1
|
Stauffer N, Knecht S, Badertscher P, Krisai P, Hennings E, Serban T, Voellmin G, Osswald S, Sticherling C, Kühne M. Repeat catheter ablation after very late recurrence of atrial fibrillation after pulmonary vein isolation. Europace 2024; 26:euae096. [PMID: 38607938 PMCID: PMC11068271 DOI: 10.1093/europace/euae096] [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: 02/10/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
AIMS Atrial fibrillation (AF) recurs in about one-third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences (VLR) after more than 1 year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after VLR of AF after index CA. METHODS AND RESULTS We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation. Out of 1864 patients included in the registry, 426 patients undergoing a repeat ablation were included in the analysis (28% female, age 63 ± 9.8 years, 46% persistent AF). Two hundred and ninety-one patients (68%) were stratified in the ER group and 135 patients (32%) in the LR group. Pulmonary vein reconnections were a common finding in both groups, with 93% in the ER group compared to 86% in the LR group (P = 0.052). In the LR group, 40 of 135 patients (30%) had a recurrence of AF compared to 90 of 291 patients (31%) in the ER group (log-rank P = 0.72). CONCLUSION There was no association between the time to recurrence of AF after initial CA and the characteristics and outcomes of the repeat procedure.
Collapse
Affiliation(s)
- Niklas Stauffer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Elisa Hennings
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| |
Collapse
|
2
|
Serban T, Hennings E, Strebel I, Knecht S, du Fay de Lavallaz J, Krisai P, Arnet R, Völlmin G, Osswald S, Sticherling C, Kühne M, Badertscher P. Biomarkers to predict improvement of left ventricular ejection fraction after atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)02371-3. [PMID: 38614192 DOI: 10.1016/j.hrthm.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure frequently coexist. Prediction of left ventricular ejection fraction (LVEF) recovery after catheter ablation (CA) for AF remains difficult. OBJECTIVE The purpose of this study was to evaluate the value of biomarkers, alone and in combination with the Antwerp score, to predict LVEF recovery after CA for AF. METHODS Patients undergoing CA for AF with depressed LVEF (<50%) were included. Plasma levels of 13 biomarkers were measured immediately before CA. Patients were categorized into "responders" and "nonresponders" in a similar fashion to the Antwerp score derivation and validation cohorts. The predictive power of the biomarkers alone and combined in outcome prediction was evaluated. RESULTS A total of 208 patients with depressed LVEF were included (median age 63 years; 19% female; median indexed left atrial volume 42 mL/m2; median LVEF 43%). At a median follow-up time of 30 months, 161 (77%) were responders and 47 (23%) were nonresponders. Of 13 biomarkers, 4-angiopoietin 2 (ANG2), growth differentiation factor 15 (GDF15), fibroblast growth factor 23, and myosin binding protein C3-were significantly different between responders and nonresponders (P ≤ .001) and combined could predict the end point with an area under the curve of 0.72 (95% confidence interval [CI] 0.64-0.81) overall, 0.69 (95% CI 0.59-0.78) in heart failure with mildly reduced ejection fraction, and 0.88 (95% CI 0.77-0.98) in heart failure with reduced ejection fraction. Only ANG2 and GDF15 remained significantly associated with LVEF recovery after adjustment for age, sex, and Antwerp score and significantly improved the accuracy of the Antwerp score predictions (P < .001). The area under the curve of the Antwerp score in the outcome prediction improved from 0.75 (95% CI 0.67-0.83) to 0.78 (95% CI 0.70-0.86). CONCLUSION A biomarker panel (ANG2 and GDF15) significantly improved the accuracy of the Antwerp score.
Collapse
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Elisa Hennings
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rebecca Arnet
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gian Völlmin
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
3
|
Jordan F, Knecht S, Isenegger C, Arnet R, Krisai P, Völlmin G, du Fay de Lavallaz J, Spreen D, Osswald S, Sticherling C, Kühne M, Badertscher P. Acute kidney injury after catheter ablation of atrial fibrillation: Comparison between different energy sources. Heart Rhythm 2024:S1547-5271(24)02373-7. [PMID: 38608916 DOI: 10.1016/j.hrthm.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 04/02/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Fabian Jordan
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Isenegger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rebecca Arnet
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gian Völlmin
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Spreen
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
4
|
Badertscher P, Serban T, Isenegger C, Krisai P, Voellmin G, Osswald S, Knecht S, Sticherling C, Kühne M. Role of 3D electro-anatomical mapping on procedural characteristics and outcomes in pulsed-field ablation for atrial fibrillation. Europace 2024; 26:euae075. [PMID: 38525649 PMCID: PMC10984560 DOI: 10.1093/europace/euae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Corinne Isenegger
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| |
Collapse
|
5
|
Weidlich S, Mannhart D, Kennedy A, Doggart P, Serban T, Knecht S, Du Fay de Lavallaz J, Kühne M, Sticherling C, Badertscher P. Reducing the burden of inconclusive smart device single-lead ECG tracings via a novel artificial intelligence algorithm. Cardiovasc Digit Health J 2024; 5:29-35. [PMID: 38390580 PMCID: PMC10879015 DOI: 10.1016/j.cvdhj.2023.12.003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background Multiple smart devices capable of automatically detecting atrial fibrillation (AF) based on single-lead electrocardiograms (SL-ECG) are presently available. The rate of inconclusive tracings by manufacturers' algorithms is currently too high to be clinically useful. Method This is a prospective, observational study enrolling patients presenting to a cardiology service at a tertiary referral center. We assessed the clinical value of applying a smart device artificial intelligence (AI)-based algorithm for detecting AF from 4 commercially available smart devices (AliveCor KardiaMobile, Apple Watch 6, Fitbit Sense, and Samsung Galaxy Watch3). Patients underwent a nearly simultaneous 12-lead ECG and 4 smart device SL-ECGs. The novel AI algorithm (PulseAI, Belfast, United Kingdom) was compared with each manufacturer's algorithm. Results We enrolled 206 patients (31% female, median age 64 years). AF was present in 60 patients (29%). Sensitivity and specificity for the detection of AF by the novel AI algorithm vs manufacturer algorithm were 88% vs 81% (P = .34) and 97% vs 77% (P < .001) for the AliveCor KardiaMobile, 86% vs 81% (P = .45) and 95% vs 83% (P < .001) for the Apple Watch 6, 91% vs 67% (P < .01) and 94% vs 82% (P < .001) for the Fitbit Sense, and 86% vs 82% (P = .63) and 94% vs 80% (P < .001) for the Samsung Galaxy Watch3, respectively. In addition, the proportion of SL-ECGs with an inconclusive diagnosis (1.2%) was significantly lower for all smart devices using the AI-based algorithm compared to manufacturer's algorithms (14%-17%), P < .001. Conclusion A novel AI algorithm reduced the rate of inconclusive SL-ECG diagnosis massively while maintaining sensitivity and improving the specificity compared to the manufacturers' algorithms.
Collapse
Affiliation(s)
- Simon Weidlich
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Diego Mannhart
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | | | | | - Teodor Serban
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Sven Knecht
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Jeanne Du Fay de Lavallaz
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Michael Kühne
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Christian Sticherling
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Patrick Badertscher
- University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| |
Collapse
|
6
|
Badertscher P, Mannhart D, Weidlich S, Krisai P, Voellmin G, Osswald S, Knecht S, Sticherling C, Kühne M. Left atrial posterior wall isolation using pulsed-field ablation: procedural characteristics, safety, and mid-term outcomes. J Interv Card Electrophysiol 2024:10.1007/s10840-023-01728-0. [PMID: 38182965 DOI: 10.1007/s10840-023-01728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Non-pulmonary vein (PV) ablation targets such as posterior wall isolation (PWI) have been tested in patients with persistent atrial fibrillation (AF). Pulsed-field ablation (PFA) offers a novel ablation technology possibly able to overcome the obstacles of incomplete PWI and concerns of damage to adjacent structures compared to thermal energy sources. Our aim was to assess procedural characteristics, safety, and mid-term outcomes of patients undergoing PWI using PFA in a clinical setting. METHODS Patients undergoing PFA-PVI with PWI were included. First-pass isolation was controlled using a multipolar mapping catheter. RESULTS One hundred consecutive patients were included (median age 69 [IQR 63-75] years, 33 females (33%), left atrial size 43 [IQR 39-47] mm, paroxysmal AF 24%). Median procedure time was 66 (IQR 59-77) min, and fluoroscopy time was 11 (8-14) min. PWI using PFA was achieved in 100% of patients with a median of 19 applications (IQR 14-26). There were no major complications. Overall, in 15 patients (15%), recurrent AF/AT was noted during a median follow-up of 144 (94-279) days. CONCLUSIONS PWI using PFA appears safe and results in high acute isolation rates and high arrhythmia survival during mid-term follow-up. Further randomized trials are essential and warranted.
Collapse
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Simon Weidlich
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| |
Collapse
|
7
|
Badertscher P, Knecht S. Pedal to the metal: is vHPSD RF ablation now reaching its full potential? J Interv Card Electrophysiol 2024; 67:21-23. [PMID: 37382824 DOI: 10.1007/s10840-023-01599-5] [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] [Received: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
8
|
Badertscher P, Weidlich S, Knecht S, Stauffer N, Krisai P, Voellmin G, Osswald S, Sticherling C, Kühne M. Efficacy and safety of pulmonary vein isolation with pulsed field ablation vs. novel cryoballoon ablation system for atrial fibrillation. Europace 2023; 25:euad329. [PMID: 38036293 PMCID: PMC10751845 DOI: 10.1093/europace/euad329] [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: 09/12/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
AIMS Pulsed-field ablation (PFA) has emerged as a novel treatment technology for patients with atrial fibrillation (AF). Cryoballoon (CB) is the most frequently used single shot technology. A direct comparison to a novel CB system is lacking. We aimed to compare pulmonary vein isolation (PVI) using PFA vs. a novel CB system regarding efficiency, safety, myocardial injury, and outcomes. METHODS AND RESULTS One hundred and eighty-one consecutive patients underwent PVI and were included (age 64 ± 9.7 years, ejection fraction 0.58 ± 0.09, left atrial size 40 ± 6.4 mm, paroxysmal AF 64%). 106 patients (59%) underwent PFA (FARAPULSE, Boston Scientific) and 75 patients (41%) underwent CB ablation (PolarX, Boston Scientific). The median procedure time, left atrial dwell time and fluoroscopic time were similar between the PFA and the CB group with 55 [interquartile range (IQR) 43-64] min vs. 58 (IQR 48-69) min (P < 0.087), 38 (30-49) min vs. 37 (31-48) min, (P = 0.871), and 11 (IQR 9.3-14) min vs. 11 (IQR 8.7-16) min, (P < 0.81), respectively. Three procedural complications were observed in the PFA group (two tamponades, one temporary ST elevation) and three complications in the CB group (3× reversible phrenic nerve palsies). During the median follow-up of 404 days (IQR 208-560), AF recurrence was similar in the PFA group and the CB group with 24 vs. 30%, P = 0.406. CONCLUSION Procedural characteristics were very similar between PFA and CB in regard to procedure duration fluoroscopy time and complications. Atrial fibrillation free survival did not differ between the PFA and CB groups.
