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Grosse Meininghaus D, Freund R, Koerber B, Kleemann T, Matthes H, Geller JC. Pulsed-field ablation does not induce esophageal and periesophageal injury-A new esophageal safety paradigm in catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:86-93. [PMID: 37975544 DOI: 10.1111/jce.16132] [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: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non-thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio-esophageal fistula (AEF). OBJECTIVE To compare the incidence of any (peri)-esophageal injury following PVI using PFA to thermic energy sources. METHODS Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)- or cryoballoon (CB)-PVI. RESULTS Between December 2022 and February 2023, 20 patients (67 ± 10 years, 53% male) undergoing PFA (Farapulse, Boston Scientific) for atrial fibrillation (AF) were studied and compared with a previous cohort of 57 patients who underwent thermic PVI (CB: n = 33; RF: n = 24). Following PFA-PVI, none of the patients had mucosal lesions, food retention, or ablation-induced vagal nerve injury; four patients showed periesophageal edema. Following thermic ablation, 33/57 patients (58%) showed esophageal and/or periesophageal injury (CB: 21/33 [64%], RF: 12/24 [50%]), in detail 4/57 mucosal lesions, 18/57 food retention, 17/57 vagal nerve injury, and 20/52 edema. Midterm success rates were similar for all energy sources. CONCLUSION In contrast to thermic ablation tools, PFA is not associated with relevant esophageal and periesophageal injury, and might, therefore, reduce or eliminate the risk of potentially lethal AEF in interventional treatment of AF. The etiology of ablation-induced periesophageal edema is unknown but has not been shown to be related to lesion progression.
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Affiliation(s)
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Britta Koerber
- Division of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Tobias Kleemann
- Division of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Harald Matthes
- Division of Gastroenterology, Community-Hospital Havelhoehe Berlin, Berlin, Germany
| | - Johann Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany
- Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
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Vu Trung K, Abou-Ali E, Caillol F, Paik WH, Napoleon B, Masaryk V, van der Wiel SE, Pérez-Cuadrado-Robles E, Musquer N, Halimi A, Soares K, Souche FR, Seyfried S, Petrone MC, Crippa S, Kleemann T, Albers D, Weismüller TJ, Dugic A, Meier B, Wedi E, Schiemer M, Regner S, Gaujoux S, Hollenbach M. Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort. Endoscopy 2023; 55:709-718. [PMID: 36746390 DOI: 10.1055/a-2029-2935] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Familial adenomatous polyposis (FAP) is a rare inherited syndrome that predisposes the patient to cancer. Treatment of FAP-related ampullary lesions is challenging and the role of endoscopic papillectomy has not been elucidated. We retrospectively analyzed the outcomes of endoscopic papillectomy in matched cohorts of FAP-related and sporadic ampullary lesions (SALs). METHODS This retrospective multicenter study included 1422 endoscopic papillectomy procedures. Propensity score matching including age, sex, comorbidity, histologic subtype, and size was performed. Main outcomes were complete resection (R0), technical success, complications, and recurrence. RESULTS Propensity score matching identified 202 patients (101 FAP, 101 SAL) with comparable baseline characteristics. FAP patients were mainly asymptomatic (79.2 % [95 %CI 71.2-87.3] vs. 46.5 % [95 %CI 36.6-56.4]); P < 0.001). The initial R0 rate was significantly lower in FAP patients (63.4 % [95 %CI 53.8-72.9] vs. 83.2 % [95 %CI 75.8-90.6]; P = 0.001). After repeated interventions (mean 1.30 per patient), R0 was comparable (FAP 93.1 % [95 %CI 88.0-98.1] vs. SAL 97.0 % [95 %CI 93.7-100]; P = 0.19). Adverse events occurred in 28.7 %. Pancreatitis and bleeding were the most common adverse events in both groups. Severe adverse events were rare (3.5 %). Overall, 21 FAP patients (20.8 % [95 %CI 12.7-28.8]) and 16 SAL patients (15.8 % [95 %CI 8.6-23.1]; P = 0.36) had recurrence. Recurrences occurred later in FAP patients (25 [95 %CI 18.3-31.7] vs. 2 [95 %CI CI 0.06-3.9] months). CONCLUSIONS Endoscopic papillectomy was safe and effective in FAP-related ampullary lesions. Criteria for endoscopic resection of ampullary lesions can be extended to FAP patients. FAP patients have a lifetime risk of relapse even after complete resection, and require long-time surveillance.
