Department of Physiology, Patophysiology and Clinical Immunology, Collegium Medicum of The Jan Kochanowski University, 25-369 Kielce, Poland; Department of Cardiac Surgery, Department of Cardiac Surgery Świętokrzyskie Center of Cardiology, Kielce, Poland
| | - Tatjana Potpara
- School of Medicine, University of Belgrade and Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Frederic Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), LIRYC Institute, 33600 Bordeaux, France
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Luebeck, 23538 Lübeck, Germany
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, 50121 Florence, Italy
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 751 85 Uppsala, Sweden
| | - Barbara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX4 2PG, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Institute for Data Analytics, University of Leeds and Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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13
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Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
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Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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14
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Turagam MK, Neuzil P, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Lemoine MD, Ruwald M, Mulder BA, Rollin A, Lehrmann H, Fink T, Jurisic Z, Chaumont C, Adelino R, Nentwich K, Gunawardene M, Ouss A, Heeger CH, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Kueffer T, Rahe G, Reddy VY. Safety and Effectiveness of Pulsed Field Ablation to Treat Atrial Fibrillation: One-Year Outcomes From the MANIFEST-PF Registry. Circulation 2023. [PMID: 37199171 DOI: 10.1161/circulationaha.123.064959] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pulsed field ablation is a novel nonthermal cardiac ablation modality using ultra-rapid electrical pulses to cause cell death by a mechanism of irreversible electroporation. Unlike the traditional ablation energy sources, pulsed field ablation has demonstrated significant preferentiality to myocardial tissue ablation, and thus avoids certain thermally mediated complications. However, its safety and effectiveness remain unknown in usual clinical care. METHODS MANIFEST-PF (Multi-National Survey on the Methods, Efficacy, and Safety on the Post-Approval Clinical Use of Pulsed Field Ablation) is a retrospective, multinational, patient-level registry wherein patients at each center were prospectively included in their respective center registries. The registry included all patients undergoing postapproval treatment with a multielectrode 5-spline pulsed field ablation catheter to treat atrial fibrillation (AF) between March 1, 2021, and May 30, 2022. The primary effectiveness outcome was freedom from clinical documented atrial arrhythmia (AF/atrial flutter/atrial tachycardia) of ≥30 seconds on the basis of electrocardiographic data after a 3-month blanking period (on or off antiarrhythmic drugs). Safety outcomes included the composite of acute (<7 days postprocedure) and latent (>7 days) major adverse events. RESULTS At 24 European centers (77 operators) pulsed field ablation was performed in 1568 patients with AF: age 64.5±11.5 years, female 35%, paroxysmal/persistent AF 65%/32%, CHA2DS2-VASc 2.2±1.6, median left ventricular ejection fraction 60%, and left atrial diameter 42 mm. Pulmonary vein isolation was achieved in 99.2% of patients. After a median (interquartile range) follow-up of 367 (289-421) days, the 1-year Kaplan-Meier estimate for freedom from atrial arrhythmia was 78.1% (95% CI, 76.0%-80.0%); clinical effectiveness was more common in patients with paroxysmal AF versus persistent AF (81.6% versus 71.5%; P=0.001). Acute major adverse events occurred in 1.9% of patients. CONCLUSIONS In this large observational registry of the postapproval clinical use of pulsed field technology to treat AF, catheter ablation using pulsed field energy was clinically effective in 78% of patients with AF.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
| | - Petr Neuzil
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Tobias Reichlin
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Kars Neven
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Jim Hansen
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- I2MC, INSERM UMR 1297, ToulouseFrance (P.M.)
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | - Frederic Anselme
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Electrophysiology, Alfried Krupp Hospital, EssenGermany (K. Neven, A.F.)
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
- Neuron Medical, Brno, Czech Republic (M.F.)
| | - Daniel Scherr
- Medical University of Graz, Austria (D. Scherr, M.M.)
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Daniel Steven
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Josef Kautzner
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Pierre Jais
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
| | - Jan Petru
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany (B.S., J.C.)
| | - Laurent Roten
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Anna Füting
- Department of Cardiology, Rouen Hospital, France (F.A., C.C.)
| | - Marc D Lemoine
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Germany (A.M., M.D.L.)
| | - Martin Ruwald
- Copenhagen University Hospital, Denmark (J.H., M.R.)
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (Y.B., B.A.M.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R.)
- Universitair Ziekenhuis VUB, Brussels, Belgium (S.B., R.A.)
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, Medical Center and Faculty of Medicine- University of Freiburg, Germany (T.A., H.L.)
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (P.S., T.F.)
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Croatia (A.A., Z.J.)
| | | | - Raquel Adelino
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France (S.B., R.A.)
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany (T.D., K. Nentwich)
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, The Netherlands (P.v.d.V., A.O.)
| | - Christian-Hendrik Heeger
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Germany (R.T., C.-H.H.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.T., C.-H.H.)
| | | | - Jan-Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Germany (R.W., J.-E.B.)
| | - Arian Sultan
- Heart Center University Hospital of Cologne, Department for Electrophysiology, Germany (D. Steven, A.S.)
| | - Petr Peichl
- IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K., P.P.)
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium (J.V., P.K.)
| | - Nicolas Derval
- 2I HU LIRYC, CHU Bordeaux, University of Bordeaux, France (P.J., N.D.)
| | - Thomas Kueffer
- Inselspital-Bern University Hospital, University of Bern, Switzerland (T.R., L.R., T.K.)
| | - Gilbert Rahe
- Department of Medicine, Witten/Herdecke University, Germany (K. Neven, A.F., G.R.)
- Department of Pulmonology, Gastroenterology and Internal Medicine, Alfried Krupp Hospital, Essen, Germany (G.R.)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T., V.Y.R.)
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Prague, Czechia (P.N., M.F., J.P., V.Y.R.)
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15
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Schiavone M, Gasperetti A, Laredo M, Breitenstein A, Vogler J, Palmisano P, Gulletta S, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Curnis A, Dello Russo A, Tondo C, Badenco N, Di Biase L, Kuschyk J, Biffi M, Tilz R, Forleo GB, Arosio R, Ruggiero D, Viecca M, Ziacchi M, Diemberger I, Angeletti A, Fierro N, Della Bella P, Mitacchione G, Compagnucci P, Casella M, Santini L, Piro A, Picarelli F, Bressi E, Calò L, Montemerlo E, Rovaris G, De Bonis S, Bisignani A, Bisignani G, Russo G, Guarracini F, Vitali F, Bertini M, Fink T, Fastenrath F, Kaiser L, Hakmi S, Waintraub X, Gandjbakhch E, Saguner A. Inappropriate Shock Rates and Long-Term Complications due to Subcutaneous Implantable Cardioverter Defibrillators in Patients With and Without Heart Failure: Results From a Multicenter, International Registry. Circ Arrhythm Electrophysiol 2023; 16:e011404. [PMID: 36595631 DOI: 10.1161/circep.122.011404] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Marco Schiavone
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.S.)
| | - Alessio Gasperetti
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Mikael Laredo
- APHP, Hôpital Pitié Salpêtrière, Paris, France (M.L.)
| | | | - Julia Vogler
- Department of Elctrophysiology, Herzzentrum Lubeck, Germany (J.V., R.T.)
| | - Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy (P.P.)
| | - Simone Gulletta
- Arrhythmology & Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan (S.G.)
| | | | | | - Ennio Pisanò
- U.O.S.V.D. Cardiac Electrophysiology - "V. Fazzi" Hospital, Lecce (E.P.)
| | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona (A.D.R.)
| | - Claudio Tondo
- Heart Rhythm Centre, Monzino Cardiology Centre, IRCCS, Milan, Italy (C.T.)
| | - Nicolas Badenco
- Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, NY (L.D.B.)
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Center Mannheim, Germany (J.K.)
| | - Mauro Biffi
- Cardiology, IRCCS, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy (M.B.)
| | - Roland Tilz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany (R.T.)
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16
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Gunawardene MA, Hartmann J, Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Willems S. [Focal atrial tachycardias: diagnostics and therapy]. Herzschrittmacherther Elektrophysiol 2022; 33:467-475. [PMID: 36342506 DOI: 10.1007/s00399-022-00907-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
In this article, typical characteristics of focal atrial tachycardias are described and a systematic approach regarding diagnostics and treatment options in the field of invasive cardiac electrophysiology (EP) is presented. Subjects of this article include the definition of focal atrial tachycardias, knowledge about localizing the origin of such, and guidance on how to approach an invasive EP study (e.g., administration of medication during the EP study to provoke tachycardias). Further, descriptions will be found on how to localize the origin of focal atrial tachycardias with the help of the 12-lead ECG and invasive three-dimensional mapping to successfully treat focal atrial tachycardias with catheter ablation.