Collapse
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Simon Weidlich
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Niklas Stauffer
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| |
Collapse
|
9
|
Saguner AM, Lunk D, Mohsen M, Knecht S, Akdis D, Costa S, Gasperetti A, Duru F, Rossi VA, Brunckhorst CB. Electroanatomical voltage mapping with contact force sensing for diagnosis of arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2023; 392:131289. [PMID: 37619879 DOI: 10.1016/j.ijcard.2023.131289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Three-dimensional electroanatomical mapping (EAM) can be helpful to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC). Yet, previous studies utilizing EAM have not systematically used contact-force sensing catheters (CFSC) to characterize the substrate in ARVC, which is the current gold standard to assure adequate tissue contact. OBJECTIVE To investigate reference values for endocardial right ventricular (RV) EAM as well as substrate characterization in patients with ARVC by using CFSC. METHODS Endocardial RV EAM during sinus rhythm was performed with CFSC in 12 patients with definite ARVC and 5 matched controls without structural heart disease. A subanalysis for the RV outflow tract (RVOT), septum, free-wall, subtricuspid region, and apex was performed. Endocardial bipolar and unipolar voltage amplitudes (BVA, UVA), signal characteristics and duration as well as the impact of catheter orientation on endocardial signals were also investigated. RESULTS ARVC patients showed lower BVA vs. controls (p = 0.018), particularly in the subtricuspid region (1.4, IQR:0.5-3.1 vs. 3.8, IQR:2.5-5 mV, p = 0.037) and RV apex (2.5, IQR:1.5-4 vs. 4.3,IQR:2.9-6.1 mV, p = 0.019). BVA in all RV regions yielded a high sensitivity and specificity for ARVC diagnosis (AUC 59-78%, p < 0.05 for all), with the highest performance for the subtricuspid region (AUC 78%, 95% CI:0.75-0.81, p < 0.001, negative predictive value 100%). A positive correlation between BVA and an orthogonal catheter orientation (46°-90°:r = 0.106, p < 0.001), and a negative correlation between BVA and EGM duration (r = -0.370, p < 0.001) was found. CONCLUSIONS EAM using CFSC validates previous bipolar cut-off values for normal endocardial RV voltage amplitudes. RV voltages are generally lower in ARVC as compared to controls, with the subtricuspid area being commonly affected and having the highest discriminatory power to differentiate between ARVC and healthy controls. Therefore, EAM using CFSC constitutes a promising tool for diagnosis of ARVC.
Collapse
Affiliation(s)
- A M Saguner
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland.
| | - D Lunk
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - M Mohsen
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, Qatar Heart Hospital 7GR5+RW4, Doha, Qatar
| | - Sven Knecht
- Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deniz Akdis
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - S Costa
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - A Gasperetti
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - F Duru
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - V A Rossi
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - C B Brunckhorst
- Arrhythmia Division, Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Schlageter V, Badertscher P, Luca A, Krisai P, Spies F, Kueffer T, Osswald S, Vesin JM, Kühne M, Sticherling C, Knecht S. A single-beat algorithm to discriminate farfield from nearfield bipolar voltage electrograms from the pulmonary veins. J Interv Card Electrophysiol 2023; 66:2047-2054. [PMID: 37014482 PMCID: PMC10694100 DOI: 10.1007/s10840-023-01535-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Superimposition of farfield (FF) and nearfield (NF) bipolar voltage electrograms (BVE) complicates the confirmation of pulmonary vein (PV) isolation after catheter ablation of atrial fibrillation. Our aim was to develop an automatic algorithm based on a single-beat analysis to discriminate PV NF from atrial FF BVE from a circular mapping catheter during the cryoballoon PV isolation. METHODS During freezing cycles in cryoablation PVI, local NF and distant FF signals were recorded, identified and labelled. BVEs were classified using four different machine learning algorithms based on four frequency domain (high-frequency power (PHF), low-frequency power (PLF), relative high power band, PHF ratio of neighbouring electrodes) and two time domain features (amplitude (Vmax), slew rate). The algorithm-based classification was compared to the true identification gained during the PVI and to a classification by cardiac electrophysiologists. RESULTS We included 335 BVEs from 57 consecutive patients. Using a single feature, PHF with a cut-off at 150 Hz showed the best overall accuracy for classification (79.4%). By combining PHF with Vmax, overall accuracy was improved to 82.7% with a specificity of 89% and a sensitivity of 77%. The overall accuracy was highest for the right inferior PV (96.6%) and lowest for the left superior PV (76.9%). The algorithm showed comparable accuracy to the classification by the EP specialists. CONCLUSIONS An automated farfield-nearfield discrimination based on two simple features from a single-beat BVE is feasible with a high specificity and comparable accuracy to the assessment by experienced cardiac electrophysiologists.
Collapse
Affiliation(s)
- Vincent Schlageter
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adrian Luca
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
11
|
Serban T, Mannhart D, Abid QUA, Höchli A, Lazar S, Krisai P, Bettelini AS, Knecht S, Kühne M, Sticherling C, du Fay de Lavallaz J, Badertscher P. Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review. Europace 2023; 25:euad335. [PMID: 37944133 PMCID: PMC10664405 DOI: 10.1093/europace/euad335] [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: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.
Collapse
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | | | - Andres Höchli
- Department of Cardiology, Triemli Stadtspital, Zürich, Switzerland
| | - Sorin Lazar
- Department of Cardiology, Cook County Health, Chicago, IL, USA
| | - Philipp Krisai
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Arianna Sofia Bettelini
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| |
Collapse
|
12
|
Maurhofer J, Kueffer T, Knecht S, Madaffari A, Badertscher P, Seiler J, Krisai P, Jufer C, Asatryan B, Heg D, Servatius H, Tanner H, Kühne M, Roten L, Sticherling C, Reichlin T. Comparison of the PolarX and the Arctic Front cryoballoon for pulmonary vein isolation in patients with symptomatic paroxysmal atrial fibrillation (COMPARE CRYO) - Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 134:107341. [PMID: 37722483 DOI: 10.1016/j.cct.2023.107341] [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: 07/01/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Single-shot devices are increasingly used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The Arctic Front cryoballoon (Medtronic) is the most frequently used single-shot technology. A recently developed novel cryoballoon has been introduced (PolarX, Boston Scientific) with the aim to address limitations of the Arctic Front system. METHODS COMPARE CRYO is a multicentre, randomized, controlled trial with blinded endpoint adjudication by an independent clinical events committee. A total of 200 patients with paroxysmal AF undergoing their first PVI are randomized 1:1 between PolarX cryoballoon ablation and Arctic Front cryoballoon ablation. Continuous monitoring during follow-up is performed using an implantable cardiac monitor (ICM) in all patients. The primary endpoint is time to first recurrence of any atrial tachyarrhythmia (AF, atrial flutter, and/or atrial tachycardia) ≥ 120 s between days 91 and 365 post ablation as detected on the (ICM). Procedural safety is assessed by a composite of cardiac tamponade, persistent phrenic nerve palsy >24 h, vascular complications requiring intervention, stroke/transient ischemic attack, atrioesophageal fistula or death occurring during or up to 30 days after the procedure. Key secondary endpoints include (1) procedure and fluoroscopy times, (2) AF burden, (3) proportion of patients with recurrence in the blanking period, (4) proportion of patients undergoing repeat ablation, and (5) quality of life changes at 12 months compared to baseline. CONCLUSION COMPARE CRYO will compare the efficacy and safety of the novel PolarX cryoballoon and the standard-of-practice Arctic Front cryoballoon for first PVI performed in patients with symptomatic paroxysmal AF. TRIAL REGISTRATION (ClinicalTrials.gov ID: NCT04704986).
Collapse
Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Jufer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
13
|
Bourquin L, Küffer T, Asatryan B, Badertscher P, Baldinger SH, Knecht S, Seiler J, Spies F, Servatius H, Kühne M, Noti F, Osswald S, Haeberlin A, Tanner H, Roten L, Reichlin T, Sticherling C. Validation of a clinical model for predicting left versus right ventricular outflow tract origin of idiopathic ventricular arrhythmias. Pacing Clin Electrophysiol 2023; 46:1186-1196. [PMID: 37616339 DOI: 10.1111/pace.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Prediction of the chamber of origin in patients with outflow tract ventricular arrhythmias (OTVA) remains challenging. A clinical risk score based on age, sex and presence of hypertension was associated with a left ventricular outflow tract (LVOT) origin. We aimed to validate this clinical score to predict an LVOT origin in patients with OTVA. METHODS In a two-center observational cohort study, unselected patients undergoing catheter ablation (CA) for OTVA were enrolled. All procedures were performed using an electroanatomical mapping system. Successful ablation was defined as a ≥80% reduction of the initial overall PVC burden after 3 months of follow-up. Patients with unsuccessful ablation were excluded from this analysis. RESULTS We included 187 consecutive patients with successful CA of idiopathic OTVA. Mean age was 52 ± 15 years, 102 patients (55%) were female, and 74 (40%) suffered from hypertension. A LVOT origin was found in 64 patients (34%). A score incorporating age, sex and presence of hypertension reached 73% sensitivity and 67% specificity for a low (0-1) and high (2-3) score, to predict an LVOT origin. The combination of one ECG algorithm (V2 S/V3 R-index) with the clinical score resulted in a sensitivity and specificity of 81% and 70% for PVCs with R/S transition at V3 . CONCLUSION The published clinical score yielded a lower sensitivity and specificity in our cohort. However, for PVCs with R/S transition at V3, the combination with an existing ECG algorithm can improve the predictability of LVOT origin.
Collapse
Affiliation(s)
- Luc Bourquin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Spies
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| |
Collapse
|
14
|
Weidlich S, Mannhart D, Serban T, Krisai P, Knecht S, Du Fay de Lavallaz J, Müller T, Schaer B, Osswald S, Kühne M, Sticherling C, Badertscher P. Accuracy in detecting atrial fibrillation in single-lead ECGs: an online survey comparing the influence of clinical expertise and smart devices. Swiss Med Wkly 2023; 153:40096. [PMID: 37769610 DOI: 10.57187/smw.2023.40096] [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] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Manual interpretation of single-lead ECGs (SL-ECGs) is often required to confirm a diagnosis of atrial fibrillation. However accuracy in detecting atrial fibrillation via SL-ECGs may vary according to clinical expertise and choice of smart device. AIMS To compare the accuracy of cardiologists, internal medicine residents and medical students in detecting atrial fibrillation via SL-ECGs from five different smart devices (Apple Watch, Fitbit Sense, KardiaMobile, Samsung Galaxy Watch, Withings ScanWatch). Participants were also asked to assess the quality and readability of SL-ECGs. METHODS In this prospective study (BaselWearableStudy, NCT04809922), electronic invitations to participate in an online survey were sent to physicians at major Swiss hospitals and to medical students at Swiss universities. Participants were asked to classify up to 50 SL-ECGs (from ten patients and five devices) into three categories: sinus rhythm, atrial fibrillation or inconclusive. This classification was compared to the diagnosis via a near-simultaneous 12-lead ECG recording interpreted by two independent cardiologists. In addition, participants were asked their preference of each manufacturer's SL-ECG. RESULTS Overall, 450 participants interpreted 10,865 SL-ECGs. Sensitivity and specificity for the detection of atrial fibrillation via SL-ECG were 72% and 92% for cardiologists, 68% and 86% for internal medicine residents, 54% and 65% for medical students in year 4-6 and 44% and 58% for medical students in year 1-3; p <0.001. Participants who stated prior experience in interpreting SL-ECGs demonstrated a sensitivity and specificity of 63% and 81% compared to a sensitivity and specificity of 54% and 67% for participants with no prior experience in interpreting SL-ECGs (p <0.001). Of all participants, 107 interpreted all 50 SL-ECGs. Diagnostic accuracy for the first five interpreted SL-ECGs was 60% (IQR 40-80%) and diagnostic accuracy for the last five interpreted SL-ECGs was 80% (IQR 60-90%); p <0.001. No significant difference in the accuracy of atrial fibrillation detection was seen between the five smart devices; p = 0.33. SL-ECGs from the Apple Watch were considered as having the best quality and readability by 203 (45%) and 226 (50%) participants, respectively. CONCLUSION SL-ECGs can be challenging to interpret. Accuracy in correctly identifying atrial fibrillation depends on clinical expertise, while the choice of smart device seems to have no impact.