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Affiliation(s)
- Kien Vu Trung
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou-Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Sophia E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Enrique Pérez-Cuadrado-Robles
- Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France
- Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | | | - Asif Halimi
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden
| | - Kevin Soares
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
- Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Maria C Petrone
- Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Stefano Crippa
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Ana Dugic
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Benjamin Meier
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Moritz Schiemer
- Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden
| | - Sebastien Gaujoux
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
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Grosse Meininghaus D, Freund R, Kleemann T, Geller JC, Matthes H. Pulmonary vein isolation-induced vagal nerve injury and gastric motility disorders detected by electrogastrography: The side effects of pulmonary vein isolation in atrial fibrillation (SEPIA) study. J Cardiovasc Electrophysiol 2023; 34:583-592. [PMID: 36640436 DOI: 10.1111/jce.15820] [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: 09/15/2022] [Revised: 11/14/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Safety of pulmonary vein isolation (PVI) has been established in clinical studies. However, despite prevention efforts the incidence of damage to (peri)-esophageal tissue has not decreased, and the pathophysiology is incompletely understood. Damage to vagal nerve branches may be involved in lesion progression to atrio-esophageal fistula. Using electrogastrography, we assessed the incidence of periesophageal vagal nerve injury (VNI) following atrial fibrillation ablation and its association with procedural parameters and endoscopic results. METHODS Patients were studied using electrogastrography, endoscopy, and endoscopic ultrasound before and after cryoballoon (CB) or radiofrequency (RF) PVI. The incidence of ablation-induced neuropathic pattern (indicating VNI) in pre- and postprocedural electrogastrography was assessed and correlated with endoscopic results and ablation data. RESULTS Between February 2021 und January 2022, 85 patients (67 ± 10 years, 53% male) were included, 33 were treated with CB and 52 with RF (38 with moderate power moderate duration [25-30 W] and 14 with high power short duration [50 W]). Ablation-induced VNI was detected in 27/85 patients independent of the energy form. Patients with VNI more frequently had postprocedural endoscopically detected pathology (8% mucosal esophageal lesions, 36% periesophageal edema, 33% food retention) but there was incomplete overlap. Pre-existing esophagitis increased the likelihood of VNI. Ablation data and esophageal temperature data did not predict VNI. CONCLUSION PVI-induced VNI is quite common and independent of ablation energy source. VNI is part of (peri)-esophageal damage and only partially overlaps with endoscopic findings. VNI-associated acidic reflux may be involved in the complex pathophysiology of esophageal lesion progression to fistula.