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Affiliation(s)
- Melanie A Gunawardene
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Jens Hartmann
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CL.NIC-University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Klinik für Elektrophysiologie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Stephan Willems
- Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
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17
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Kottmaier M, Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Iden L, Tilz R, Metzner A, Chun KRJ, Steven D, Jansen H, Jadidi A, Ewertsen C, Reents T. Erratum to: Atypical atrial flutter: Diagnostics and therapy. Herzschrittmacherther Elektrophysiol 2022; 33:486. [PMID: 36205786 PMCID: PMC9691488 DOI: 10.1007/s00399-022-00901-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Marc Kottmaier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinikum Kardiologie u. Angiologie, Charite - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC - University Hospital Barcelona, Barcelona, Spanien
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland
- University Faculty of Health, Center for Clinical Medicine Witten-Herdecke, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf Hamburg, Hamburg, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | | | - Amir Jadidi
- Klinik für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Deutschland
| | - Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | - Tilko Reents
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, München, Deutschland
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18
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Gasperetti A, Schiavone M, Vogler J, Laredo M, Fastenrath F, Palmisano P, Ziacchi M, Angeletti A, Mitacchione G, Kaiser L, Compagnucci P, Breitenstein A, Arosio R, Vitali F, De Bonis S, Picarelli F, Casella M, Santini L, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Calò L, Curnis A, Bertini M, Gulletta S, Dello Russo A, Badenco N, Tondo C, Kuschyk J, Tilz R, Forleo GB, Biffi M. The need for a subsequent transvenous system in patients implanted with subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2022; 19:1958-1964. [PMID: 35781042 DOI: 10.1016/j.hrthm.2022.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The absence of pacing capabilities may reduce the appeal of subcutaneous implantable cardioverter-defibrillator (S-ICD) devices for patients at risk for conduction disorders or with antitachycardia pacing (ATP)/cardiac resynchronization (CRT) requirements. Reports of rates of S-ICD to transvenous implantable cardioverter-defibrillator (TV-ICD) system switch in real-world scenarios are limited. OBJECTIVE The purpose of this study was to investigate the need for a subsequent transvenous (TV) device in patients implanted with an S-ICD and its predictors. METHODS All patients implanted with an S-ICD were enrolled from the multicenter, real-world iSUSI (International SUbcutaneouS Implantable cardioverter defibrillator) Registry. The need for a TV device and its clinical reason, and appropriate and inappropriate device therapies were assessed. Logistic regression with Firth penalization was used to assess the association between baseline and procedural characteristics and the overall need for a subsequent TV device. RESULTS A total of 1509 patients were enrolled (age 50.8 ± 15.8 years; 76.9% male; 32.0% ischemic; left ventricular ejection fraction 38% [30%-60%]). Over 26.5 [13.4-42.9] months, 155 (10.3%) and 144 (9.3%) patients experienced appropriate and inappropriate device therapies, respectively. Forty-one patients (2.7%) required a TV device (13 bradycardia; 10 need for CRT; 10 inappropriate shocks). Body mass index (BMI) >30 kg/m2 and chronic kidney disease (CKD) were associated with need for a TV device (odds ratio [OR] 2.57 [1.37-4.81], P = .003; and OR 2.67 [1.29-5.54], P = .008, respectively). CONCLUSION A low rate (2.7%) of conversion from S-ICD to a TV device was observed at follow-up, with need for antibradycardia pacing, ATP, or CRT being the main reasons. BMI >30 kg/m2 and CKD predicted all-cause need for a TV device.
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Affiliation(s)
- Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | | | - Julia Vogler
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany
| | | | - Fabian Fastenrath
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | | | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angeletti
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gianfranco Mitacchione
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology Unit, Spedali Civili Brescia, Brescia, Italy
| | | | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | | | - Francesco Vitali
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Silvana De Bonis
- Department of Cardiology, Castrovillari Hospital, Cosenza, Italy
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Luca Santini
- Cardiology Unit, Ospedale G.B. Grassi, Ostia, Italy
| | | | | | - Ennio Pisanò
- Cardiac Electrophysiology Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | | | | | - Matteo Bertini
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | - Claudio Tondo
- Heart Rhythm Center, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Roland Tilz
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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19
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Ekanem E, Reddy VY, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Füting A, Rillig A, Mulder BA, Johannessen A, Rollin A, Lehrmann H, Sohns C, Jurisic Z, Savoure A, Combes S, Nentwich K, Gunawardene M, Ouss A, Kirstein B, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Turagam MK, Neuzil P. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace 2022; 24:1256-1266. [PMID: 35647644 PMCID: PMC9435639 DOI: 10.1093/europace/euac050] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 01/11/2023] Open
Abstract
AIMS Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement.
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Affiliation(s)
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Boris Schmidt
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Tobias Reichlin
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Jim Hansen
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Yuri Blaauw
- Universitair Medish Groningen, Groningen, The Netherlands
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France,I2MC, INSERM UMR 1297, Toulouse, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Tom Deneke
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Pepijn van der Voort
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Roland Tilz
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | - Moritoshi Funasako
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic,Neuron Medical, Brno, Czech Republic
| | | | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Josef Kautzner
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Pierre Jais
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Jan Petru
- Cardiology Department, Na Homolce Hospital, Homolka Hospital, Roentgenova 37/2, 15030 Praha 5 Prague, Czech Republic
| | - Julian Chun
- MVZ CCB Frankfurt und Main-Taunus GbR, Frankfurt, Germany
| | - Laurent Roten
- Inselspital—Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany,Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Andreas Rillig
- University Heart and Vascular Center, University of Hamburg, Hamburg, Germany
| | - Bart A Mulder
- Universitair Medish Groningen, Groningen, The Netherlands
| | | | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Zrinka Jurisic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split, Croatia
| | | | - Stephanes Combes
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France,Universitair Ziekenhuis VUB, Brussels, Belgium
| | - Karin Nentwich
- Heart Center Bad Neustadt, Rhoen-Clinic Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Alexandre Ouss
- Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Bettina Kirstein
- Department of Rhythmology, University Heart Center, Lubeck, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany,LANS Cardio, Hamburg, Germany
| | | | - Jan Eric Bohnen
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | | | - Petr Peichl
- IKEM—Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pieter Koopman
- Department of Cardiology, Jessa Hospitals, Hasselt, Belgium
| | - Nicolas Derval
- IHU LIRYC, CHU Bordeaux, University of Bordeaux, Bordeaux, France
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20
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Kirstein B, Heeger C, Vogler J, Eitel C, Phan L, Keelani A, Feher M, Traub A, Samara O, Kuck K, Tilz R. Impact of very wide antral pulmonary vein isolation on esophageal temperature changes during pulsed field ablation. Europace 2022. [DOI: 10.1093/europace/euac053.218] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Esophageal thermal injury (ETI) is a serious drawback of available energy sources for atrial fibrillation (AF) ablation, especially on the posterior left atrial (LA) wall. Pulsed field ablation (PFA) is a novel non-thermal energy source with promising safety advantages over existing methods due to its unique myocardial tissue specificity sparing the esophagus.
Objective
To evaluate esophageal temperature changes during very wide antral pulmonary vein isolation (PVI) using the PFA system.
Methods
Thirteen consecutive AF patients (62% with paroxysmal AF; age: 61 years; 70% male) underwent first-time PFA under deep sedation. Eight pulse trains (2kV/2.5 sec, bipolar, biphasic, 4x basket/flower configuration each) were delivered to each pulmonary vein (PV). Extra pulse trains in the flower configuration were added for very wide antral circumferential ablation (vWACA). Continuous intraluminal esophageal temperature (TESO) was monitored with an S-shaped esophageal temperature probe.
Results
A median of 32 (IQR 32;32) and 8 (IQR 8;9) pulse trains for PVI and vWACA with a procedural time and catheter dwell time of 67 min (IQR 61-69) and 17 min (IQR 16-18) were applied. PFA with vWACA resulted in consecutive posterior LA wall isolation in 11/13 patients. Fluoroscopically, the esophagus coursed near the right PVs in 2/13, left PVs in 8/13 and mid-posterior wall position in 3/13 patients. Maximum TESO increase from baseline was 0.8 ±0.9 °C. However, no clinically relevant TESO changes occurred (Table 1). On short-term, all patients remained asymptomatic for sore throat, cough, or other symptoms potentially related to ETI. No esophago-duodenoscopy was necessary.
Conclusion
PFA of the PVs and lesion extension to the posterior LA wall demonstrated clinically non-significant TESO changes and has the potential to eliminate the risk of a thermal damage to the esophagus.
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Affiliation(s)
- B Kirstein
- University Heart Center, Luebeck, Germany
| | - C Heeger
- University Heart Center, Luebeck, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
| | - L Phan
- University Heart Center, Luebeck, Germany
| | - A Keelani
- University Heart Center, Luebeck, Germany
| | - M Feher
- University Heart Center, Luebeck, Germany
| | - A Traub
- University Heart Center, Luebeck, Germany
| | - O Samara
- University Heart Center, Luebeck, Germany
| | - K Kuck
- LANS Cardio, Hamburg, Germany
| | - R Tilz
- University Heart Center, Luebeck, Germany
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21
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Kirstein B, Vogler J, Eitel C, Phan L, Feher M, Keelani A, Traub A, D’ Ambrosio G, Grosse N, Reincke S, Hatahet S, Trajanoski D, Kuck K, Tilz R, Heeger C. Very high-power short-duration temperature-controlled ablation for cavotricuspid isthmus block : the Fast-and-Furious CTI study. Europace 2022. [DOI: 10.1093/europace/euac053.072] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation for typical right atrial flutter (AFL) provides an effective treatment associated with encouraging clinical outcome. The novel micro-electrode ablation catheter allows very high-power short-duration (vHP-SD, 90 W/4 sec) ablation and potentially offers the ability to perform a safe, effective and faster cavotricuspid isthmus (CTI) ablation.