Collapse
Affiliation(s)
- Simon Weidlich
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne Du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tatjana Müller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
15
|
Badertscher P, Weidlich S, Serban T, Krisai P, Voellmin G, Osswald S, Knecht S, Sticherling C, Kühne M. Pulsed-field ablation versus single-catheter high-power short-duration radiofrequency ablation for atrial fibrillation: Procedural characteristics, myocardial injury, and mid-term outcomes. Heart Rhythm 2023; 20:1277-1278. [PMID: 37169160 DOI: 10.1016/j.hrthm.2023.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Simon Weidlich
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
16
|
Knecht S, Waldmann F, Kuhn R, Mannhart D, Kühne M, Sticherling C, Badertscher P, Wildhaber RA. Technical Characterization of Single-Lead ECG Signals From 4 Different Smartwatches and its Potential Clinical Implications. JACC Clin Electrophysiol 2023; 9:1415-1417. [PMID: 37074248 DOI: 10.1016/j.jacep.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 04/20/2023]
|
17
|
Serban T, Knecht S, Mannhart D, Nestelberger T, Kaiser C, Leibundgut G, Bischof MA, Sticherling C, Kühne M, Badertscher P. Sex-specific Differences in Infranodal Conduction Properties in Patients Undergoing Transcatheter Aortic Valve Replacement. J Cardiovasc Transl Res 2023; 16:968-970. [PMID: 36884130 PMCID: PMC10480272 DOI: 10.1007/s12265-023-10366-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Maurice Antoine Bischof
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| |
Collapse
|
18
|
Hennings E, Aeschbacher S, Coslovsky M, Paladini RE, Meyre PB, Voellmin G, Blum L, Kastner P, Ziegler A, Conen D, Zuern CS, Krisai P, Badertscher P, Sticherling C, Osswald S, Knecht S, Kühne M. Association of bone morphogenetic protein 10 and recurrent atrial fibrillation after catheter ablation. Europace 2023; 25:euad149. [PMID: 37314197 PMCID: PMC10265951 DOI: 10.1093/europace/euad149] [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: 04/17/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS Atrial remodelling, defined as a change in atrial structure, promotes atrial fibrillation (AF). Bone morphogenetic protein 10 (BMP10) is an atrial-specific biomarker released to blood during atrial development and structural changes. We aimed to validate whether BMP10 is associated with AF recurrence after catheter ablation (CA) in a large cohort of patients. METHODS AND RESULTS We measured baseline BMP10 plasma concentrations in AF patients who underwent a first elective CA in the prospective Swiss-AF-PVI cohort study. The primary outcome was AF recurrence lasting longer than 30 s during a follow-up of 12 months. We constructed multivariable Cox proportional hazard models to determine the association of BMP10 and AF recurrence. A total of 1112 patients with AF (age 61 ± 10 years, 74% male, 60% paroxysmal AF) was included in our analysis. During 12 months of follow-up, 374 patients (34%) experienced AF recurrence. The probability for AF recurrence increased with increasing BMP10 concentration. In an unadjusted Cox proportional hazard model, a per-unit increase in log-transformed BMP10 was associated with a hazard ratio (HR) of 2.28 (95% CI 1.43; 3.62, P < 0.001) for AF recurrence. After multivariable adjustment, the HR of BMP10 for AF recurrence was 1.98 (95% CI 1.14; 3.42, P = 0.01), and there was a linear trend across BMP10 quartiles (P = 0.02 for linear trend). CONCLUSION The novel atrial-specific biomarker BMP10 was strongly associated with AF recurrence in patients undergoing CA for AF. CLINICALTRIALS.GOV IDENTIFIER NCT03718364; https://clinicaltrials.gov/ct2/show/NCT03718364.
Collapse
Affiliation(s)
- Elisa Hennings
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Coslovsky
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rebecca E Paladini
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Pascal B Meyre
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Gian Voellmin
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Livia Blum
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | | | - André Ziegler
- Roche Diagnostics International AG, Rotkreuz, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Christine S Zuern
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
- Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| |
Collapse
|
19
|
Serban T, Knecht S, du Lavallaz JDF, Nestelberger T, Kaiser C, Leibundgut G, Osswald S, Schaer B, Sticherling C, Kühne M, Badertscher P. Ventricular pacing burden in patients with left bundle branch block after transcatheter aortic valve replacement therapy. J Cardiovasc Electrophysiol 2023; 34:1464-1468. [PMID: 37146212 DOI: 10.1111/jce.15920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/12/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Electrophysiological testing has been proposed in the latest European Society of Cardiology (ESC) guidelines for cardiac pacing to identify left bundle branch block (LBBB) patients with infrahisian conduction delay (IHCD) after transcatheter aortic valve replacement (TAVR). While in general IHCD is defined by a His-ventricular (HV) interval of >55 ms, a cut-off of ≥70 ms to trigger pacemaker (PM) implantation has been proposed in the latest ESC guidelines. The ventricular pacing (VP) burden during follow-up in such patients is largely unknown. As such, we aimed to assess the VP burden during follow-up of patients receiving PM therapy for LBBB after TAVR based on an HV interval > 55 ms and ≥70 ms. METHODS All patients with new-onset or pre-existing LBBB after undergoing TAVR at a tertiary referral center underwent EP testing the day after TAVR. In patients with a prolonged HV interval (>55 ms), PM implantation was performed by a trained electrophysiologist in a standardized fashion. All devices were programmed to avoid unnecessary VP by specific algorithms (e.g., AAI-DDD). RESULTS 701 patients underwent TAVR at the University Hospital of Basel. One hundred seventy-seven patients presented with new-onset or pre-existing LBBB the day following TAVR and underwent EP testing. An HV interval > 55 ms was found in 58 patients (33%) and an HV interval ≥ 70 ms in 21 patients (12%). 51 patients (mean age 84 ± 6.2 years, 45% women) agreed to receive a PM, out of which 20 (39%) patients had an HV Interval over 70 ms. Atrial fibrillation was present in 53% of the patients. A dual chamber PM was implanted in 39 (77%), and a single chamber PC in 12 (23%) patients, respectively. Median follow-up was 21 months. The median VP burden overall was 3%. The median VP burden was not significantly different between patients with an HV ≥ 70 ms (6.5 [0.8-52]) and those with an HV between 55 and 69 ms (2 [0-17], p = .23). 31% of patients demonstrated a VP burden < 1%, 27% 1%-5% and 41% > 5%. The median HV intervals in patients with VP burdens < 1%, 1%-5% and >5% were 66 (IQR 62-70) ms, 66 (IQR 63-74) ms and 68 (IQR 60-72) ms, respectively, p = .52. When only assessing patients with an HV interval 55-69 ms, 36% demonstrated a VP burden of <1%, 29% of 1%-5% and 35% of >5%. In patients with an HV Interval ≥ 70 ms, 25% demonstrated a VP burden < 1%, 25% of 1%-5% and 50% of >5% %, p = .64 (Figure). CONCLUSION In patients with LBBB after TAVR and IHCD defined by an HV interval > 55 ms, VP burden is relevant in a non-negligible amount of patients during follow-up. Further studies are warranted to define the optimal cut-off value for the HV interval or to develop risk models incorporating HV measurements and other risk factors to trigger PM implantation in patients with LBBB after TAVR.
Collapse
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jeanne du Fay du Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
20
|
Badertscher P, Weidlich S, Stauffer N, Krisai P, Voellmin G, Knecht S, Sticherling C, Kühne M. Impact of a standardized pacing protocol on endpoint verification and first pass isolation using a multipolar pulsed-field ablation catheter for pulmonary vein isolation. Heart Rhythm 2023:S1547-5271(23)02317-2. [PMID: 37247685 DOI: 10.1016/j.hrthm.2023.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/10/2023] [Revised: 05/20/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Simon Weidlich
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Niklas Stauffer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Gian Voellmin
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
21
|
Serban T, du Fay de Lavallaz J, Mannhart D, Pfister O, van der Stouwe JG, Kaufmann BA, Knecht S, Kühne M, Sticherling C, Badertscher P. Echocardiographic pattern of left ventricular function recovery in tachycardia-induced cardiomyopathy patients. ESC Heart Fail 2023. [PMID: 37218391 PMCID: PMC10375182 DOI: 10.1002/ehf2.14365] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/02/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Tachycardia-induced cardiomyopathy (TCM) represents a partially reversible type of cardiomyopathy (CM) that is often underdiagnosed and cardiac chamber remodelling in TCM remains incompletely understood. We aim to explore differences in the dimensions of the left ventricle and functional recovery in patients with TCM compared with patients with other forms of CM. METHODS AND RESULTS We identified patients with reduced ejection fraction (≤50%) and/or atrial fibrillation or flutter with a left ventricular ejection fraction that improved from baseline (≥15% in left ventricular ejection fraction at follow-up or normalization of cardiac function with at least 10% improvement). Patients were then divided into two groups: (A) TCM patients and (B) patients with other forms of CM (controls). Two hundred thirty-eight patients were included (31% female, 70 years median age), 127 patients had TCM, and 111 had other forms of CM. Patients with TCM did not significantly improve indexed left ventricular volume (LVEDVI) after treatment (60 [45, 84] mL/m2 versus 56 [45, 70] mL/m2 , P = ns) compared with controls (67 [54, 81] mL/m2 versus 52 [42, 69] mL/m2 , P < 0.001). Patients with TCM patients had significantly worse fractional shortening at baseline than controls (15.5 [12, 23] vs. 20 [13, 30], P = 0.01) and higher indexed left atrial volume (LAVI) at baseline than controls (48 [37, 58] vs. 41 [33, 51], P = 0.01) that remained dilated at follow-up (follow-up LAVI 41 [33, 52] mL/m2 ). Good predictors of TCM were: normal LVEDVI (LVEDVI < 58 mL/m2 (M) and < 52 mL/m2 (F)) (odds ratio [OR] 5.2; 95% confidence interval [CI] 2.2-13.3, P < 0.001), fractional shortening < 30% (OR 3.5; 95% CI 1.4-9.2, P = 0.009), LAVI >40 mL/m2 (OR 3.4; 95% CI 1.6-7.3, P = 0.001) and normal wall thickness left ventricle (OR 3.2; 95% CI 1.4-7.8, P = 0.008). 54% of patients with TCM demonstrated diastolic dysfunction at follow-up, without differences from controls (54% vs. 43%, P = ns). 21% of patients with TCM showed persistent heart failure symptoms at follow-up compared with 4.5% of controls, P = 0.004. CONCLUSIONS TCM patients have a specific pattern of functional recovery with persistent remodelling of the left atria and left ventricle. Several echocardiographic parameters might help identify TCM before treatment.
Collapse
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jan Gerrit van der Stouwe
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
22
|
Knecht S, Schlageter V, Badertscher P, Krisai P, Jousset F, Küffer T, Madaffari A, Schaer B, Osswald S, Sticherling C, Kühne M. Atrial substrate characterization based on bipolar voltage electrograms acquired with multipolar, focal and mini-electrode catheters. Europace 2023; 25:euad127. [PMID: 37165671 PMCID: PMC10228606 DOI: 10.1093/europace/euad127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Bipolar voltage (BV) electrograms for left atrial (LA) substrate characterization depend on catheter design and electrode configuration. AIMS The aim of the study was to investigate the relationship between the BV amplitude (BVA) using four catheters with different electrode design and to identify their specific LA cutoffs for scar and healthy tissue. METHODS AND RESULTS Consecutive high-resolution electroanatomic mapping was performed using a multipolar-minielectrode Orion catheter (Orion-map), a duo-decapolar circular mapping catheter (Lasso-map), and an irrigated focal ablation catheter with minielectrodes (Mifi-map). Virtual remapping using the Mifi-map was performed with a 4.5 mm tip-size electrode configuration (Nav-map). BVAs were compared in voxels of 3 × 3 × 3 mm3. The equivalent BVA cutoff for every catheter was calculated for established reference cutoff values of 0.1, 0.2, 0.5, 1.0, and 1.5 mV. We analyzed 25 patients (72% men, age 68 ± 15 years). For scar tissue, a 0.5 mV cutoff using the Nav corresponds to a lower cutoff of 0.35 mV for the Orion and of 0.48 mV for the Lasso. Accordingly, a 0.2 mV cutoff corresponds to a cutoff of 0.09 mV for the Orion and of 0.14 mV for the Lasso. For healthy tissue cutoff at 1.5 mV, a larger BVA cutoff for the small electrodes of the Orion and the Lasso was determined of 1.68 and 2.21 mV, respectively. CONCLUSION When measuring LA BVA, significant differences were seen between focal, multielectrode, and minielectrode catheters. Adapted cutoffs for scar and healthy tissue are required for different catheters.