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Affiliation(s)
| | - Robert Freund
- Carl-Thiem-Hospital Cottbus, Thiem Research, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Johann Christoph Geller
- Zentralklinik Bad Berka, Division of Cardiology, Arrhythmia Section, Bad Berka, Germany.,Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
| | - Harald Matthes
- Department of Gastroenterology, Community-Hospital Havelhoehe Berlin, Berlin, Germany
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Kuellmer A, Mangold T, Bettinger D, Schiemer M, Mueller J, Wannhoff A, Caca K, Wedi E, Kleemann T, Thimme R, Schmidt A. Reduced mortality for over-the-scope clips (OTSC) versus surgery for refractory peptic ulcer bleeding: a retrospective study. Surg Endosc 2023; 37:1854-1862. [PMID: 36253626 PMCID: PMC10017662 DOI: 10.1007/s00464-022-09679-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgery or transcatheter arterial embolization or are both considered as standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-The-Scope clips (OTSC) have shown superiority to standard endoscopic treatment but a comparison with surgery has not been performed, yet. PATIENTS AND METHODS In this retrospective, multicenter study, 103 patients treated with OTSC (n = 66) or surgery (n = 37) for refractory PUB in four tertiary care centers between 2009 and 2019 were analyzed. Primary endpoint was clinical success (successful hemostasis and no rebleeding within seven days). Secondary endpoints were adverse events, length of ICU-stay and in-hospital mortality. Univariable and multivariable regression models were performed to define predictive factors for allocation to surgical therapy and for mortality. RESULTS Age, comorbidities, anticoagulation therapy, number of pretreatments, ulcer location, and Rockall-Score were similar in both groups. In the surgical group, there were significantly more patients in shock at rebleeding (78.1% vs. 43.9%; p = 0.002), larger ulcers (18.6 ± 7.4 mm vs. 23.0 ± 9.4 mm; p = 0.017) and more FIa bleedings (64.9% vs. 19.7%; p < 0.001) were detected. Clinical success was comparable (74.2% vs. 83.8%; p = 0.329). In the surgical group, length of ICU-stay (16.2 ± 18.0 days vs. 4.7 ± 6.6 days; p < 0.001), severe adverse events (70.3% vs. 4.5%; p < 0.001) and in-hospital mortality (35.1% vs. 9.1%; p = 0.003) were significantly higher. Multivariable analysis defined shock at rebleeding as the main predictor for allocation to surgical therapy (OR 4.063, 95%CI {1.496-11.033}, p = 0.006). Postsurgical adverse events were the main reason for the in-hospital mortality (OR 5.167, 95% CI {1.311-20.363}, p = 0.019). CONCLUSION In this retrospective study, OTSC compared to surgical treatment showed comparable clinical success but was associated with shorter ICU-stay, less severe adverse events and lower in-hospital mortality.
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Affiliation(s)
- Armin Kuellmer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Tobias Mangold
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Moritz Schiemer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Julius Mueller
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Andreas Wannhoff
- Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Edris Wedi
- Medizinische Klinik II / IV, Sana Klinikum Offenbach, Offenbach, Germany
| | - Tobias Kleemann
- Medinische Klinik IV, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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5
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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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6
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Schmitz D, Valiente CT, Dollhopf M, Perez-Miranda M, Küllmer A, Gornals J, Vila J, Weigt J, Voigtländer T, Redondo-Cerezo E, von Hahn T, Albert J, vom Dahl S, Beyna T, Hartmann D, Franck F, García-Alonso FJ, Schmidt A, Garcia-Sumalla A, Arrubla A, Joerdens M, Kleemann T, Tomo JRA, Grassmann F, Rudi J. Percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage in malignant distal bile duct obstruction using a self-expanding metal stent: Study protocol for a prospective European multicenter trial (PUMa trial). PLoS One 2022; 17:e0275029. [PMID: 36302047 PMCID: PMC9612485 DOI: 10.1371/journal.pone.0275029] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
Abstract
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) was associated with better clinical success and a lower rate of adverse events (AEs) than fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD) in recent single center studies with mainly retrospective design and small case numbers (< 50). The aim of this prospective European multicenter study is to compare both drainage procedures using ultrasound-guidance and primary metal stent implantation in patients with malignant distal bile duct obstruction (PUMa Trial). Methods The study is designed as a non-randomized, controlled, parallel group, non-inferiority trial. Each of the 16 study centers performs the procedure with the best local expertise (PTBD or EUS-BD). In PTBD, bile duct access is performed by ultrasound guidance. EUS-BD is performed as an endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS) or EUS-guided antegrade stenting (EUS-AGS). Insertion of a metal stent is intended in both procedures in the first session. Primary end point is technical success. Secondary end points are clinical success, duration pf procedure, AEs graded by severity, length of hospital stay, re-intervention rate and survival within 6 months. The target case number is 212 patients (12 calculated dropouts included). Discussion This study might help to clarify whether PTBD is non-inferior to EUS-BD concerning technical success, and whether one of both interventions is superior in terms of efficacy and safety in one or more secondary endpoints. Randomization is not provided as both procedures are rarely used after failed endoscopic biliary drainage and study centers usually prefer one of both procedures that they can perform best. Trial registration ClinicalTrials.gov ID: NCT03546049 (22.05.2018).