Aims
We evaluated feasibility and efficacy of a vHP-SD (90 W/4 sec) temperature-controlled radiofrequency (RF) CTI ablation for AFL using a novel contact force (CF) sensing ablation catheter with micro-electrodes.
Methods
Fifteen consecutive patients (median age 75 years (interquartile range, IQR: 67, 79), 67 % male) with documented typical AFL were prospectively enrolled and underwent vHP-SD based CTI ablation (90 W/4 sec). Durability of CTI block was proven by pacing maneuvers from both sides of the ablation line.
Results
Complete CTI block using vHP-SD ablation was achieved in all patients (Figure 1). At median 23 (IQR 20; 39) RF applications over a median RF ablation time of 92 (IQR 78, 154) seconds were applied. It was not necessary to switch to the standard temperature-controlled mode to achieve durable CTI block. No periprocedural complications, no charring and no steam pops were observed.
Conclusions
Very high-power short-duration (90 W/4 sec) CTI ablation for the treatment of typical AFL is feasible and efficient. Effective CTI block can be achieved in about 1.5 minutes of RF time.
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Affiliation(s)
- B Kirstein
- University Heart Center, Luebeck, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
| | - L Phan
- University Heart Center, Luebeck, Germany
| | - M Feher
- University Heart Center, Luebeck, Germany
| | - A Keelani
- University Heart Center, Luebeck, Germany
| | - A Traub
- University Heart Center, Luebeck, Germany
| | | | - N Grosse
- University Heart Center, Luebeck, Germany
| | - S Reincke
- University Heart Center, Luebeck, Germany
| | - S Hatahet
- University Heart Center, Luebeck, Germany
| | | | - K Kuck
- LANS Cardio, Hamburg, Germany
| | - R Tilz
- University Heart Center, Luebeck, Germany
| | - C Heeger
- University Heart Center, Luebeck, Germany
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22
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Tilz R, Heeger C, Eitel C, Vogler J, Phan L, Feher M, Keelani A, Kuck K, Kirstein B. Comparison of ostial versus very wide antral circumferential pulmonary vein isolation using pulsed field ablation. Europace 2022. [DOI: 10.1093/europace/euac053.219] [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
Pulmonary vein isolation (PVI) is the gold standard for first-time atrial fibrillation (AF) ablation procedures. Wide antral circumferential ablation (WACA) in comparison to ostial PVI has been attributed to an improved rhythm outcome after AF ablation. Pulsed field ablation (PFA) is a novel energy source with promising safety and efficacy advantages over existing ablation methods due to its unique myocardial tissue specificity. Feasibility of PFA for very WACA has not been investigated so far.
Objective
To evaluate procedural characteristics and lesion formation during wide antral circumferential PVI in comparison to ostial PVI using a PFA system.
Methods
Thirty-seven consecutive AF patients underwent first-time PFA under deep sedation. Patients eighter received ostial (ostial group; N = 15: 66 % paroxysmal AF; age: 69 years; 66 % male) or very wide antral (vWACA group; N = 22: 59 % paroxysmal AF; age: 62 years; 73 % male) PFA. Pre and post ablation LA voltage maps were acquired using a 20-pole spiral catheter together with a 3-dimensional electroanatomic mapping system (voltage cutoff ≤0.5 mV). On post ablation maps, lesion size by encircling the ablated area was measured. In all patients, 8 pulse trains (2kV/2.5 sec, bipolar, biphasic, 4x basket/flower configuration each) were delivered to each pulmonary vein (PV). In the vWACA-group, extra pulse trains in flower configuration were added to each PV in a wide antral position continuous intraluminal esophageal temperatures (TESO) were monitored with an S-shaped esophageal temperature probe.
Results
A median of 8 [IQR 8;8] and 10 [IQR 10;11] pulse trains per PV for ostial and vWACA PVI were applied. vWACA PFA resulted in significant larger lesion formation (47.3 cm2 [IQR 39.1; 52.0]) in comparison to ostial PFA (35.5 cm2 [IQR 30.3; 38.1], p=0.013) with consecutive posterior LA wall isolation in 19/22 (86 %) patients (Figure 1). In the vWACA group, median TESO increased by 0.7 °C (TESOmax 36.5 °C [IQR 36.0;36.9]). However, the vWACA approach was not associated with a significant increase in procedure time, sedation dosage or exposure to radiation.
Conclusion
Very wide antral circumferential PFA of the PVs is feasible and was associated with significant larger lesion formation in comparison to conventional ostial PFA. Concomitant posterior LA wall isolation occurred in the majority of patient and did not result in a clinically significant increase of intraluminal esophageal temperatures, procedure time, sedation and radiation dosage.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - C Heeger
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
| | - L Phan
- University Heart Center, Luebeck, Germany
| | - M Feher
- University Heart Center, Luebeck, Germany
| | - A Keelani
- University Heart Center, Luebeck, Germany
| | - K Kuck
- LANS Cardio, Hamburg, Germany
| | - B Kirstein
- University Heart Center, Luebeck, Germany
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23
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Tilz R, Martin CA, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.079] [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: Private company. Main funding source(s): Boston Scientific
Background/Introduction
Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.
Purpose
The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.
Results
Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - CA Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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Schiavone M, Gasperetti A, Vogler J, Breitenstein A, Hakmi S, Mitacchione G, Gulletta S, Laredo M, Lavalle C, Casella M, Tondo C, Kuschyk J, Tilz R, Biffi M, Forleo GB. S-ICD in heart failure patients: real-world data from a multicenter, european analysis. Europace 2022. [DOI: 10.1093/europace/euac053.459] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Data on patients with heart failure (HF) and subcutaneous implantable cardioverter defibrillator (S-ICD) are very scarce and limited to a single prospective analysis from the UNTOUCHED trial.
Purpose
Aim of this study was to assess clinical outcomes of the S-ICD in HF patients, comparing them with a no-HF population, in a real-world analysis from the largest European retrospective S-ICD registry (ELISIR registry).
Methods
All consecutive patients undergoing S-ICD implantation at 20 European institutions enrolled in the ELISIR registry were used for the current analysis. According to European Guidelines, the registry population was classified into two groups: the HF cohort (further classified as HF with reduced and mid-range ejection fraction – HFrEF and HFmrEF) vs the no-HF group. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device-related complications during follow-up were assessed.
Results
A total of 1409 patients from the ELISIR registry were included in this analysis; HF patients represented 57.3% of the entire cohort (n=701, 86.9% HFrEF; n=106,13.1% HFmrEF). As expected, the HF cohort showed significantly higher rates of cardiovascular risk factors and comorbidities when compared to the no-HF cohort. Over a median follow-up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p=0.689). 133 complex ventricular arrhythmias were adequately recognized and treated in the overall cohort, showing similar rates of appropriate shocks (9.2% vs 9.8%, p=0.689). Inappropriate and effective shocks-free survival has been represented in Figure 1, showing Kaplan-Meier estimates comparing HF vs no-HF patients, also stratified by left ventricular ejection fraction (LVEF). The impact of baseline and procedural characteristics on the primary outcome was tested through univariable and multivariable Cox regression analysis in HF patients; at multivariate analysis, only age (HR=0.974 [0.955–0.992], p=0.005), LVEF (HR=0.954 [0.926-0.984], p=0.003), ARVC (HR=3.364 [1.206-9.384], p=0.020) and smart pass algorithm "on" (HR=0.321 [0.184-0.560], p<0.001) remained associated with inappropriate shocks (Figure 2). A low number of patients (n=76) experienced device-related complications, more frequently in the HF cohort (6.2% vs 3.8%, p=0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p=0.381), pocket infection (1.9% vs 0.8%, p=0.107), pocket hematoma (3.2% vs 2.8%, p=0.668).
Conclusion
The rate of inappropriate shocks seems to be comparable in both HF and non-HF patients implanted with S-ICD. However, the rate of device-related complications was slightly more frequent in HF patients.