Collapse
Affiliation(s)
- Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vincent Schlageter
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Jousset
- Boston Scientific, Rhythm Management, Solothurn, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
23
|
Mannhart D, Lefebvre B, Gardella C, Henry C, Serban T, Knecht S, Kühne M, Sticherling C, Badertscher P. Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms. Arch Cardiovasc Dis 2023; 116:249-257. [PMID: 37183163 DOI: 10.1016/j.acvd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Several smart devices are able to detect atrial fibrillation automatically by recording a single-lead electrocardiogram, and have created a work overload at the hospital level as a result of the need for over-reads by physicians. AIM To compare the atrial fibrillation detection performances of the manufacturers' algorithms of five smart devices and a novel deep neural network-based algorithm. METHODS We compared the rate of inconclusive tracings and the diagnostic accuracy for the detection of atrial fibrillation between the manufacturers' algorithms and the deep neural network-based algorithm on five smart devices, using a physician-interpreted 12-lead electrocardiogram as the reference standard. RESULTS Of the 117 patients (27% female, median age 65 years, atrial fibrillation present at time of recording in 30%) included in the final analysis (resulting in 585 analyzed single-lead electrocardiogram tracings), the deep neural network-based algorithm exhibited a higher conclusive rate relative to the manufacturer algorithm for all five models: 98% vs. 84% for Apple; 99% vs. 81% for Fitbit; 96% vs. 77% for AliveCor; 99% vs. 85% for Samsung; and 97% vs. 74% for Withings (P<0.01, for each model). When applying our deep neural network-based algorithm, sensitivity and specificity to correctly identify atrial fibrillation were not significantly different for all assessed smart devices. CONCLUSION In this clinical validation, the deep neural network-based algorithm significantly reduced the number of tracings labeled inconclusive, while demonstrating similarly high diagnostic accuracy for the detection of atrial fibrillation, thereby providing a possible solution to the data surge created by these smart devices.
Collapse
Affiliation(s)
| | | | | | | | - Teodor Serban
- University Hospital of Basel, 4031 Basel, Switzerland
| | - Sven Knecht
- University Hospital of Basel, 4031 Basel, Switzerland
| | - Michael Kühne
- University Hospital of Basel, 4031 Basel, Switzerland
| | | | | |
Collapse
|
24
|
Hennings E, Blum S, Aeschbacher S, Coslovsky M, Knecht S, Eken C, Lischer M, Paladini RE, Krisai P, Reichlin T, Rodondi N, Beer JH, Ammann P, Conte G, De Perna ML, Kobza R, Blum MR, Bossard M, Kastner P, Ziegler A, Müller C, Bonati LH, Pfister O, Zuern CS, Conen D, Kühne M, Osswald S. Bone Morphogenetic Protein 10-A Novel Biomarker to Predict Adverse Outcomes in Patients With Atrial Fibrillation. J Am Heart Assoc 2023; 12:e028255. [PMID: 36926939 PMCID: PMC10111531 DOI: 10.1161/jaha.122.028255] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 03/18/2023]
Abstract
Background Patients with atrial fibrillation (AF) face an increased risk of death and major adverse cardiovascular events (MACE). We aimed to assess the predictive value of the novel atrial-specific biomarker BMP10 (bone morphogenetic protein 10) for death and MACE in patients with AF in comparison with NT-proBNP (N-terminal prohormone of B-type natriuretic peptide). Methods and Results BMP10 and NT-proBNP were measured in patients with AF enrolled in Swiss-AF (Swiss Atrial Fibrillation Study), a prospective multicenter cohort study. A total of 2219 patients were included (median follow-up 4.3 years [interquartile range 3.9, 5.1], mean age 73±9 years, 73% male). In multivariable Cox proportional hazard models, the adjusted hazard ratio (aHR) associated with 1 ng/mL increase of BMP10 was 1.60 (95% CI, 1.37-1.87) for all-cause death, and 1.54 (95% CI, 1.35-1.76) for MACE. For all-cause death, the concordance index was 0.783 (95% CI, 0.763-0.809) for BMP10, 0.784 (95% CI, 0.765-0.810) for NT-proBNP, and 0.789 (95% CI, 0.771-0.815) for both biomarkers combined. For MACE, the concordance index was 0.732 (95% CI, 0.715-0.754) for BMP10, 0.747 (95% CI, 0.731-0.768) for NT-proBNP, and 0.750 (95% CI, 0.734-0.771) for both biomarkers combined. When grouping patients according to NT-proBNP categories (<300, 300-900, >900 ng/L), higher aHRs were observed in patients with high BMP10 in the categories of low NT-proBNP (all-cause death aHR, 2.28 [95% CI, 1.15-4.52], MACE aHR, 1.88 [95% CI, 1.07-3.28]) and high NT-proBNP (all-cause death aHR, 1.61 [95% CI, 1.14-2.26], MACE aHR, 1.38 [95% CI, 1.07-1.80]). Conclusions BMP10 strongly predicted all-cause death and MACE in patients with AF. BMP10 provided additional prognostic information in low- and high-risk patients according to NT-proBNP stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
Collapse
Affiliation(s)
- Elisa Hennings
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Steffen Blum
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Michael Coslovsky
- Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Sven Knecht
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Ceylan Eken
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Mirko Lischer
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Rebecca E. Paladini
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Philipp Krisai
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Tobias Reichlin
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Nicolas Rodondi
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
| | - Jürg H. Beer
- Department of Internal MedicineCantonal Hospital BadenBadenSwitzerland
| | - Peter Ammann
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Giulio Conte
- Cardiocentro Ticino InstituteEnte Ospedaliero CantonaleLuganoSwitzerland
| | | | - Richard Kobza
- Cardiology DivisionHeart Center, Luzerner KantonsspitalLuzernSwitzerland
| | - Manuel R. Blum
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
| | - Matthias Bossard
- Cardiology DivisionHeart Center, Luzerner KantonsspitalLuzernSwitzerland
| | | | - André Ziegler
- Roche Diagnostics International AGRotkreuzSwitzerland
| | - Christian Müller
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Leo H. Bonati
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- Department of Neurology and Stroke CenterUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Otmar Pfister
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christine S. Zuern
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - David Conen
- Population Health Research InstituteMcMaster UniversityHamiltonCanada
| | - Michael Kühne
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Stefan Osswald
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | | |
Collapse
|
25
|
Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Madaffari A, Seiler J, Mühl A, Tanner H, Roten L, Reichlin T. Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters. J Cardiovasc Electrophysiol 2023; 34:292-299. [PMID: 36490307 DOI: 10.1111/jce.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
26
|
Mannhart D, Lischer M, Knecht S, du Fay de Lavallaz J, Strebel I, Serban T, Vögeli D, Schaer B, Osswald S, Mueller C, Kühne M, Sticherling C, Badertscher P. Clinical Validation of 5 Direct-to-Consumer Wearable Smart Devices to Detect Atrial Fibrillation: BASEL Wearable Study. JACC Clin Electrophysiol 2023; 9:232-242. [PMID: 36858690 DOI: 10.1016/j.jacep.2022.09.011] [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: 06/15/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multiple smart devices capable to detect atrial fibrillation (AF) are presently available. Sensitivity and specificity for the detection of AF may differ between available smart devices, and this has not yet been adequately investigated. OBJECTIVES The aim was to assess the accuracy of 5 smart devices in identifying AF compared with a physician-interpreted 12-lead electrocardiogram as the reference standard in a real-world cohort of patients. METHODS We consecutively enrolled patients presenting to a cardiology service at a tertiary referral center in a prospective, diagnostic study. RESULTS We prospectively analyzed 201 patients (31% women, median age 66.7 years). AF was present in 62 (31%) patients. Sensitivity and specificity for the detection of AF were comparable between devices: 85% and 75% for the Apple Watch 6, 85% and 75% for the Samsung Galaxy Watch 3, 58% and 75% for the Withings Scanwatch, 66% and 79% for the Fitbit Sense, and 79% and 69% for the AliveCor KardiaMobile, respectively. The rate of inconclusive tracings (the algorithm was unable to determine the heart rhythm) was 18%, 17%, 24%, 21%, and 26% for the Apple Watch 6, Samsung Galaxy Watch 3, Withings Scan Watch, Fitbit Sense, and AliveCor KardiaMobile (P < 0.01 for pairwise comparison), respectively. By manual review of inconclusive tracings, the rhythm could be determined in 955 (99%) of 969 single-lead electrocardiograms. Regarding patient acceptance, the Apple Watch was ranked first (39% of participants). CONCLUSIONS In this clinical validation of 5 direct-to-consumer smart devices, we found differences in the amount of inconclusive tracings diminishing sensitivity and specificity of the smart devices. In a clinical setting, manual review of tracings is required in about one-fourth of cases.
Collapse
Affiliation(s)
- Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirko Lischer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Vögeli
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
27
|
Badertscher P, Mäder N, Serban T, Nestelberger T, Leibundgut G, Kaiser C, Osswald S, Sticherling C, Knecht S, Kühne M. Incidence of infranodal conduction delay in patients with left bundle branch block after transcatheter aortic valve replacement: Impact of the 2021 ESC guidelines for cardiac pacing. Heart Rhythm 2023; 20:646-647. [PMID: 36693613 DOI: 10.1016/j.hrthm.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/21/2022] [Revised: 12/30/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Nina Mäder
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
28
|
Knecht S, Zeljkovic I, Badertscher P, Krisai P, Spies F, Vognstrup J, Pavlovic N, Manola S, Osswald S, Kühne M, Sticherling C. Role of empirical isolation of the superior vena cava in patients with recurrence of atrial fibrillation after pulmonary vein isolation-a multi-center analysis. J Interv Card Electrophysiol 2023; 66:435-443. [PMID: 35980512 PMCID: PMC9977848 DOI: 10.1007/s10840-022-01314-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-pulmonary vein (PV) triggers play a role in the initiation of atrial fibrillation (AF), with the superior vena cava (SVC) being a common location. The aim of the current study was to investigate a strategy of empirical SVC isolation (SVCI) in addition to re-isolation of PV in patients with recurrence of AF after index PV isolation (PVI). METHODS We retrospectively analyzed consecutive patients from two centers with recurrence of AF after index PVI, undergoing a repeat ablation. Whereas only a re-isolation of the PV was intended in patients with reconnections of equal or more than two PV (PVI group), an additional SVCI was aimed for in patients with < 2 isolated PV in addition to the re-isolation of the PV (PVI + group). Analysis was performed as-treated and per-protocol. RESULTS Of the 344 patients included in the study (age 60 ± 10 years, 73% male, 66% paroxysmal AF), PVI only was performed in 269 patients (77%) and PVI plus SVCI (PVI +) in 75 patients (23%). Overall, freedom from AF/AT after repeat PVI was 80% (196 patients) in the PVI group and 73% in the PVI + group (p = 0.151). In multivariable Cox regression analysis, presence of persistent AF (HR 2.067 (95% CI 1.389-3.078), p < 0.001) and hypertension (HR 1.905 (95% CI 1.218-2.980), p = 0.005) were identified as only significant predictors of AF/AT recurrence. The per-protocol results did not differ from this observation. CONCLUSIONS A strategy of an empirical additional SVCI at repeat PVI ablation for recurrence of AF/AT does not improve outcome compared to a PVI only approach.