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Affiliation(s)
- Daniel Schmitz
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
- Department of Gastroenterology and Infectiology, Helios Kliniken Schwerin, Schwerin, Germany
- * E-mail:
| | - Carlos T. Valiente
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
| | - Markus Dollhopf
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach, München, Germany
| | - Manuel Perez-Miranda
- Department of Gastrointestinal Endoscopy, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Armin Küllmer
- Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Joan Gornals
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Juan Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jochen Weigt
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Eduardo Redondo-Cerezo
- Department of Gastrointestinal Endoscopy, Hospital universitario Virgen de las Nieves, Granada, Spain
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology, and Interventional Endoscopy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Jörg Albert
- Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Torsten Beyna
- Department of Internal Medicine, Gastroenterology and Interventional Endoscopy Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Dirk Hartmann
- Department of General Internal Medicine, Diabetology, Gastroenterology and Oncology, Katholisches Klinikum Mainz, Mainz, Germany
| | - Franziska Franck
- Department of Gastroenterology and Hepatology, München Klinik Neuperlach, München, Germany
| | | | - Arthur Schmidt
- Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Albert Garcia-Sumalla
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Amaia Arrubla
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Markus Joerdens
- Department of Gastroenterology, Hepatology and Infectiology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | | | - Felix Grassmann
- Institute for Medical Statistics and Epidemiology, Medical School Hamburg, Hamburg, Germany
| | - Jochen Rudi
- Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus und St. Hedwig-Klinik, Lehrkrankenhaus der Universität Heidelberg, Mannheim, Germany
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7
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Kleemann T, Lampropoulou E, Kouraki K, Strauss M, Fendt A, Mohammad O, Zahn R. The role of trigger factors in the occurrence of appropriate ICD shocks and their prognostic implications. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The role of triggers in the occurrence of appropriate ICD shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome.
Methods
A total of 710 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed.
Results
In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication intoxication (4%) (Table 1). The trigger factors can be summarized under the acronym ICD-STEMi. Patients with trigger associated ICD shocks had a more depressed ejection fraction and presented more often with ventricular fibrillation or electrical storm. The therapy after VT/VF shock in the trigger group comprised trigger optimization in 100% and heart failure optimization in 21% as compared to 0% respectively 10% in the no-trigger group (p<0.001). The ventricular arrhythmia therapy (antiarrhythmics or VT ablation) was not different between both groups (35% in each group). Patients with triggered first ICD shock had an increased 5-year mortality rate (50% versus 38%, p<0.001) (Figure 1).
Conclusions
In one third of ICD patients with first appropriate ICD shock, at least one trigger can be identified. Finding a trigger strongly influenced therapy after VT/VF shock. Patients with triggered ICD shock have a higher 5-year mortality rate. The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD-STEMi.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Kleemann
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | | | - K Kouraki
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - M Strauss
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - A Fendt
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - O Mohammad
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - R Zahn
- Klinikum Ludwigshafen , Ludwigshafen , Germany
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8
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Grosse Meininghaus D, Freund R, Kushnir A, Koerber B, Geller JC, Kleemann T. Asymptomatic esophageal perforation following high-power short-duration pulmonary vein isolation—A case of conservative cure. HeartRhythm Case Rep 2022; 8:661-665. [PMID: 36310731 PMCID: PMC9596363 DOI: 10.1016/j.hrcr.2022.07.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dirk Grosse Meininghaus
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
- Address reprint requests and correspondence: Dr Dirk Grosse Meininghaus, Department of Cardiology, Carl-Thiem-Hospital, Thiemstr. 111, 03048 Cottbus, Germany.