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Affiliation(s)
- M Schiavone
- Luigi Sacco University Hospital, Milan, Italy
| | - A Gasperetti
- Johns Hopkins University, Baltimore, United States of America
| | - J Vogler
- University of Lubeck, Luebeck, Germany
| | | | - S Hakmi
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | | | - M Laredo
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - C Lavalle
- Sapienza University of Rome, Rome, Italy
| | - M Casella
- Sapienza University of Rome, Rome, Italy
| | - C Tondo
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - J Kuschyk
- University Medical Centre of Mannheim, Mannheim, Germany
| | - R Tilz
- University of Lubeck, Luebeck, Germany
| | - M Biffi
- S. Orsola-Malpighi Policlinic, Bologna, Italy
| | - GB Forleo
- Luigi Sacco University Hospital, Milan, Italy
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Schiavone M, Gasperetti A, Gulletta S, Steffel J, Kaiser L, Mitacchione G, Lavalle C, Badenco N, Dello Russo A, Olivotto I, Tondo C, Kuschyk J, Biffi M, Tilz R, Forleo GB. Age-related differences and associated outcomes of S-ICD: insights from a large, european, multicenter, real-world registry. Europace 2022. [DOI: 10.1093/europace/euac053.446] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Young patients often represent the most suitable candidates for an entirely subcutaenous implantable cardioverter defibrillator (S-ICD) system, since they have to face a lifetime of device therapy and they rarely have a pre-existing or concurrent pacing or cardiac resynchronization therapy (CRT) indication. Moreover, S-ICD offers lower rate and a safer management of lead and major procedure-related complications. To date, a few limited case series and experiences with S-ICD in teenagers and young adults have shown that the S-ICD system is safe and feasible in this population, with a rate of inappropriate shocks (IS) comparable to transvenous (TV) ICD, but focused analysis on a large scale are currently lacking in this setting.
Purpose
The aim of the current study was to compare the age-related differences observed in patient selection, baseline characteristics, and device long-term associated outcomes in a large real world cohort of S-ICD recipients. The primary outcome of the study was defined as the comparisons of the IS rate observed during the entirety of follow up in the teenagers/young adult vs the adult populations. Rate of complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were also assessed in the two cohorts and assessed as secondary outcomes.
Methods
All S-ICD recipients in the ELISIR project were enrolled in the current study. Patients were classified into teenagers + young adults (≤ 30 years old) vs adults (> 30 years old), depending from patient age at device implantation (Figure 1). Rates of device-related complications and IS were compared between the cohorts.
Results
A total of 1349 patients were extracted from the ELISIR project. Teenagers and young adults represented 12.4% of the registry (n=56 teenagers; n=112 young adults). Patients were followed-up for a median of 23.1 [12.6–37.9] months. Overall, 117 (8.7%) patients experienced inappropriate S-ICD shocks and 100 (7.4%) device related complications were observed, with no age-related differences. IS resulted more frequent in the teenager and young adult cohort (14.3% vs 7.9%; p=0.006). Figure 2 reports Kaplan Meier curves for the occurrence of IS. At univariate analysis, young age was associated with IS, but after correcting for differences in arrhythmic substrate, this association resulted non-significant (aHR: 1.428 [0.883–2.331]; p=0.146). The use of SMART pass algorithm was instead associated to a strong reduction in IS (aHR 0.367 [0.245–0.548]; p<0.001).
Conclusion
The use of S-ICD in teenagers/young adults resulted safe and effective. Indeed, the rate of complications between teenagers/young adults and adults was not significantly different. Although a higher rate of IS was observed in the teenagers/young adults, when accounting for differences in baseline substrate and comorbidities, young age did not result associated with an increased risk of IS.
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Affiliation(s)
- M Schiavone
- Luigi Sacco University Hospital, Milan, Italy
| | - A Gasperetti
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | | | - J Steffel
- University of Zurich, Zurich, Switzerland
| | - L Kaiser
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - C Lavalle
- Sapienza University of Rome, Rome, Italy
| | - N Badenco
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - I Olivotto
- Careggi University Hospital, Florence, Italy
| | - C Tondo
- IRCCS Monzino Cardiology Center, Milan, Italy
| | - J Kuschyk
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Biffi
- S. Orsola-Malpighi Policlinic, Bologna, Italy
| | - R Tilz
- University of Lubeck, Luebeck, Germany
| | - GB Forleo
- Luigi Sacco University Hospital, Milan, Italy
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26
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Schiavone M, Gasperetti A, Vogler J, Mitacchione G, Gulletta S, Palmisano P, Breitenstein A, Laredo M, Compagnucci P, Angeletti A, Kaiser L, Hakmi S, Russo G, Ricciardi D, De Bonis S, Arosio R, Casella M, Santini L, Pignalberi C, Piro A, Lavalle C, Pisanò E, Denora M, Viecca M, Curnis A, Badenco N, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Tilz R, Biffi M, Forleo G. C9 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN PATIENTS WITH LOW BMI: REAL–WORLD DATA FROM A EUROPEAN MULTICENTER ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.008] [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: 11/14/2022]
Abstract
Abstract
Background
One of the current limitations of the S–ICD is the relatively large size of the generator compared to the TV (transvenous) ICD. There is little evidence whether the size of the current S–ICD generator is associated with an elevated risk of device–related complications in patients with a low body mass index (BMI).
Purpose
Aim of this study was to compare the device–related complications and long–term outcomes in a large real world cohort of S–ICD recipients in patients with a BMI <18 kg/m2 compared to patients with a BMI >18 kg/m2.
Methods
All consecutive patients meeting current guideline indications for ICD implantation and undergoing implantation of a S–ICD device (Boston Scientific, Marlborough, Massachusetts, USA) at 21 European institutions enrolled in the extended ELISIR registry were used for the current analysis. Patients were classified into two cohorts, depending on the BMI at the time of device implantations: BMI < 18 kg/m2 versus > 18 kg/m2.
Results
Out of a total of 1497 pts, 58 pts (3.9%) had a BMI < 18 kg/m2. Patients with BMI <18 kg/m2 were younger (44.6±2.4 vs 50.8±0.4; p = 0.004) and more frequently female (58.6% vs 22.3%, p < 0.001). No differences in any of the other baseline characteristic were observed. Implantation techniques resulted comparable between the groups (rates of 2–incision technique: 87.8% vs 91.9%; p = 0.256; inter–muscular placement: 89.7% vs 83.3%; p = 0.198). Of note, the mean PRAETORIAN score at implantation of patients with BMI <18 kg/m2 was significantly lower (33.8±9.1 vs 54.1±47.3; p = 0.035), although the vast majority of patients in both cohorts qualified as at low risk of conversion failure (100% vs 91.4%; p = 0.436). Over a median follow up time of 22.4 [11.6–36.8] months, both overall device–related complications (5.2% vs 7.4%) and rates of inappropriate shocks (12.0% vs 8.8%) resulted comparable between the two groups (p = 0.517 and p = 0.385, respectively). Figure 1 reports Kaplan–Meier curves showing the combined incidence of device–related complications and inappropriate shocks in the two groups (log–rank p = 0.576).
Conclusion
No differences in device–related complications and long–term outcomes after S–ICD implantation were observed in patients with BMI <18 kg/m2 compared to the remaining recipients in a large multicentered real–world analysis.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
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Schiavone M, Gasperetti A, Gulletta S, Vogler J, Fastenrath F, Breitenstein A, Laredo M, Mitacchione G, Palmisano P, Compagnucci P, Kaiser L, Denora M, Hakmi S, Angeletti A, De Bonis S, Picarelli F, Casella M, Steffel J, Ferro N, Guarracini F, Santini L, Pignalberi C, Piro A, Lavalle C, Russo G, Pisanò E, Viecca M, Curnis A, Badenco N, Ricciardi D, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Biffi M, Tilz R, Forleo G. P21 AGE–RELATED DIFFERENCES AND ASSOCIATED OUTCOMES OF S–ICD: INSIGHTS FROM A LARGE, EUROPEAN, MULTICENTER REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.019] [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]
Abstract
Abstract
Background
The subcutaneous implantable cardioverter defibrillator (S–ICD) has become an alternative to transvenous ICDs (TV–ICD) in patients who do not need pacing. To date, there is little evidence directly comparing the rates of inappropriate shocks (IAS) in young vs old S–ICD recipients.
Purpose
Aim of our study was to assess differences in device–related complications and inappropriate shocks (IS) between teenagers/young adults and adult recipients of a subcutabeous implantable cardioverter defibrillator (S–ICD) device.
Methods
Two propensity–matched cohorts of teenagers + young adults (≤ 30–year–old) and adults (> 30–year–old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock (IAS) rate; complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were deemed secondary outcomes.
Results
A total of 1491 patients were extracted from the ELISIR project. Teenagers + young adults represented 11.0% of the entire cohort. Two propensity–matched groups of 161 patients each were used for the analysis (Figure 1); median follow–up was 23.1 [13.2–40.5] months. 15.2% patients experienced inappropriate S–ICD shocks and 9.3% device related complications were observed with no age–related differences in IAS (16.1% vs 14.3%; p = 0.642) and complication rates (9.9% vs 8.7%; p = 0.701); Figure 2 shows a survival analysis from inappropriate shocks in the teen–ager/young adult cohort (red) and in the adult cohort (blue). At univariate analysis, young age was not associated with increased rates of IAS (HR 1.204 [0.675–2.148]: p = 0.529). At multivariate analysis (Figure 3), the use of SMART pass algorithm was associated to a strong reduction in IAS (aHR 0.292 [0.161–0.525]; p < 0.001), while ARVC was associated with higher rates of IAS (aHR 2.380 [1.205–4.697]; p = 0.012).