Collapse
Affiliation(s)
- Sven Knecht
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
| | - Ivan Zeljkovic
- Department of Cardiology, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jan Vognstrup
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
29
|
Hennings E, Coslovsky M, Paladini RE, Aeschbacher S, Knecht S, Schlageter V, Krisai P, Badertscher P, Sticherling C, Osswald S, Kühne M, Zuern CS. Assessment of the atrial fibrillation burden in Holter ECG recordings using artificial intelligence. Cardiovascular Digital Health Journal 2023; 4:41-47. [PMID: 37101946 PMCID: PMC10123500 DOI: 10.1016/j.cvdhj.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Emerging evidence indicates that a high atrial fibrillation (AF) burden is associated with adverse outcome. However, AF burden is not routinely measured in clinical practice. An artificial intelligence (AI)-based tool could facilitate the assessment of AF burden. Objective We aimed to compare the assessment of AF burden performed manually by physicians with that measured by an AI-based tool. Methods We analyzed 7-day Holter electrocardiogram (ECG) recordings of AF patients included in the prospective, multicenter Swiss-AF Burden cohort study. AF burden was defined as percentage of time in AF, and was assessed manually by physicians and by an AI-based tool (Cardiomatics, Cracow, Poland). We evaluated the agreement between both techniques by means of Pearson correlation coefficient, linear regression model, and Bland-Altman plot. Results We assessed the AF burden in 100 Holter ECG recordings of 82 patients. We identified 53 Holter ECGs with 0% or 100% AF burden, where we found a 100% correlation. For the remaining 47 Holter ECGs with an AF burden between 0.01% and 81.53%, Pearson correlation coefficient was 0.998. The calibration intercept was -0.001 (95% CI -0.008; 0.006), and the calibration slope was 0.975 (95% CI 0.954; 0.995; multiple R2 0.995, residual standard error 0.017). Bland-Altman analysis resulted in a bias of -0.006 (95% limits of agreement -0.042 to 0.030). Conclusion The assessment of AF burden with an AI-based tool provided very similar results compared to manual assessment. An AI-based tool may therefore be an accurate and efficient option for the assessment of AF burden.
Collapse
|
30
|
Knecht S, Sticherling C, Roten L, Badertscher P, Krisai P, Chollet L, Küffer T, Spies F, Völlmin G, Madaffari A, Mühl A, Baldinger SH, Servatius H, Tanner H, Osswald S, Reichlin T, Kühne M. Efficacy and safety of a novel cryoballoon ablation system: multicentre comparison of 1-year outcome. Europace 2022; 24:1926-1932. [PMID: 35727739 DOI: 10.1093/europace/euac094] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of the study was to compare the 1-year efficacy and safety of a novel cryoballoon (NCB) ablation system (POLARx; Boston Scientific) for pulmonary vein isolation (PVI) compared with the standard cryoballoon (SCB) system (Arctic Front, Medtronic). METHODS AND RESULTS Consecutive patients with atrial fibrillation (AF) undergoing PVI using the NCB and the SCB at two centres were included. We report 1-year efficacy after 12 months, short-term safety and hospitalizations within the blanking period, and predictors for AF recurrence. In case of repeat procedures, pulmonary vein (PV) reconnection patterns were characterized. Eighty patients (age 66 ± 10 years, ejection fraction 57 ± 10%, left atrial volume index 39 ± 13 mL/m2, paroxysmal AF in 64%) were studied. After a single procedure and a follow-up of 12 months, 68% in the NCB group and 70% in the SCB group showed no recurrence of AF/atrial tachycardias (P = 0.422). One patient in the NCB group suffered a periprocedural stroke with full recovery. There were no differences regarding hospitalizations during follow-up between the groups. PV reconnection observed during 12 repeat procedures (4 NCB, 8 SCB) pattern was comparable between the groups with more reconnections in the right-sided compared with the left-sided PVs. CONCLUSION In this multicentre study comparing two currently available cryoballoon ablation systems for PVI, no differences were observed in the efficacy and safety during a follow-up of 12 months.
Collapse
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | | | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Philipp Krisai
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Laurève Chollet
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Gian Völlmin
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University of Basel Hospital, Basel, Switzerland
| |
Collapse
|
31
|
Knecht S, Sticherling C. Ethanol infusion in the vein of Marshall is feasible in experienced centers — but is it ready for every Tom, Dick, and Harry? J Interv Card Electrophysiol 2022; 66:513-514. [PMID: 36441426 DOI: 10.1007/s10840-022-01424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| |
Collapse
|
32
|
Zwimpfer L, Aeschbacher S, Krisai P, Coslovsky M, Springer A, Paladini RE, Girod M, Hufschmid J, Knecht S, Badertscher P, Beer JH, Bonati LH, Zuern CS, Roten L, Reichlin T, Sticherling C, Conen D, Osswald S, Kühne M. Neurocognitive function in patients with atrial fibrillation undergoing pulmonary vein isolation. Front Cardiovasc Med 2022; 9:1000799. [PMID: 36505379 PMCID: PMC9732530 DOI: 10.3389/fcvm.2022.1000799] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with cognitive dysfunction. However, neurocognitive function in AF patients undergoing pulmonary vein isolation (PVI) has not been well studied. The aim of this analysis is to compare neurocognitive function in patients who did or did not undergo PVI. Materials and methods We used data from the Swiss Atrial Fibrillation Cohort study (Swiss-AF), a prospective, observational, multicenter study in Switzerland. Patients with documented AF were enrolled and data of 1,576 patients without history of PVI and with complete information on PVI status and neurocognitive function were used. Information on PVI was collected at baseline and during 1 year of follow-up. Neurocognitive testing was performed at baseline and after 1 year of follow-up, using the Montreal Cognitive Assessment (MoCA), trail making test (TMT) A and B, digit symbol substitution test (DSST) and semantic fluency test (SFT). To investigate the association of PVI with neurocognitive function, we use propensity score matching (1:3) and inverse probability of treatment weighting (IPTW). Results The mean age of this population was 74 ± 8 years, 27.1% were women. Overall, 88 (5.5%) patients underwent PVI during 1 year of follow-up. Using ITPW (n = 1576), PVI was weakly associated with the MoCA score after adjusting for time since PVI, baseline MoCA score and other covariates (β (95%CI) 1.19 (0.05; 2.32), p = 0.04). In the propensity matched comparison (n = 352), there was no significant association between PVI and the MoCA score (β (95%CI) 1.04 (-0.19; 2.28), p = 0.1). There were no significant associations between PVI and cognitive function when using the TMT A and B, DSST or SFT independent of the method used. Conclusion In this population of AF patients, there was no consistent evidence of an association between PVI and neurocognitive function. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT02105844].
Collapse
Affiliation(s)
- Leon Zwimpfer
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland,Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Rebecca E. Paladini
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Marc Girod
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Janik Hufschmid
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Jürg H. Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland
| | - Leo H. Bonati
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Reha Rheinfelden, Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland,Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christine S. Zuern
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland,Cardiology Division, University Hospital Basel, Basel, Switzerland,*Correspondence: Michael Kühne,
| |
Collapse
|
33
|
de Lavallaz JDF, Mézier J, Mertz L, Mannhart D, Serban T, Knecht S, Abid QUA, Nguyen TT, Kühne M, Sticherling C, Huang H, Gold MR, Badertscher P. Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01421-8. [DOI: 10.1007/s10840-022-01421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Abstract
Background
Premature ventricular complexes (PVCs) are a potentially reversible cause of heart failure. However, the characteristics of patients most likely to develop impaired left ventricular function are unclear. Hence, the objective of this study is to systematically assess risk factors for the development of PVC-induced cardiomyopathy.
Methods
We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced cardiomyopathy (PVC-CM). We investigated the reporting of PVC-CM risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.
Results
A total of 26 studies (9 prospective and 17 retrospective studies) involving 16,764,641 patients were analyzed (mean age 55 years, 58% women, mean PVC burden 17%). Eleven RF were suitable for quantitative analysis (≥ 3 occurrences in multivariable model assessing a binary change in left ventricular (LV) function). Among these, age (OR 1.02 per increase in the year of age, 95% CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95% CI [0.05, 0.64]), non-sustained ventricular tachycardias (VT) (OR 3.01, 95% CI [1.39, 6.50]), LV origin (OR 2.20, 95% CI [1.14, 4.23]), epicardial origin (OR 4.72, 95% CI [1.81, 12.34]), the presence of interpolation (OR 4.93, 95% CI [1.66, 14.69]), PVC duration (OR 1.05 per ms increase in QRS-PVC duration [1.004; 1.096]), and PVC burden (OR 1.06, 95% CI [1.04, 1.08]) were all significantly associated with PVC-CM.
Conclusions
In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VT, LV, epicardial origin, interpolation, and PVC burden, whereas the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up of patients presenting with frequent PVCs and normal LV function.
Collapse
|
34
|
Mannhart D, Lefebvre B, Gardella C, Henry C, Serban T, Knecht S, Kuehne M, Sticherling C, Badertscher P. Clinical validation of an artificial intelligence algorithm offering cross-platform detection of atrial fibrillation using smart device electrocardiograms. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Multiple smart devices capable of “screening” for atrial fibrillation (AF) based on single-lead electrocardiogram (SL ECG) are presently available. Manufacturers' algorithm capabilities and accuracy for the automated detection of AF vary. Reliable artificial intelligence (AI) algorithms would be valuable to assist physicians with managing the large amount of data. We aimed to assess the clinical value of applying a smart device agnostic AI-based algorithm for the detection of AF from five different smart devices (four smartwatches, one handheld device) and compared the results to the cardiologist-interpreted 12-lead ECG in a real world cohort of patients.
Methods
This is a prospective, observational study enrolling patients presenting to a cardiology service at a tertiary referral center. Patients were prescribed a 12-lead ECG, followed by five consecutive smart device recordings from five different manufacturers. SL ECGs were exported as PDF files from the devices and analyzed by a deep neural network (DNN) based platform which allows automated AI assisted cardiac rhythm interpretation.
Results
We prospectively enrolled 157 patients (32% female, median age 66 years). AF was present in 48 patients (31%) at time of recording, as documented by the 12-lead ECG. Accuracy for the detection of AF by the DNN-based algorithm was 96.6% for the Apple Watch 6, 95.2% for the AliveCor Kardia Mobile, 96.0% for the Fitbit Sense, 95.7% for the Samsung Galaxy Watch 3 and 93.8% for the Withings Scanwatch, respectively (Figure 1, left). While diagnostic accuracy of the DNN-based algorithm was similar compared to each manufacturer's individual algorithm, the proportion of SL ECGs with a conclusive diagnosis was significantly higher for all smart devices when using the DNN-based algorithm, p<0.001 (Figure 1, right). As complementary analysis, we assessed sensitivity and specificity detection capabilities in both algorithms (Figure 2).
Conclusion
In this clinical validation, a DNN-based algorithm reported significantly more conclusive diagnoses for each smart device compared to the manufacturers' algorithms, whilst showing similarly high accuracy in the detection of AF compared to the cardiologist-interpreted standard 12-lead ECG. Given further validation, SL ECG assisted rhythm interpretation through a cross-platform AI-algorithm presents a promising clinical value for AF detection and offers a possible solution for managing the data surge for smart device-acquired ECGs.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Mannhart
- University Hospital Basel , Basel , Switzerland
| | | | | | | | - T Serban
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
| | | | | |
Collapse
|
35
|
Serban T, Du Fay De Lavallaz J, Mannhart D, Knecht S, Kuehne M, Sticherling C, Badertshcer P. Echocardiographic pattern of left ventricular function recovery in tachycardia-induced cardiomyopathy patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tachycardia-induced Cardiomyopathy (TIC) represents a reversible type of cardiomyopathy (CM) that is underdiagnosed. Prior pilot studies suggested a specific left ventricular (LV) function recovery pattern in TIC patients. Cardiac chamber remodeling in TIC, however, remains incompletely understood.
Purpose
We aimed to explore differences in LV dimensions and functional recovery in TIC patients when compared to a control group of patients with other forms of CM and functional recovery.