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Anton Kushnir
- Department of Radiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Britta Koerber
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J. Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik Bad Berka, Bad Berka, Germany
- Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
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9
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Grosse Meininghaus D, Freund R, Heimbaecher L, Kleemann T, Kushnir A, Geller JC. Incidence and clinical relevance of upper gastrointestinal pathology during preprocedural endoscopy in patients undergoing pulmonary vein isolation. Clin Res Cardiol 2022; 111:1069-1076. [PMID: 35716196 DOI: 10.1007/s00392-022-02050-x] [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: 01/26/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Reflux-induced esophagitis might facilitate ablation-induced esophageal lesions (ELs) following pulmonary vein isolation (PVI), and these may progress to atrio-esophageal fistula (AEF). In contrast, preexisting ELs are not prone to progression but may affect procedure planning. OBJECTIVE To study the incidence of preexisting esophageal and upper gastrointestinal (UGI) pathology in patients undergoing PVI, and the relation to ablation-induced ELs. METHODS From 08/2018 to 09/2021, consecutive patients undergoing (radiofrequency [RF] or cryoballoon [CB]) PVI were examined by esophagogastroscopy (EGD) before and following ablation. Postprocedural endoscopic ultrasound (EUS) was added in 2021. RESULTS 412 patients (median age 67.5 [IQR 61.3-75.0] years, 56.1% male) were studied. Preprocedural EGD showed abnormalities in 226/399 patients, 15% in the lower third of the esophagus. Half (99/226) were relevant for PVI, 13 procedures were postponed, 6 due to pathological EGD results. A third of the patients with new esophageal injury following ablation had preexisting esophagitis which was associated with a trend for a higher incidence of ELs after RF ablation (12.5 vs. 6.9%, p = 0.232), and a six- and two-fold higher rate of food retention after CB-PVI (28.6 vs. 4.5%, p = 0.008) and RF ablation (8.3 vs. 4.4%, p = 0.279), respectively. CONCLUSION (1) EGD before PVI showed UGI abnormalities in > 50% of patients, one-fourth of these relevant for PVI. (2) Esophageal inflammation was associated with a higher incidence of post-ablation (peri)-esophageal injury. Whether having this information before ablation is able to reduce ELs or AEF remains to be shown.
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Affiliation(s)
- Dirk Grosse Meininghaus
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany.
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Lukas Heimbaecher
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Anton Kushnir
- Department of Radiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-Von-Guericke University School of Medicine, Magdeburg, Germany
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10
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Puhahn-Schmeiser B, Kleemann T, Jabbarli R, Bock HH, Beck J, Freiman TM. Granule cell dispersion in two mouse models of temporal lobe epilepsy and reeler mice is associated with changes in dendritic orientation and spine distribution. Hippocampus 2022; 32:517-528. [PMID: 35621370 DOI: 10.1002/hipo.23447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
Temporal lobe epilepsy is characterized by hippocampal neuronal death in CA1 and hilus. Dentate gyrus granule cells survive but show dispersion of the compact granule cell layer. This is associated with decrease of the glycoprotein Reelin, which regulates neuron migration and dendrite outgrow. Reelin-deficient (reeler) mice show no layering, their granule cells are dispersed throughout the dentate gyrus. We studied granule cell dendritic orientation and distribution of postsynaptic spines in reeler mice and two mouse models of temporal lobe epilepsy, namely the p35 knockout mice, which show Reelin-independent neuronal migration defects, and mice with unilateral intrahippocampal kainate injection. Granule cells were Golgi-stained and analyzed, using a computerized camera lucida system. Granule cells in naive controls exhibited a vertically oriented dendritic arbor with a small bifurcation angle if positioned proximal to the hilus and a wider dendritic bifurcation angle, if positioned distally. P35 knockout- and kainate-injected mice showed a dispersed granule cell layer, granule cells showed basal dendrites with wider bifurcation angles, which lost position-specific differences. Reeler mice lacked dendritic orientation. P35 knockout- and kainate-injected mice showed increased dendritic spine density in the granule cell layer. Molecular layer dendrites showed a reduced spine density in kainate-injected mice only, whereas in p35 knockouts no reduced spine density was seen. Reeler mice showed a homogenous high spine density. We hypothesize that granule cells migrate in temporal lobe epilepsy, develop new dendrites which show a spread of the dendritic tree, create new spines in areas proximal to mossy fiber sprouting, which is present in p35 knockout- and kainate-injected mice and loose spines on distal dendrites if mossy cell death is present, as it was in kainate-injected mice only. These results are in accordance with findings in epilepsy patients.