Conclusion
In a large multicentered European registry of patients with S–ICD, 11.0% of all recipients were teenagers or young adults. The use of S–ICD in teenagers/young adults resulted safe and effective, and the rates of complications and IAS between teenagers/young adults and adults were not significantly different. The only predictor of increased IAS was a diagnosis of ARVC.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Picarelli
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Ferro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Guarracini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
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Schiavone M, Gasperetti A, Mitacchione G, Angeletti A, Vogler J, Laredo M, Breitenstein A, Gulletta S, Fastenrath F, Kaiser L, Compagnucci P, Palmisano P, Ricciardi D, Santini L, De Bonis S, Piro A, Pignalberi C, Pisanò E, Hakmi S, Arosio R, Casella M, Lavalle C, Badenco N, Della Bella P, Dello Russo A, Curnis A, Tondo C, Steffel J, Viecca M, Kuschyk J, Tilz R, Biffi M, Forleo G. P25 SUBCUTANEOUS–ICD IN PATIENTS WITH HEART FAILURE: RESULTS FROM A MULTICENTER, EUROPEAN ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.023] [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]
Abstract
Abstract
Background
Data on patients with heart failure (HF) with a subcutaneous implantable cardioverter defibrillator (S–ICD) are scarce.
Objective
Aim of this study was to assess clinical outcomes of the S–ICD in HF patients in a real–world analysis from the largest European retrospective S–ICD registry (ELISIR).
Methods
All consecutive patients undergoing S–ICD implantation at several European institutions were used for the current analysis. The population was classified into two groups: the HF (classified as HF with reduced and mid–range ejection fraction – HFrEF and HFmrEF) vs the no–HF cohort. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device–related complications during follow–up were assessed
Results
A total of 1409 patients from the ELISIR registry were included; HF patients represented 57.3% of the entire cohort (n = 701, 86.9% HFrEF; n = 106,13.1% HFmrEF). Over a median follow–up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p = 0.689). 133 complex ventricular arrhythmias were adequately recognized and treated, with similar rates of appropriate shocks (9.2% vs 9.8%, p = 0.689). Inappropriate and effective shocks–free survival has been represented in Figure 1 (Kaplan–Meier estimates). At multivariate analysis (Figure 2), age (HR = 0.974 [0.955–0.992], p = 0.005), LVEF (HR = 0.954 [0.926–0.984], p = 0.003), arrhythmogenic right ventricular cardiomyopathy – ARVC (HR = 3.364 [1.206–9.384], p = 0.020) and smart pass + (HR = 0.321 [0.184–0.560], p < 0.001) remained associated with inappropriate shocks. Moreover, a low number of patients (n = 76) experienced device–related complications, more frequently in the HF cohort (6.2% vs 3.8%, p = 0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p = 0.381), pocket infection (1.9% vs 0.8%, p = 0.107), pocket hematoma (3.2% vs 2.8%, p = 0.668).
Conclusion
The use of S–ICD in HF patients did not result in a higher rate of inappropriate shocks when compared to no–HF patients, even when stratifying for LVEF. Only age, LVEF, ARVC e Smart Pass algorithm were predictors of the primary outcome at multivariate analysis. Despite a lower overall rate of complications in the entire cohort, HF patients experienced device–related complications more frequently.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
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Gulletta S, Gasperetti A, Schiavone M, Vogler J, Fastenrath F, Breitenstein A, Laredo M, Palmisano P, Mitacchione G, Compagnucci P, Kaiser L, Hakmi S, Angeletti A, De Bonis S, Picarelli F, Arosio R, Casella M, Steffel J, Fierro N, Guarracini F, Santini L, Pignalberi C, Piro A, Lavalle C, Pisanò E, Viecca M, Curnis A, Badenco N, Ricciardi D, Russo AD, Tondo C, Kuschyk J, Bella PD, Biffi M, Forleo GB, Tilz R. Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter defibrillators: a propensity-matched analysis from a multicenter European registry. Heart Rhythm 2022; 19:1109-1115. [DOI: 10.1016/j.hrthm.2022.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
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Bourier F, Busch S, Sommer P, Maurer T, Althoff T, Shin DI, Duncker D, Johnson V, Estner H, Rillig A, Bertagnolli L, Iden L, Deneke T, Tilz R, Metzner A, Chun J, Steven D. [Catheter ablation of ventricular tachycardias in patients with ischemic cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2022; 33:88-97. [PMID: 35157112 DOI: 10.1007/s00399-022-00845-z] [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] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
Radiofrequency (RF) ablation is an effective treatment option of scar-related ventricular tachycardias (VT) in patients with ischemic cardiomyopathy. Several studies proved the benefit of VT catheter ablation, which has become routine in most electrophysiology laboratories. This article provides practical instructions to perform a VT catheter ablation. The authors describe conventional and substrate-based mapping and ablation strategies as well as concepts for image integration. This article continues a series of publications created for education in advanced electrophysiology.
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Affiliation(s)
- Felix Bourier
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, München, Deutschland.
| | - Sonia Busch
- Medizinische Klinik, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Thomas Deneke
- Klinik für Kardiologie, Rhön-Klinikum, Campus Bad Neustadt, Bad Neustadt a. d. Saale, Deutschland
| | - Roland Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien - CCB, Frankfurt, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
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31
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Tilz R, Sano M, Vogler J, Fink T, Meyer-Saraei R, Sciacca V, Kirstein B, Kirstein B, Eitel C, Schlüter M, Kuck KH, Heeger CH. B-PO05-107 VERY HIGH-POWER SHORT-DURATION TEMPERATURE-CONTROLLED ABLATION VS CONVENTIONAL ABLATION-INDEX GUIDED POWER-CONTROLLED ABLATION FOR PULMONARY VEIN ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Forleo GB, Gasperetti A, Breitenstein A, Laredo M, Schiavone M, Ziacchi M, Vogler J, Ricciardi D, Palmisano P, Piro A, Compagnucci P, Waintraub X, Mitacchione G, Carrassa G, Russo G, De Bonis S, Angeletti A, Bisignani A, Picarelli F, Casella M, Bressi E, Rovaris G, Calò L, Santini L, Pignalberi C, Lavalle C, Viecca M, Pisanò E, Olivotto I, Curnis A, Dello Russo A, Tondo C, Love CJ, Di Biase L, Steffel J, Tilz R, Badenco N, Biffi M. Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study. Heart Rhythm 2021; 18:2072-2079. [PMID: 34214647 DOI: 10.1016/j.hrthm.2021.06.1201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/10/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported. OBJECTIVE The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients. METHODS Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. RESULTS Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003). CONCLUSION In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
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Affiliation(s)
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy.
| | - Matteo Ziacchi
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Julia Vogler
- Cardiology Department, University Hospital of Lubeck, Lubeck, Germany
| | | | | | - Agostino Piro
- Cardiology Department, Policlinico Umberto I, Rome, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | | | | | | | - Giulia Russo
- Cardiology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Silvana De Bonis
- Cardiology Department, Ferrari Hospital, Castrovillari, Cosenza, Italy
| | - Andrea Angeletti
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Bisignani
- Cardiology Department, Ferrari Hospital, Castrovillari, Cosenza, Italy
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Edoardo Bressi
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | | | - Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Luca Santini
- Cardiology Department, Ospedale G.B. Grassi, Ostia, Italy
| | | | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I, Rome, Italy
| | - Maurizio Viecca
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Ennio Pisanò
- Cardiology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Charles J Love
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jan Steffel
- Cardiology Department, Zurich University Hospital, Zurich, Switzerland
| | - Roland Tilz
- Cardiology Department, University Hospital of Lubeck, Lubeck, Germany
| | | | - Mauro Biffi
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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Gessler N, Willems S, Steven D, Aberle J, Akbulak RO, Gosau N, Hoffmann BA, Meyer C, Sultan A, Tilz R, Vogler J, Wohlmuth P, Scholz S, Gunawardene MA, Eickholt C, Lüker J. Supervised Obesity Reduction Trial for AF Ablation Patients: Results from the SORT-AF trial. Europace 2021; 23:1548-1558. [PMID: 33895833 PMCID: PMC8502497 DOI: 10.1093/europace/euab122] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Abstract
Aims 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 < 0.001). Atrial fibrillation burden after ablation decreased significantly (P < 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.