Methods
We identified patients with reduced left ventricular ejection fraction (≤50%) and/or atrial fibrillation or flutter treated between 2015 and 2022. Patients had at least two serial transthoracic echocardiographies (TTE). The minimal interval between the TTEs had to be at least 3 months, and the left ventricular ejection fraction (LVEF) had to either improve (≥15% in absolute value) or normalize (LVEF at follow-up ≥50%). Patients were then divided into two groups: A) patients with atrial fibrillation or atrial flutter at baseline and sinus rhythm at follow-up. These patients were assumed to have TIC. B) Patients with sinus rhythm at both baseline and follow-up, consisting of patients with other forms of CM. The change in ventricular dimensions and function (indexed left ventricular end-systolic – LVESDI, end-diastolic diameters – LVEDDI – and volumes – LVEDVI, LVEF, and fractional shortening – FS) were compared within and across group A and B at baseline and at follow-up. The groups were compared using Kruskal (for independent data) and Wilcoxon (for paired data) tests. A p<0.05 was considered significant.
Results
A total of 261 patients were included (34% female, median age 68 years). The median time between TTEs was 25 months. 104 (39.8%) patients were considered to suffer from TIC and 157 (60.2%) patients were considered to suffer from other forms of CM. The changes in ventricular dimensions and function in both groups are shown in Figure 1 and Table 1. The TIC group showed no improvement in LVEDVI from baseline to the follow-up examination, while the control group showed significant improvement in LVEDVI (1.7% [−24.7, 22.8] vs. 12.4% [−7.1, 29.3], p=0.008). There was no difference in LVEDDI recovery between TIC and control patients (1.7% [−7.3, 10.3] versus 3.1% [−5.4, 10.2], p=0.578).
Conclusions
TIC patients have a specific pattern of functional recovery with similar improvements in systolic function and diameters compared with patients with other CMs, while diastolic parameters remained impaired.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- T Serban
- University Hospital Basel , Basel , Switzerland
| | | | - D Mannhart
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
| | | | | |
Collapse
|
36
|
Hennings E, Blum S, Aeschbacher S, Coslovsky M, Knecht S, Paladini RE, Krisai P, Kastner P, Ziegler A, Mueller C, Zuern CS, Bonati L, Conen D, Kuehne M, Osswald S. Bone morphogenetic protein 10 as predictor for adverse outcomes in patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.515] [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
Background
Patients with atrial fibrillation (AF) face an increased risk of death and major adverse cardiovascular events (MACE). Bone morphogenetic protein 10 (BMP10) is a novel atrial-specific biomarker, but data about its prognostic value in AF patients are lacking.
Purpose
We aimed to assess the predictive value of BMP10 for death and MACE in AF patients in comparison to N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).
Methods
Baseline concentrations of BMP10 and NT-proBNP were measured in stable patients with AF enrolled in Swiss-AF, a prospective multicenter observational cohort study. Primary outcomes were all-cause death and MACE (composite of heart failure hospitalization, cardiovascular death, stroke, systemic embolism, myocardial infarction). Measures of discriminative power were used to compare multivariable Cox proportional hazard models using the different biomarkers.
Results
A total of 2219 AF patients were included with a median follow-up of 4.3 years (IQR 3.9, 5.1). Mean age was 73±9 years and 27% were women. Incidence rate per 100 patient-years of all-cause death and MACE increased across BMP10 quartiles (Figure 1). In the multivariable adjusted Cox proportional hazard model, the hazard ratio (HR) and 95% confidence interval (CI) of BMP10 was 1.60 (1.37; 1.87) to predict all-cause death, and 1.54 (1.35; 1.76) to predict MACE. For all-cause death, the C-index (95% CI) was 0.783 (0.763; 0.809) for BMP10, 0.784 (0.765; 0.810) for NT-proBNP, and 0.789 (0.771; 0.815) for both biomarkers combined. For MACE, the C-index (95% CI) was 0.732 (0.715; 0.754) for BMP10, 0.747 (0.731; 0.768) for NT-proBNP, and 0.750 (0.734; 0.771) for both biomarkers combined. When grouping patients according to clinical used NT-proBNP categories (<300, 300–900, >900 ng/l), higher incidence rates and adjusted HRs were observed for the primary outcomes in patients with high BMP10 in the categories of low NT-proBNP (all-cause death aHR 2.28 [1.15; 4.52], MACE aHR 1.88 [1.07; 3.28]) and high NT-proBNP (all-cause death aHR 1.61 [1.14; 2.26], MACE aHR 1.38 [1.07; 1.80]) (Figure 2).
Conclusion
The novel atrial-specific biomarker BMP10 strongly predicts all-cause death and MACE in patients with AF. BMP10 provides additional prognostic information in low- and high-risk patients according to NT-proBNP stratification.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
Collapse
Affiliation(s)
- E Hennings
- University Hospital Basel , Basel , Switzerland
| | - S Blum
- University Hospital Basel , Basel , Switzerland
| | | | - M Coslovsky
- University Hospital Basel , Basel , Switzerland
| | - S Knecht
- University Hospital Basel , Basel , Switzerland
| | | | - P Krisai
- University Hospital Basel , Basel , Switzerland
| | - P Kastner
- Roche Diagnostics GmbH , Penzberg , Germany
| | - A Ziegler
- Roche Diagnostics International AG , Rotkreuz , Switzerland
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
| | - C S Zuern
- University Hospital Basel , Basel , Switzerland
| | - L Bonati
- University Hospital Basel , Basel , Switzerland
| | - D Conen
- McMaster University , Hamilton , Canada
| | - M Kuehne
- University Hospital Basel , Basel , Switzerland
| | - S Osswald
- University Hospital Basel , Basel , Switzerland
| |
Collapse
|
37
|
Pradella M, Anastasopoulos C, Yang S, Moor M, Badertscher P, Gehweiler JE, Spies F, Haaf P, Zellweger M, Sommer G, Stieltjes B, Bremerich J, Osswald S, Kühne M, Sticherling C, Knecht S. Associations between fully-automated, 3D-based functional analysis of the left atrium and classification schemes in atrial fibrillation. PLoS One 2022; 17:e0272011. [PMID: 35969532 PMCID: PMC9377598 DOI: 10.1371/journal.pone.0272011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Atrial fibrillation (AF) has been linked to left atrial (LA) enlargement. Whereas most studies focused on 2D-based estimation of static LA volume (LAV), we used a fully-automatic convolutional neural network (CNN) for time-resolved (CINE) volumetry of the whole LA on cardiac MRI (cMRI). Aim was to investigate associations between functional parameters from fully-automated, 3D-based analysis of the LA and current classification schemes in AF. Methods We retrospectively analyzed consecutive AF patients who underwent cMRI on 1.5T systems including a stack of oblique-axial CINE series covering the whole LA. The LA was automatically segmented by a validated CNN. In the resulting volume-time curves, maximum, minimum and LAV before atrial contraction were automatically identified. Active, passive and total LA emptying fractions (LAEF) were calculated and compared to clinical classifications (AF Burden score (AFBS), increased stroke risk (CHA2DS2VASc≥2), AF type (paroxysmal/persistent), EHRA score, and AF risk factors). Moreover, multivariable linear regression models (mLRM) were used to identify associations with AF risk factors. Results Overall, 102 patients (age 61±9 years, 17% female) were analyzed. Active LAEF (LAEF_active) decreased significantly with an increase of AFBS (minimal: 44.0%, mild: 36.2%, moderate: 31.7%, severe: 20.8%, p<0.003) which was primarily caused by an increase of minimum LAV. Likewise, LAEF_active was lower in patients with increased stroke risk (30.7% vs. 38.9%, p = 0.002). AF type and EHRA score did not show significant differences between groups. In mLRM, a decrease of LAEF_active was associated with higher age (per year: -0.3%, p = 0.02), higher AFBS (per category: -4.2%, p<0.03) and heart failure (-12.1%, p<0.04). Conclusions Fully-automatic morphometry of the whole LA derived from cMRI showed significant relationships between LAEF_active with increased stroke risk and severity of AFBS. Furthermore, higher age, higher AFBS and presence of heart failure were independent predictors of reduced LAEF_active, indicating its potential usefulness as an imaging biomarker.
Collapse
Affiliation(s)
- Maurice Pradella
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | | | - Shan Yang
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Moor
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Julian E. Gehweiler
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Zellweger
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| |
Collapse
|
38
|
Badertscher P, Knecht S, Spies F, Auberson C, Salis M, Jeger RV, Fahrni G, Kaiser C, Schaer B, Osswald S, Sticherling C, Kühne M. Value of Periprocedural Electrophysiology Testing During Transcatheter Aortic Valve Replacement for Risk Stratification of Patients With New-Onset Left Bundle-Branch Block. J Am Heart Assoc 2022; 11:e026239. [PMID: 35876404 PMCID: PMC9375470 DOI: 10.1161/jaha.122.026239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/16/2022]
Abstract
Background Despite being the most frequent complication following transcatheter aortic valve replacement (TAVR), optimal management of left bundle-branch block (LBBB) remains unknown. Electrophysiology study has been proposed for risk stratification. However, the optimal timing of electrophysiology study remains unknown. We aimed to investigate the temporal dynamics of atrioventricular conduction in patients with new-onset LBBB after TAVR by performing serial electrophysiology study and to deduce a treatment strategy. Methods and Results We assessed consecutive patients undergoing TAVR via His-ventricular interval measurement prevalve and postvalve deployment and the day after TAVR. Infranodal conduction delay was defined as a His-ventricular interval >55 milliseconds. Among 107 patients undergoing TAVR, 53 patients (50%) experienced new-onset LBBB postvalve deployment and infranodal conduction delay was noted in 24 of 53 patients intraprocedurally (45%). LBBB resolved the day after TAVR in 35 patients (66%). In patients with new-onset LBBB postvalve deployment and no infrahisian conduction delay intraprocedurally, the His-ventricular interval did not prolong in any patient to >55 milliseconds the following day. Overall, 4 patients (7.5%) with new-onset LBBB after TAVR were found to have persistent infrahisian conduction delay 24 hours after TAVR. During 30-day follow-up, 1 patient (1.1%) with new LBBB and a normal His-ventricular interval after TAVR developed new high-grade atrioventricular block. Conclusions Among patients with new-onset LBBB postvalve deployment, infrahisian conduction delay can safely be excluded intraprocedurally, suggesting that early intracardiac intraprocedural conduction studies may be of value in these patients.
Collapse
Affiliation(s)
- Patrick Badertscher
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Sven Knecht
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Florian Spies
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Chloé Auberson
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Marc Salis
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Raban V Jeger
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Gregor Fahrni
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Beat Schaer
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Christian Sticherling
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| | - Michael Kühne
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel Basel Switzerland
| |
Collapse
|
39
|
Mannhart D, Hennings E, Lischer M, Vernier C, Du Fay de Lavallaz J, Knecht S, Schaer B, Osswald S, Kühne M, Sticherling C, Badertscher P. Clinical Validation of Automated Corrected QT-Interval Measurements From a Single Lead Electrocardiogram Using a Novel Smartwatch. Front Cardiovasc Med 2022; 9:906079. [PMID: 35811720 PMCID: PMC9259864 DOI: 10.3389/fcvm.2022.906079] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The Withings Scanwatch (Withings SA, Issy les Moulineaux, France) offers automated analysis of the QTc. We aimed to compare automated QTc-measurements using a single lead ECG of a novel smartwatch (Withings Scanwatch, SW-ECG) with manual-measured QTc from a nearly simultaneously recorded 12-lead ECG. Methods We enrolled consecutive patients referred to a tertiary hospital for cardiac workup in a prospective, observational study. The QT-interval of the 12-lead ECG was manually interpreted by two blinded, independent cardiologists through the tangent-method. Bazett’s formula was used to calculate QTc. Results were compared using the Bland-Altman method. Results A total of 317 patients (48% female, mean age 63 ± 17 years) were enrolled. HR-, QRS-, and QT-intervals were automatically calculated by the SW in 295 (93%), 249 (79%), and 177 patients (56%), respectively. Diagnostic accuracy of SW-ECG for detection of QTc-intervals ≥ 460 ms (women) and ≥ 440 ms (men) as quantified by the area under the curve was 0.91 and 0.89. The Bland-Altman analysis resulted in a bias of 6.6 ms [95% limit of agreement (LoA) –59 to 72 ms] comparing automated QTc-measurements (SW-ECG) with manual QTc-measurement (12-lead ECG). In 12 patients (6.9%) the difference between the two measurements was greater than the LoA. Conclusion In this clinical validation of a direct-to-consumer smartwatch we found fair to good agreement between automated-SW-ECG QTc-measurements and manual 12-lead-QTc measurements. The SW-ECG was able to automatically calculate QTc-intervals in one half of all assessed patients. Our work shows, that the automated algorithm of the SW-ECG needs improvement to be useful in a clinical setting.