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Affiliation(s)
- Nele Gessler
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,University Heart Center Hamburg Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany)
| | - Stephan Willems
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany).,AFNET, Münster, Germany
| | - Daniel Steven
- University of Cologne, University Hospital Cologne, Department of Electrophysiology, Cologne, Germany
| | - Jens Aberle
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ruken Oezge Akbulak
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany)
| | - Nils Gosau
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany)
| | - Boris A Hoffmann
- Asklepios Clinic Harburg, Department of Cardiology, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Christian Meyer
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany).,EVK Düsseldorf, Department of Cardiology/Angiology/Intensive Care, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, cNEP Research Consortium, University of Düsseldorf, Düsseldorf Germany
| | - Arian Sultan
- University of Cologne, University Hospital Cologne, Department of Electrophysiology, Cologne, Germany
| | - Roland Tilz
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany).,University Heart Center Lübeck, Division of Electrophysiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Julia Vogler
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany).,University Heart Center Lübeck, Division of Electrophysiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Peter Wohlmuth
- Asklepios Proresearch, Research institute, Hamburg, Germany
| | - Susanne Scholz
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Melanie A Gunawardene
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany)
| | - Christian Eickholt
- Asklepios Hospital St. Georg, Department of Cardiology and Internal intensive care medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany)
| | - Jakob Lüker
- University of Cologne, University Hospital Cologne, Department of Electrophysiology, Cologne, Germany
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Ledwoch J, Nommensen A, Keelani A, Meyer-Saraei R, Stiermaier T, Saad M, Pöss J, Desch S, Tilz R, Thiele H, Eitel I, Eitel C. Impact of transcatheter mitral valve repair on ventricular arrhythmias. Europace 2020; 21:1385-1391. [PMID: 31505617 DOI: 10.1093/europace/euz061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/07/2018] [Accepted: 03/15/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Patients with heart failure and severe mitral regurgitation (MR) have a poor prognosis and carry an increased risk for ventricular arrhythmias. The present study evaluates the impact of transcatheter mitral valve repair using the MitraClip on the potential reduction of ventricular arrhythmias. METHODS AND RESULTS Patients undergoing MitraClip implantation were prospectively enrolled into the present study and received 24 h Holter ECG assessment prior to and 6 months after the procedure. In addition, left ventricular dimensions and function were assessed at baseline and follow-up. A total of 50 patients with mainly functional MR (82%) were included. Non-sustained or sustained ventricular tachycardia (nsVT and/or sVT) occurred in 32% of patients and was reduced to 14% at follow-up (P = 0.01). Also, premature ventricular complex (PVC) burden ≥5% decreased from 16% to 4% (P = 0.04). Patients with persistent (n = 6) or new (n = 1) nsVT and/or sVT at follow-up showed a significant decrease in left ventricular ejection fraction from 38% (interquartile range 26-45%) to 33% (interquartile range 22-44%; P = 0.03). CONCLUSIONS In this prospective study, transcatheter mitral valve repair using MitraClip was associated with a reduced prevalence of ventricular arrhythmias. The subset of patients with persistent or new ventricular arrhythmias after MitraClip implantation showed progression of left ventricular dysfunction.
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Affiliation(s)
- Jakob Ledwoch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK).,Department of Cardiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anna Nommensen
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Ahmed Keelani
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Roza Meyer-Saraei
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Mohammed Saad
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Janine Pöss
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Steffen Desch
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK).,Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Roland Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK)
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Mathew S, Saguner AM, Schenker N, Kaiser L, Zhang P, Yashuiro Y, Lemes C, Fink T, Maurer T, Santoro F, Wohlmuth P, Reißmann B, Heeger CH, Tilz R, Wissner E, Rillig A, Metzner A, Kuck KH, Ouyang F. Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach. J Am Heart Assoc 2020; 8:e010365. [PMID: 30813830 PMCID: PMC6474920 DOI: 10.1161/jaha.118.010365] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background It has been suggested that endocardial and epicardial ablation of ventricular tachycardia (VT) improves outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia. We investigated our sequential approach for VT ablation in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia in a single center. Methods and Results We included 47 patients (44±16 years) with definite (81%) or borderline (19%) arrhythmogenic right ventricular cardiomyopathy/dysplasia between 1998 and 2016. Our ablation strategy was to target the endocardial substrate. Epicardial ablation was performed in case of acute ablation failure or lack of an endocardial substrate. Single and multiple procedural 1‐ and 5‐year outcome data for the first occurrence of the study end points (sustained VT/ventricular fibrillation, heart transplant, and death after the index procedure, and sustained VT/ventricular fibrillation for multiple procedures) are reported. Eighty‐one radiofrequency ablation procedures were performed (mean 1.7 per patient, range 1–4). Forty‐five (56%) ablation procedures were performed via an endocardial, 11 (13%) via an epicardial, and 25 (31%) via a combined endo‐ and epicardial approach. Complete acute success was achieved in 65 (80%) procedures, and partial success in 13 (16%). After a median follow‐up of 50.8 (interquartile range, [18.6; 99.2]) months after the index procedure, 17 (36%) patients were free from the primary end point. After multiple procedures, freedom from sustained VT/ventricular fibrillation was 63% (95% CI, 52–75) at 1 year, and 45% (95% CI, 34–61) at 5 years, with 36% of patients receiving only endocardial radiofrequency ablation. A trend (log rank P=0.058) towards an improved outcome using a combined endo‐/epicardial approach was observed after multiple procedures. Conclusion Endocardial ablation can be effective in a considerable number of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with VT, potentially obviating the need for an epicardial approach.
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Affiliation(s)
- Shibu Mathew
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Ardan M Saguner
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany.,2 Department of Cardiology University Heart Center Zurich Switzerland
| | - Niklas Schenker
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Lukas Kaiser
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Pengpai Zhang
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Yoshiga Yashuiro
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Christine Lemes
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Thomas Fink
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Tilman Maurer
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Francesco Santoro
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Peter Wohlmuth
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Bruno Reißmann
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Christian H Heeger
- 3 University Heart Center Lübeck Medical Clinic II University Hospital Schleswig Holstein Lübeck Germany
| | - Roland Tilz
- 3 University Heart Center Lübeck Medical Clinic II University Hospital Schleswig Holstein Lübeck Germany
| | - Erik Wissner
- 4 University of Illinois Chicago, College of Medicine Chicago IL
| | - Andreas Rillig
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Andreas Metzner
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Karl-Heinz Kuck
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Feifan Ouyang
- 1 Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
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36
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Sano M, Fink T, Sciacca V, Vogler J, Saad M, Joost A, Heeger CH, Eitel C, Keelani A, Langer H, Eitel I, Tilz R. P1438Predictors and clinical impact of bleeding events after left atrial appendage closure in patients with high risk or a history of bleeding. Europace 2020. [DOI: 10.1093/europace/euaa162.095] [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: 11/12/2022] Open
Abstract
Abstract
Background
Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and may be especially attractive in patients with high risk or a history of bleeding. However, data of clinical benefit and incidence of post-procedural bleeding in patients with both high risk of bleeding and ischemic cerebral stroke after LAAC are lacking.
Objectives
This study sought to identify predictors and the prognostic impact of post-LAAC bleeding in patients at high risk and/or history of bleeding in the direct oral anticoagulant therapy (DOAC) era.
Methods and results
We retrospectively enrolled a total of 195 patients (75 ± 8.7 years, 38% female, 47% with previous major bleeding, mean CHA2DS2-VASc score 4.3 ± 1.6 and mean HAS-BLED score 2.7 ± 1.1) undergoing endocardial (91%) or epicardial (9%) LAAC during a mean follow-up of 339 ± 319 days. Twenty-three (11.9%) patients developed procedure-unrelated bleeding events after a median of 147 (43, 362) days after LAAC, in 12/23 (52%) patients under single antiplatelet therapy (SAPT), 6/23 (26%) dual antiplatelet therapy (DAPT), 1/23 (4%) DOAC, 1/23 (4%) VKA, 2/23 (9%) dual therapy (SAPT and DOAC/VKA) and 1/23 (4%) triple therapy (DAPT and DOAC/VKA). (Figure) Diabetes mellitus and previous major bleeding were identified as the independent predictors of post-LAAC bleeding (Odds ratio 2.65 [95% CI:1.04-6.73], p = 0.041, and 5.50 [95% confidence interval:1.72-17.5], p = 0.004). Post-LAAC bleeding was associated with all-cause death (9/23 [39%] vs 18/171 [11%], p = 0.001), but not ischemic stroke/TIA (1/23 [4%] vs 6/171 [4%], p = 0.593) nor device thrombus (2/23 [9%] vs 3/171 [2%], p = 0.108). Kaplan-Meier curve estimated that patients with post-LAAC bleeding had a worse mortality than those without post-LAAC bleeding (3-year mortality; 35.6% [95%CI; 11.6-61.0%] vs 68.7% [45.0-83.8], p = 0.029)
Conclusions
In AF patients with high bleeding risk or history of bleeding undergoing LAAC, bleeding events are common and may occur even after long-term duration after LAAC. Previous major bleeding history strongly predicts subsequent bleeding events following LAAC and is associated with unfavorable mortality. Further investigations are required to identify optimal post-procedural antithrombotic strategies for patients undergoing LAAC with previous major bleeding.
Abstract Figure. The association between time to bleeding
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Affiliation(s)
- M Sano
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - T Fink
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - V Sciacca
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - J Vogler
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - M Saad
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - A Joost
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - C-H Heeger
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - C Eitel
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - A Keelani
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - H Langer
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - I Eitel
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - R Tilz
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
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37
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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Tilz R, Lenz CL, Sommer PS, Sawan N, Meyer-Saraei R, Shpun S, Sarver A, Heeger C, Hindricks G, Vogler J, Eitel C. P2846Focal impulse and rotor modulation ablation versus pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation (FIRMAP AF study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Based on the assumption of trigger elimination, pulmonary vein isolation (PVI) currently presents the gold standard of atrial fibrillation (AF) ablation. Recently, rapidly spinning rotors or focal impulse formation has been raised as a crucial sustaining mechanism of AF. Ablation of these rotors may potentially obviate the need for trigger elimination with PVI.
Purpose
This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM) guided catheter ablation only with the gold standard of pulmonary vein isolation (PVI) in patients with paroxysmal AF.
Methods
This was a post-market, prospective, single-blinded, randomized, multi-center trial. Patients were enrolled at three centers and equally (1:1) randomized between those undergoing conventional RF ablation with PVI (PVI group) vs. those treated with FIRM-guided RF ablation without PVI (FIRM group). Data was collected at enrollment, procedure, and at 7-day, 3-month, 6-month, and 12-month follow-up visits. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived.
Results
From February 2016 until February 2018, a total of 51 (out of a planned 170) patients (mean age 63±10.6 years, 57% male) were enrolled and randomized. Four patients withdrew from the study prior to treatment, resulting in 23 patients allocated to the FIRM group and 24 in the PVI group. Only 13 patients in the FIRM group and 11 patients in the PVI group completed the 12-month follow-up. Statistical analysis was not completed given the small number of patients.
Single-procedure effectiveness (freedom from AF/atrial tachycardia recurrence after blanking period) was 52.9% (9/17) in the FIRM group and 85.7% (12/14) in the PVI group at 6 months; and 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Repeat procedures were performed in 45.8% (11/24) patients in the FIRM group and 7.4% (2/27) in the PVI group.
The acute safety endpoint [freedom from procedure-related serious adverse events (SAE)] was achieved in 87% (20/23) of FIRM group patients and 100% (24/24) of PVI group patients. Procedure related SAEs occurred in three patients in the FIRM group: 1 femoral artery aneurysm and 2 injection site hematomas. No additional procedure-related SAEs were reported >7 days post-procedure.
Conclusions
These partial study effectiveness results reinforce the importance of PVI in paroxysmal atrial fibrillation patients and suggest that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients. Further study is needed to understand the effectiveness of adding FIRM-guided ablation as an adjunct to PVI in this patient group.
Acknowledgement/Funding
Abbot
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - C L Lenz
- UKB Berlin, Cardiology, Berlin, Germany
| | - P S Sommer
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - N Sawan
- University Heart Center, Luebeck, Germany
| | | | - S Shpun
- Abbot, Plymouth, United States of America
| | - A Sarver
- Abbot, Plymouth, United States of America
| | - C Heeger
- University Heart Center, Luebeck, Germany
| | - G Hindricks
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
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39
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Tilz R, Lyan E, Heeger C, Fink T, Liosis S, Brueggemann B, Meyer-Sarai R, Sano M, An D, Eitel C, Vogler J. P343Comparison of Focal Impulse and Rotor Modulation Ablation (FIRM) only versus second-generation cyroballoon ablation in patients with paroxysmal atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0177] [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: 11/12/2022] Open
Abstract
Abstract
Background
Rotors have been postulated to be a major driver of atrial fibrillation (AF). Initial studies demonstrated, that focal impulse and rotor modulation (FIRM) might be an effective therapy for the treatment of paroxysmal AF (PAF). However, data about FIRM-guided ablation strategies without PVI is sparse.
Objective
To compare the safety and efficacy of FIRM-guided catheter ablation (without PVI; FIRM arm) and second generation cryoballoon (CB2, CB2 arm) based PVI in patients with paroxysmal atrial fibrillation (PAF) and de-novo catheter ablation of AF.
Methods
In this retrospective single-center study patients with PAF undergoing de-novo ablation of PAF between February 2016 and January 2017 were enrolled. Patients treated with FIRM-guided AF ablation as a standalone therapy without PVI were included and compared with patients undergoing CB2 based PVI. All patients in the FIRM arm were part of the randomized multicenter FIRMAP AF trial (results of this trial will be presented at this meeting). In patients undergoing FIRM-guided ablation, 3D electroanatomical mapping of both atria was performed. Rotor mapping using FIRM technology was conducted in spontaneous or induced AF. The procedural endpoint was the elimination of all rotors and focal impulses; no PVI was performed in those patients. In the CB2 arm, CB based PVI with the procedural endpoint of isolation of all veins was performed. Procedural data and arrhythmia-free survival after 12 months were compared.
Results
FIRM-guided and CB2 based AF ablation was performed in 22 and 86 patients, respectively. Follow up was completed in 20 and 79 patients LA diameter differed between groups. Otherwise, baseline characteristics did not differ between the FIRM group (mean age 60±11 years, 59.1% males) and the CB2 group (mean age 62±13, 62.4% male).
Arrhythmia-free survival including a 90-day blanking period was 25.0% (15/20) in the FIRM group and 86.1% (11/79) in the CB2 PVI group (p=0.000; Figure 1). Procedure duration was significantly longer in the FIRM group (152 [120; 176] minutes) compared to the CB2 PVI group (122 [110; 145] minutes) (p=0.031), whereas radiation dose was lower in the FIRM group (1266 [1027; 2281] cGy·cm2 vs. 3020 [1677; 4215] cGy·cm2). Adverse events (groin complications) occurred in 1 patient (1.2%) in the CB2 PVI group and 5 patients (22.7%) in the FIRM group.
Figure 1. Kaplan-Meier-survival curve dem
Conclusion
De novo ablation of PAF using a FIRM-guided AF ablation only (without PVI) is associated with poor arrhythmia-free survival after 12 months compared to CB2 PVI. These results underline the importance of PVI as the first-line approach in catheter ablation of AF.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - E Lyan
- University Heart Center, Luebeck, Germany
| | - C Heeger
- University Heart Center, Luebeck, Germany
| | - T Fink
- University Heart Center, Luebeck, Germany
| | - S Liosis
- University Heart Center, Luebeck, Germany
| | | | | | - M Sano
- University Heart Center, Luebeck, Germany
| | - D An
- University Heart Center, Luebeck, Germany
| | - C Eitel
- University Heart Center, Luebeck, Germany
| | - J Vogler
- University Heart Center, Luebeck, Germany
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40
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Tilz R, Dagres N, Arbelo E, Blomstroem Lundqvist CH, Pokushalov E, Crijns HJ, Kirchhof P, Kautzner J, Temporelli PL, Laroche CH, Pisapia A, Pehrson S, Lip GYH, Brugada J, Tavazzi L. P341Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EURObservational Research Programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0175] [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: 11/14/2022] Open
Abstract
Abstract
Aims
Great heterogeneity in rhythm control management of patients with atrial fibrillation (AF) has been described. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.
Methods
Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC-EORP EHRA AFA-LT) Registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC-EORP EHRA AF-Gen) PilotRegistry. Data collection was performed using a web-based system.
Results
In the AFA and in the AFG pilot registries 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger,more commonly male, and had significantly less co-morbidities. Lone AF was predominant in AFA patients who were at lower risk of stroke (CHA2DS2-VASc >5: 2.9% vs. 24.5%, all P<0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P<0.001) but with EHRA scores >1 and more prevalentAF-related symptoms such as palpitations, fatigue and weakness (all p<0.001)as compared to the general AF patients. AFA patients were significantly more often male, had higher LV ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P<0.001 each).
Conclusions
The comparison of the patient chorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and otherwise relatively healthy patients.