Collapse
Affiliation(s)
- Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Elisa Hennings
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Mirko Lischer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Claudius Vernier
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Jeanne Du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- *Correspondence: Patrick Badertscher,
| |
Collapse
|
40
|
Knecht S, Badertscher P. Time to say good bye? – the value of waiting period after pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1734-1736. [DOI: 10.1111/jce.15575] [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] [Received: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sven Knecht
- Department of CardiologyUniversity Hospital BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselBaselSwitzerland
| | - Patrick Badertscher
- Department of CardiologyUniversity Hospital BaselBaselSwitzerland
- Cardiovascular Research Institute BaselUniversity Hospital BaselBaselSwitzerland
| |
Collapse
|
41
|
Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Servatius H, Madaffari A, Seiler J, Muehl A, Franzeck F, Asatryan B, Noti F, Tanner H, Roten L, Reichlin T. Comparison of the accuracy of contact force measurement in four commercially available force-sensing ablation catheters. Europace 2022. [DOI: 10.1093/europace/euac053.101] [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
Contact force-sensing catheters are widely used for ablation of cardiac arrhythmias. They allow precise quantification of catheter-to-tissue contact, which is an important determinant of lesion size and durability. Moreover, contact force information reduces the risk for cardiac perforation and is used for estimation of lesion size. However, the accuracy of contact force sensors across different manufacturers has not been validated independently.
Objective
To compare the accuracy and reproducibility of different force sensing catheters used in cardiac electrophysiology procedures.
Methods
A force measurement setup containing a heated saline water bath and a catheter fixation mechanism was constructed. The setup allows to accurately measure forces applied to a platform with the catheter. We studied four different catheter models, equipped with the following, unique force-measurement technologies (figure 1): 1) multiple-fiber optical sensor; 2) single-fiber optical sensor; 3) inductive sensor; and 4) magnetic field sensors. For each model, we assessed three catheters. Repeated measurements within the force range of 0g to 60g and at electrode-tissue contact angles of 0°, 45°, and 90° were performed and validated against the force measurement unit of our measurement setup.
Results
For each catheter, at least 500 measurements at different contact forces (equally distributed across the measurement range of 0 to 60 grams) were performed. Correlation of measured-force to real-force was ρSpearman=0.99 for MFOS, ρSpearman=0.98 for SFOS, ρSpearman=0.99 for IS, and ρSpearman=0.98 for MFS. MFS and SFOS showed a higher variance for high forces and increased intra-catheter variability compared to MFOS and IS. IS overestimated higher contact force at 0° and 30°. MFS and SFOS underestimated contact force for higher forces at 30° and 45° (figure 2). Within a clinical range of 5g to 40g, the catheters reached the following root-mean-square-error, independent of contact angle: MFOS 0.88g ±0.68g, SFOS 2.15g ±1.74g, IS 0.88g ±0.72g, and MFS 1.13g ±1.01g.
Conclusion
Measured contact by force-sensing catheters correlates well with true exerted electrode-tissue force. Despite an excellent overall correlation, some technologies may be prone to significant errors at higher forces (>10g under-/overestimation of true contact force) with potential clinical consequences related to increased risk of perforation.
Collapse
Affiliation(s)
- T Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - SH Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - J Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Franzeck
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
42
|
Schlageter V, Badertscher P, Krisai P, Spies F, Luca A, Osswald S, Vesin JM, Kuehne M, Sticherling C, Knecht S. An automatic single beat algorithm to discriminate farfield from nearfield bipolar voltage electrograms from the pulmonary veins. Europace 2022. [DOI: 10.1093/europace/euac053.564] [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: Public hospital(s). Main funding source(s): “Stiftung für Herzschrittmacher und Elektrophysiologie” Basel, Switzerland
Background
Confirmation of pulmonary vein (PV) isolation (PVI) during ablation of atrial fibrillation can be challenging due to superimposition of nearfield (NF) PV and farfield (FF) atrial bipolar voltage electrograms (BVE).
Purpose
To develop an automatic algorithm allowing to discriminate PV nearfield (PV-NF) from atrial farfield (atrial-FF) BVE from a circular mapping catheter during cryoballoon (CB) PVI based on a single-heartbeat analysis.
Methods
BVEs from a decapolar inner-lumen diagnostic catheter (Achieve, Medtronic) during CB PVI were manually classified as PV-NF, atrial-FF and combined FF-NF signal based on the characteristics and disappearance of the PV signal during isolation (Figure, upper row). BVE power spectra were computed using the fast Fourier transform (FFT) and the automatic classification of PV-NF, atrial-FF and combined FF-NF signals was performed using the power in different frequency bands (Figure, lower row). Support vector machine classifier was used to identify PV-NF BVE due to its highest predictive accuracy for the two classes PV-NF+ (PV-NF only and combined FF-NF) and PV-NF- (atrial-FF only). Validation of the approach was performed by comparison of a subset of 80 random samples, which were classified in addition by five experienced electrophysiologists.
Results
We analysed a dataset of 355 BVEs from 57 patients. The examples were balanced between the two classes PV-NF+ and PV-NF-. The mean duration (95% CI) of the BVE was 58 ms (26 to 86), 70 ms (50 to 100) and 94 ms (71 to 139) for PV NF, atrial-FF and combined FF-NF, respectively. The overall balanced accuracy including BVE from all PVs was 82.7% (95% CI: 80.3% to 85.1%). The analysis on individual PVs showed an accuracy of 96.6%, 85.2%, 80.8%, and 76.9% for the right inferior, right superior, left inferior and left superior PV, respectively. Validation of the algorithm in the subset of 80 patients showed a comparable accuracy, sensitivity and specificity in PV-NF detection between the automatic algorithm and the experienced electrophysiologists (82.8%, 89.2%, and 76.3%, compared to 85.2%, 91.9%, and 78.5%, respectively).
Conclusion
A reliable automatic based classification algorithm to identify PV-NF BVE could be developed based on a single-beat analysis. Real-time applications as well as using other electrode configurations may improve local signal interpretation.
Collapse
Affiliation(s)
- V Schlageter
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - A Luca
- Swiss Federal Institute of Technology of Lausanne, Applied Signal Processing Group, Lausanne, Switzerland
| | - S Osswald
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - JM Vesin
- Swiss Federal Institute of Technology of Lausanne, Applied Signal Processing Group, Lausanne, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| |
Collapse
|
43
|
Badertscher P, Knecht S, Zeljkovic I, Sticherling C, De Asmundis C, Conte G, Kuehne M, Boveda S. Management of conduction disorders after transcatheter aortic valve implantation: results of an EHRA survey. Europace 2022. [DOI: 10.1093/europace/euac053.411] [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
Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block. Consensus regarding a reasonable strategy to manage cardiac conduction disturbances after TAVI has been elusive
Methods
The European Heart Rhythm Association (EHRA) conducted a survey to capture contemporary clinical practice for conduction disorders after TAVI. A 25-item online questionnaire was developed and distributed among the EHRA electrophysiology research network centres.
Results
Of 117 respondents, 44% were affiliated with university hospitals. This survey has revealed that a standardized management protocol for advanced conduction disorders such as LBBB or AVB after TAVR is available in 63% of participating centres. Telemetry was chosen by most participants as the most frequent management strategy for patients with new or preexisting LBBB after TAVI (79%, 70%, respectively, Figure 1). Duration of telemetry in patients with new LBBB varied: 18% chose 24 hours, 35% 48 hours, 27% 72 hours and 20% ≥ 72 hours. Similarly, in patients with new LBBB after TAVI undergoing EP study, the cut-off for a prolonged HV interval for PM implantation was heterogenous among European centers (7.4% ≥ 55ms and 44% ≥ 75ms). Conduction system pacing was chosen as preferred device therapy in patients with LBBB and normal LVEF in 3.7% and in patients with LBBB and reduced LVEF in 5.6%.
Conclusions
The management of conduction disorders after TAVI is very heterogeneous across European centres. Risk stratification strategies vary substantially. The role of conduction system pacing in patients with LBBB after TAVI needs to be defined. There is a considerable room for better uniformity in clinical practice.
Collapse
Affiliation(s)
- P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - I Zeljkovic
- Silesian Center for Heart Diseases (SCHD), 2nd Department of Cardiology, Zabrze, Poland
| | - C Sticherling
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | | | - G Conte
- Cardiocentro Ticino, Lugano, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - S Boveda
- Clinic Pasteur, Toulouse, France
| |
Collapse
|
44
|
Krisai P, Knecht S, Badertscher P, Voellmin G, Spiess F, Schaer B, Osswald S, Sticherling C, Kuehne M. Healthy lifestyle and atrial fibrillation recurrence after pulmonary vein isolation. Europace 2022. [DOI: 10.1093/europace/euac053.206] [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/Introduction: Data on the relationship of a healthy lifestyle at the time of atrial fibrillation (AF) ablation with AF recurrence is limited.
Purpose
We investigated the association of healthy lifestyle markers with AF recurrence after ablation.
Methods
In 1439 patients undergoing AF ablation at a tertiary university hospital, a lifestyle score was built. The score included categories of BMI, smoking, blood pressure, fish intake, fruits/vegetable intake, alcohol consumption and physical activity. A higher score indicated a healthier lifestyle and patients were grouped into tertiles. Follow-up included 24h-Holter ECGs at 3 and 6 months and 7d-Holter ECGs at 12 months. Survival analyses and Cox-regression models were used to assess associations of individual factors and score-tertiles with AF recurrence.
Results
Mean age was 61.5 years, 25.9% were female and 59.1% had paroxysmal AF. In 941 patients all lifestyle score variables were available: 129, 675 and 137 patients were in the low, intermediate and high lifestyle group, respectively. Over increasing lifestyle groups, patients were more often female (9.3, 23.3, 38.7%; p<0.0001), had less hypertension (70.5, 53.3, 32.9%; p<0.0001), diabetes (15.5, 6.2, 3.7%; p=0.0002), a smaller left atrial diameter (44.1, 41.0, 37.6mm; p<0.0001) and numerically more paroxysmal AF (56.6, 62.4, 69.4%; p=0.32) with no differences in anti-arrhythmic drugs. In survival analyses (Figure), we saw a trend of more recurrences in the healthiest group compared to the unhealthiest group (logrank p=0.06 for low vs high group). Individually, higher fish intake (logrank p=0.04) and lower blood pressure (logrank p=0.02) were associated with AF recurrence. In Cox-regression models the HR (95% CI) for increasing lifestyle groups was 1.21 (0.98; 1.50, p=0.07). In individual models only higher fish intake (1.25 [1.01; 1.55], p=0.045) was associated with AF recurrence.
Conclusion(s): AF recurrence was numerically more frequent in patients with a healthier lifestyle, despite less comorbidities and smaller LA diameters. This paradoxical relationship might be due to lifestyle changes after PVI, differences in PVI efficacy or residual confounding. Further studies are needed to better understand this association.