Acknowledgement/Funding
Abbott Vascular Int.; Amgen Cardiovascular, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb and Pfizer Alliance
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - N Dagres
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - E Arbelo
- University of Barcelona, Arrhythmia Section, Cardiology Department, Barcelona, Spain
| | | | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - H J Crijns
- Maastricht University, Maastricht, Netherlands (The)
| | - P Kirchhof
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - P L Temporelli
- Istituto Scientifico di Veruno, Division of Cardiology, Veruno, Italy
| | - C H Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia-Antipolis, France
| | - A Pisapia
- St. Joseph Hospital of Marseille, Marseille, France
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Y H Lip
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg, Denmark
| | - J Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu Uni, Barcelona, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, 18GVM Care and Research, E.S. Health Science Fnd, Cotignola, Italy
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Glikson M, Wolff R, Hindricks G, Mandrola J, Camm AJ, Lip GYH, Fauchier L, Betts TR, Lewalter T, Saw J, Tzikas A, Sternik L, Nietlispach F, Berti S, Sievert H, Bertog S, Meier B, Lenarczyk R, Nielsen-Kudsk JE, Tilz R, Kalarus Z, Boveda S, Deneke T, Heinzel FR, Landmesser U, Hildick-Smith D. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update. Europace 2019; 22:184. [DOI: 10.1093/europace/euz258] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Michael Glikson
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rafael Wolff
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gerhard Hindricks
- Heartcenter Leipzig at Leipzig University and Leipzig Heart Institute, Department of Electrophysiology, Leipzig, Germany
| | | | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Tim R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford Biomedical Research Centre, Department of Cardiology, Oxford, United Kingdom
| | - Thorsten Lewalter
- Dept. of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Dept. of Cardiology, University of Bonn, Bonn, Germany
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Apostolos Tzikas
- Structural & Congenital Heart Disease, AHEPA University Hospital & Interbalkan European Medical Center, Thessaloniki, Greece
| | - Leonid Sternik
- Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Fabian Nietlispach
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland
| | - Sergio Berti
- Heart Hospital-Fondazione C.N.R. Reg. Toscana G. Monasterio, Cardiology Department, Massa, Italy
| | - Horst Sievert
- CardioVascular Center CVC, Cardiology and Angiology, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, United Kingdom
- University of California San Francisco, San Francisco, CA, USA
- Yunnan Hospital Fuwai, Kunming, China
| | - Stefan Bertog
- CardioVascular Center CVC, Cardiology and Angiology, Frankfurt, Germany
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital Bern, Bern, Switzerland
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van den Bruck JH, Sultan A, Lüker J, Thomas D, Willems S, Weinmann K, Kuniss M, Hochadel M, Senges J, Andresen D, Brachmann J, Kuck KH, Tilz R, Steven D. Remote vs. conventional navigation for catheter ablation of atrial fibrillation: insights from prospective registry data. Clin Res Cardiol 2018; 108:298-308. [PMID: 30159751 DOI: 10.1007/s00392-018-1356-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/17/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Robotic (RNS) or magnetic navigation systems (MNS) are available for remotely performed catheter ablation for atrial fibrillation (AF). OBJECTIVE The present study compares remotely assisted catheter navigation (RAN) to standard manual navigation (SMN) and both systems amongst each other. METHODS The analysis is based on a sub-cohort enrolled by five hospitals from the multicenter German ablation Registry. RESULTS Out of 2442 patients receiving catheter ablation of AF, 267 (age 61.4 ± 10.4, 69.7% male) were treated using RAN (RNS n = 187, 7.7% vs. MNS n = 80, 3.3%). Fluoroscopy time [RNS median 17 (IQR 12-25) min vs. MNS 22 (16-32) min; p < 0.001] and procedure duration [RNS 180 (145-220) min vs. MNS 265 (210-305) min; p < 0.001] were significantly different. Comparing RAN (11%) to SMN (89%) fluoroscopy time (RAN 19 (13-27) min, vs. SMN 25 (16-40) min; p < 0.001), energy delivery (RAN 3168 (2280-3840) s vs. SMN 2640 (IQR 1799-3900) s; p = 0.008) and procedure duration [RAN 195 (150-255) min vs. SMN 150 (120-150) min; p = 0.001] differed significantly. In terms of acute and 12 months outcome, no differences were seen between the two systems or in comparison to SMN. CONCLUSION AF ablation can be performed safely, with high acute success rates using RAN. RNS results in less fluoroscopy burden and shorter procedure durations. Compared to SMN, a reduced fluoroscopy burden, prolonged procedure and ablation duration were observed using RAN. Overall, the number of RAN procedures is small suggesting low impact on clinical routine of AF ablation.
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Affiliation(s)
- Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Arian Sultan
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital, Heidelberg, Germany
| | - Stephan Willems
- Department of Electrophysiology, Heart Center University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Weinmann
- Department of Cardiology and Angiology, Helios-Klinikum, Pforzheim, Germany
| | - Malte Kuniss
- Department of Cardiology, Heart Center Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | - Roland Tilz
- Department of Cardiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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43
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Jędrzejczyk-Patej E, Boveda S, Kalarus Z, Mazurek M, Gościńska-Bis K, Kiliszek M, Przybylski A, Potpara TS, Tilz R, Fumagalli S, Dagres N, Lenarczyk R. Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: a sub-study of the European Heart Rhythm Association prospective survey. Kardiol Pol 2018; 76:1507-1515. [PMID: 30091137 DOI: 10.5603/kp.a2018.0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/23/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) may be an alternative to transvenous ICD (TV-ICD). AIM We sought to evaluate factors determining the choice of S-ICD vs. TV-ICD in Polish patients in comparison to other European countries. METHODS All consecutive patients who underwent TV-ICD or S-ICD implantation in centres participating in the European Heart Rhythm Association prospective snapshot survey were included. RESULTS During an eight-week study period, 429 patients were recruited, including 136 (31.7%) ICD patients from Poland (eight with S-ICD). In comparison to other European centres, the proportion of S-ICD implantations in Poland was lower (7% vs. 26%, p < 0.001), whereas the ratio of cardiac resynchronisation therapy defibrillator implantations was higher (43% vs. 26%; p < 0.001). Subjects receiving S-ICD in Poland were more often over 75 years old (25% vs. 0%, p < 0.001), in New York Heart Association class II (87.5% vs. 29.4%, p = 0.001), with chronic kidney disease (37.5% vs. 5.9%, p = 0.003), and with lower left ventricular ejection fraction (32% [14%-50%] vs. 50% [25%-60%], p = 0.04), compared to other European countries. Additionally, in comparison to subjects from other European centres, Polish patients were significantly more often implanted with S-ICD due to prior infection (37.5% vs. 1.5%, p < 0.001) and a lack of venous access (25% vs. 0%, p < 0.001), whereas the largest subset of patients in other European countries were implanted with S-ICD because of young age (50% vs. 25%, p = NS). CONCLUSIONS The main reasons leading to S-ICD implantations in Polish patients differ from the indications adopted in other European countries. In Poland, patients referred for TV-ICD or S-ICD implantation had more advanced heart failure and more comorbidities in comparison to subjects from other European countries. S-ICD is still underused in Polish patients.
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Affiliation(s)
- Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland.
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44
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Scherr D, Laroche C, Tilz R, Missiamenou V, Folkesson E, Dagres N, Brugada Terradellas J, Arbelo E. P3827Is there a difference in rhythm outcome between patients undergoing first line versus second line paroxysmal atrial fibrillation ablation? Results of the EORP AF Ablation Long-Term Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3827] [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)
- D Scherr
- Medical University of Graz, Graz, Austria
| | | | - R Tilz
- Medical University, Lübeck, Germany
| | | | | | - N Dagres
- Leipzig University Hospital, Leipzig, Germany
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Barcelona, Spain
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45
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Schmidt B, Brugada J, Arbelo E, Laroche C, Bayramova S, Bertini M, Letsas K, Pison L, Pokushalov E, Romanov D, Scherr D, Tilz R, Maggioni A, Dagres N. 1011Ablation Strategies for different types of atrial fibrillation in Europe - Results of the EORP Atrial Fibrillation Ablation Long-Term Registry. Europace 2018. [DOI: 10.1093/europace/euy015.560] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - J Brugada
- University of Barcelona, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Barcelona, Spain
| | - C Laroche
- European Society of Cardiology, Sophia-Antipolis, France
| | - S Bayramova
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - M Bertini
- Arcispedale Sant'Anna, Ferrara, Italy
| | - K Letsas
- “KAT” General Hospital of Attica, Athens, Greece
| | - L Pison
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - D Romanov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - D Scherr
- Medical University of Graz, Graz, Austria
| | - R Tilz
- Medical University, Lübeck, Germany
| | - A Maggioni
- European Society of Cardiology, Sophia-Antipolis, France
| | - N Dagres
- Heart Center of Leipzig, Leipzig, Germany
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46
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Scherr D, Dagres N, Brugada J, Laroche C, Tilz R, Schmidt B, Maggioni AP, Pokushalov E, Kautzner J, Tavazzi L, Blomstroem Lundqvist C, Arbelo E. 1017Is there a difference in rhythm outcome between patients undergoing first line versus second line paroxysmal atrial fibrillation ablation? - Results of the EORP AF Ablation Long-Term Registry. Europace 2018. [DOI: 10.1093/europace/euy015.566] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Scherr
- Medical University of Graz, Graz, Austria
| | - N Dagres
- Heart Center of Leipzig, Leipzig, Germany
| | - J Brugada
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Laroche
- European Society of Cardiology (ESC), Sophia Antipolis, France
| | - R Tilz
- University of Lubeck, Lubeck, Germany
| | - B Schmidt
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | | | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - L Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | | | - E Arbelo
- Hospital Clinic de Barcelona, Barcelona, Spain
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47
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Yalin K, Lyan E, Abdin A, Sawan N, Eitel C, Thiele H, Eitel I, Tilz R. P1109Safety and efficacy of persistent atrial fibrillation ablation using the second generation cryoballoon. Europace 2018. [DOI: 10.1093/europace/euy015.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - H Thiele
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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48
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Abdin A, Sieg HJ, Eitel C, Eitel I, Tilz R. P377Incidence and predictors for left atrial appendage thrombus in patients with left atrial arrhythmia. Europace 2018. [DOI: 10.1093/europace/euy015.188] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Abdin
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - H J Sieg
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - C Eitel
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - I Eitel
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - R Tilz
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
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49
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Lyan E, Yalin K, Abdin A, Sawan N, Eitel C, Eitel I, Tilz R. P753Mechanism of atrial tachycardia following atrial fibrillation ablation using the second generation cryoballoon. Europace 2018. [DOI: 10.1093/europace/euy015.358] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
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50
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Yalin K, Lyan E, Abdin A, Sawan N, Eitel C, Thiele H, Eitel I, Tilz R. P1099Safety, acute efficacy, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with pulmonary vein abnormality. Europace 2018. [DOI: 10.1093/europace/euy015.585] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - H Thiele
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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