Collapse
Affiliation(s)
- P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - G Voellmin
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - F Spiess
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| |
Collapse
|
45
|
Luca A, Baskaralingam A, Mccann A, Vesin JM, Pascale P, Le Bloa M, Herrera C, Roten L, Kuhne M, Spies F, Knecht S, Sticherling C, Pruvot E. Amplitude of fibrillatory wave correlates with long-term maintenance of sinus rhythm after ablation in persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.063] [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: Public grant(s) – National budget only. Main funding source(s): Commission for Technology and Innovation (CTI), Switzerland
Background
Amplitude of fibrillatory wave (fWA) on surface ECG is regarded as a predictor of ablation outcome for atrial fibrillation (AF).
Purpose
We sought to investigate whether fWA and its changes during ablation predicts long-term maintenance of sinus rhythm (SR) after wide circumferential isolation of pulmonary veins (WPVI) in persistent AF (peAF).
Methods
41 patients (63±10 y, sustained AF 11±7 months) underwent a de-novo WPVI. A second WPVI was performed in patients with recurrent AF in order to provide complete PV disconnection. We defined "success" as patients who remained in SR after one or two procedures, and "failure" otherwise. 60-sec ECG signals devoid of QRST waves were recorded during the index ablation at baseline and at the end of ablation (end_WPVI, before cardioversion or conversion of AF into SR). fWA was computed on leads V1 and V6b (placed on the pts’ back) as the average difference between the upper and lower envelope of atrial ECG signals.
Results
Over a mean follow-up of 33±9 months, 30 patients remained free from AF (success group), while 11 patients had AF recurrence after 2 WPVIs (failure group). The clinical characteristics (e.g. age, body mass index, left atrial volume or duration in sustained AF) were similar between groups (p > 0.05). The success group displayed significantly higher fWA values at baseline and end_WPVI than that of the failure group (p<0.05, Panel A and B). No significant difference was found between baseline fWA values and those measured at end_WPVI (p > 0.05).
Conclusion
As fWA is independent of PVs contribution, it is a marker of atrial body remodelling. Low fWA values identify patients with peAF unresponsive to WPVI.
Collapse
Affiliation(s)
- A Luca
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - A Mccann
- Swiss Federal Institute of Technology of Lausanne, Lausanne, Switzerland
| | - J-M Vesin
- Swiss Federal Institute of Technology of Lausanne, Lausanne, Switzerland
| | - P Pascale
- University Hospital of Lausanne, Lausanne, Switzerland
| | - M Le Bloa
- University Hospital of Lausanne, Lausanne, Switzerland
| | - C Herrera
- University Hospital of Lausanne, Lausanne, Switzerland
| | - L Roten
- Inselspital - University of Bern, Bern, Switzerland
| | - M Kuhne
- University Hospital Basel, Basel, Switzerland
| | - F Spies
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | | | - E Pruvot
- University Hospital of Lausanne, Lausanne, Switzerland
| |
Collapse
|
46
|
Badertscher P, Lischer M, Mannhart D, Knecht S, Isenegger C, Du Fay De Lavallaz J, Spiess F, Schaer B, Osswald S, Kuehne M, Sticherling C. Clinical validation of a novel smartwatch for automated detection of atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.574] [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.
Introduction
The Withings Scanwatch is a novel smartwatch able to record an intelligent (i)ECG with automated detection of AF. While the iECG function from three major manufacturers have been extensively investigated, there is a paucity of data regarding the performance of the iECG function of the Withings Scanwatch.
Methods
We performed a prospective, observational study enrolling consecutive patients presenting to a cardiology service at a tertiary referral center. The aim was to assess the diagnostic performance of the iECG function of the Withings Scanwatch to detect AF compared to a simultaneously acquired cardiologist-interpreted 12-lead ECG. All iECG rhythm strips and 12-lead ECGs were anonymized and distributed to two blinded cardiologists who independently interpreted each tracing and assigned a diagnosis of sinus rhythm, AF or unclassified.
Results
iECGs and 12-lead ECGs were simultaneously recorded in 319 patients (67 yo (IQR 54-76), 48% female, Figure 1). Using the automated algorithm, rhythm was deemed inconclusive in 44 patients (14%). Overall, AF was present in 34 patients (11%). Among the tracings where the algorithm provided a diagnosis, it correctly identified AF with 76% (95%CI 55-91%) sensitivity, 99% (95%CI 97-100%) specificity, and a Kappa (K) coefficient of 0.72 when compared with cardiologist-interpreted 12-lead ECGs. Among patients in sinus rhythm, 3 were labeled AF (false-positive). From the 44 unclassified recordings, blinded cardiologists were able to correctly diagnose AF with 100% (95%CI 59-100%) sensitivity, 93% (95%CI 77-99%) specificity, and a K coefficient of 0.49. A total of 13 iECG recordings (4.1%) were determined to be noninterpretable by the cardiologists. Of the remaining 306 patients with simultaneous recordings, cardiologist interpretation of the iECG tracings demonstrated 97% (95%CI 84-100%) sensitivity, 99% (95%CI 96-100%) specificity and a K coefficient of 0.75.
Conclusion
Automatic rhythm classification was inferior to manual interpretation of iECGs. We found a lower sensitivity for the detection of AF using the Withings iECG function compared to data published on other devices. Cardiologist-iECG interpretation, however, was highly reliable with a diagnostic accuracy of 98% (95%CI 96-100%). Clinical interpretation of iECG readings by a cardiologist is therefore strongly encouraged
Collapse
Affiliation(s)
| | - M Lischer
- University Hospital Basel, Basel, Switzerland
| | - D Mannhart
- University Hospital Basel, Basel, Switzerland
| | - S Knecht
- University Hospital Basel, Basel, Switzerland
| | - C Isenegger
- University Hospital Basel, Basel, Switzerland
| | | | - F Spiess
- University Hospital Basel, Basel, Switzerland
| | - B Schaer
- University Hospital Basel, Basel, Switzerland
| | - S Osswald
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | | |
Collapse
|
47
|
Badertscher P, Vergne C, Fery C, Spies F, Schlageter V, Mannhart D, Quirin T, Kuehne M, Sticherling C, Pascal J, Knecht S. Magnetic field interactions of smartwatches and portable electronic devices with cardiovascular implantable electronic devices. Europace 2022. [DOI: 10.1093/europace/euac053.576] [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.
Introduction
Magnetic interference of portable electronic devices (PEDs), such as state-of-the-art mobile phones, with cardiovascular implantable electronic devices (CIEDs) has been reported.
Purpose
The aim of the study was to quantify the magnetic fields of latest generation Smartwatches and other PEDs and to evaluate and predict their risk of CIED interactions.
Method
High resolution magnetic field characterization of five smartwatches able to record an ECG Apple Watch, Series 6 and 7, Fitbit Sense, Samsung Galaxy Watch 3, and Withings Move ECG Watch was performed using a magnetic field camera consisting of 1024 calibrated three axis Hall sensors. Maximal distance of 1 mT (10 Gauss) field strength and 1 mT volume was calculated. Ex vivo measurements of the minimal safety distance (MSD) at which no mode switch can be observed between six representative CIEDs and the PEDs was performed. Results were compared to other PEDs, such as digital pens, headsets and their cases, and a Smartphone.
Result
Maximal 1 mT distances ranged between 10 mm and 19 mm, and 1 mT volumes between 6 cm3 and 19 cm3. The smartwatches and PEDs with measured 1 mT distance 15 mm (B: Microsoft surface pen, C: Airpods Pro case) showed device interaction up to > 15 mm (Figure). Linear regression analysis showed an inverse linear relationship of the MSD with 1 mT distance (B coefficient: 0.459; 95% CI: 0.246-0.672; p<0.001) but not with the volume (p=0.842)
Conclusions
Standardized measurements of the 1 mT field distance and volume is feasible and has the potential to assess the risk of CIED interaction. Smartwatches seem to be safe in contrast to other PEDs such as the Microsoft surface pen or Airpods Pro case with high 1mT volumes and maximal distances with regards to CIED interaction.
Collapse
Affiliation(s)
- P Badertscher
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Vergne
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - C Fery
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - F Spies
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - V Schlageter
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - D Mannhart
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Quirin
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - M Kuehne
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - J Pascal
- School of Life Sciences FHNW, Institute for Medical Engineering and Medical Informatics, Muttenz, Switzerland
| | - S Knecht
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| |
Collapse
|
48
|
Moccetti F, Yadava M, Latifi Y, Strebel I, Pavlovic N, Knecht S, Asatryan B, Schaer B, Kühne M, Henrikson CA, Stephan FP, Osswald S, Sticherling C, Reichlin T. Simplified Integrated Clinical and Electrocardiographic Algorithm for Differentiation of Wide QRS-Complex Tachycardia. JACC Clin Electrophysiol 2022; 8:831-839. [DOI: 10.1016/j.jacep.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
|
49
|
Luca A, Baskaralingam A, McCann A, Vesin JM, Pascale P, Siklody CH, Siklody CH, Roten L, Kühne M, Spies F, Knecht S, Sticherling C, Pruvot E. PO-694-04 AMPLITUDE OF FIBRILLATORY WAVE ON SURFACE ECG PREDICTS LONG-TERM ABLATION OUTCOME IN PERSISTENT ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.977] [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: 11/04/2022]
|
50
|
Girod M, Coslovsky M, Aeschbacher S, Sticherling C, Reichlin T, Roten L, Rodondi N, Ammann P, Auricchio A, Moschovitis G, Kobza R, Badertscher P, Knecht S, Krisai P, Marugg A, Aebersold H, Hennings E, Serra-Burriel M, Schwenkglenks M, Zuern CS, Bonati LH, Conen D, Osswald S, Kühne M. Association of pulmonary vein isolation and major cardiovascular events in patients with atrial fibrillation. Clin Res Cardiol 2022; 111:1048-1056. [PMID: 35403852 PMCID: PMC9424150 DOI: 10.1007/s00392-022-02015-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Background Patients with atrial fibrillation (AF) face an increased risk of adverse cardiovascular events. Evidence suggests that early rhythm control including AF ablation may reduce this risk. Methods To compare the risks for cardiovascular events in AF patients with and without pulmonary vein isolation (PVI), we analysed data from two prospective cohort studies in Switzerland (n = 3968). A total of 325 patients who had undergone PVI during a 1-year observational period were assigned to the PVI group. Using coarsened exact matching, 2193 patients were assigned to the non-PVI group. Outcomes were all-cause mortality, hospital admission for acute heart failure, a composite of stroke, transient ischemic attack and systemic embolism (Stroke/TIA/SE), myocardial infarction (MI), and bleedings. We calculated multivariable adjusted Cox proportional-hazards models. Results Overall, 2518 patients were included, median age was 66 years [IQR 61.0, 71.0], 25.8% were female. After a median follow-up time of 3.9 years, fewer patients in the PVI group died from any cause (incidence per 100 patient-years 0.64 versus 1.87, HR 0.39, 95%CI 0.19–0.79, p = 0.009) or were admitted to hospital for acute heart failure (incidence per 100 patient-years 0.52 versus 1.72, HR 0.44, 95%CI 0.21–0.95, p = 0.035). There was no significant association between PVI and Stroke/TIA/SE (HR 0.94, 95%CI 0.52–1.69, p = 0.80), MI (HR 0.43, 95%CI 0.11–1.63, p = 0.20) or bleeding (HR 0.75, 95% CI 0.50–1.12, p = 0.20). Conclusions In our matched comparison, patients in the PVI group had a lower incidence rate of all-cause mortality and hospital admission for acute heart failure compared to the non-PVI group. ClinicalTrials.gov Identifier NCT02105844, April 7th 2014. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02015-0.
Collapse
Affiliation(s)
- Marc Girod
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Ammann
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Angelo Auricchio
- Division of Cardiology, Institute Cardiocentro Ticino, Lugano, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ente Ospedaliero Cantonale, Regional Hospital of Lugano, Lugano, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Marugg
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Helena Aebersold
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Elisa Hennings
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Christine S Zuern
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Stefan Osswald
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|