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Affiliation(s)
- Barbara Puhahn-Schmeiser
- Faculty of Medicine, Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Hospital, Cottbus, Germany
| | - Ramazan Jabbarli
- Faculty of Medicine, Department of Neurosurgery, Medical Center, University of Duisburg-Essen, Essen, Germany
| | - Hans H Bock
- Faculty of Medicine, Department of Gastroenterology, Hepatology and Infectiology, Medical Center, University of Duesseldorf, Duesseldorf, Germany
| | - Jürgen Beck
- Faculty of Medicine, Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany
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11
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Kaiser L, Hochadel M, Senges J, Kleemann T, Szendey I, Voss F, Steinbeck G, Leschke M, Butter C, Becker R, Willems S, Hakmi S. Procedure related complications following implantation of cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices - Insights from the German DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.465] [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: Foundation. Main funding source(s): Stiftung Institut für Herzinfarktforschung
Background
The number of patients receiving cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices has been increasing in the last decades. Both CRT and ICD play an essential role in modern heart failure therapy. However, the implantation procedure might be ensued by serious complications. Therefore, knowledge about the prevalence of complications and identification of risk factors are key to improve patient care.
Methods
Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD or CRT implantation. Patient characteristics, data on procedural outcome, adverse events and mortality during index hospitalization and follow-up at 1 year from discharge, were recorded. Patients who suffered from perioperative complications during or shortly after device implantation were identified for comparative analysis with patients without complications.
Results
Out of 4170 patients enrolled, 119 (2.9%) suffered from procedure related complications. The proportion of female patients suffering from perioperative complications was higher with 29.4%, compared to 18.5% of female patients without complications (p=0.003). There were neither any differences in age (66.3±13.6 vs. 65.4±12.5 years; p=0.13), nor in cardiac or non-cardiac comorbidities and in the indications for device implantation between groups. There was a trend towards a higher rate of complications with procedures on pre-existing devices (24,8 vs. 18.1%; p=0.064), than observed with de-novo implantations (75.2 vs. 81.9%; p=0.064). CRT implantations were more frequent among patients who suffered from complications (46.2 vs. 28.9%; p<0.001), compared to the group without complications, in which the proportion of ICD implantations was much more frequent (53.8 vs. 71.1%; p<0.001). The most frequent complication overall was pocket hematoma (55.1%), followed by pneumothorax (30.3%), pericardial effusion/tamponade (12.7%) and haemothorax (4.2%). The median hospital stay was significantly longer for patients with complications (7 [5; 11] vs. 3 [2; 5] days; p<0.001)). There was no difference in all-cause in-hospital mortality between respective groups. Median follow-up was 455 [398; 551] vs. 462 [391; 569] days (p=0.82) with no differences in all-cause mortality (6.5 vs. 6.9%; p=0.88), device-associated complications (12.6 vs. 8.5%; p=0.18) or rehospitalizations (37.9 vs. 32.2%; p=0.26) after 1-year follow-up.
Conclusion
The overall procedure-related complication rate following CRT or ICD implantation is low (2.9%). Among patients with complications female gender and patients receiving CRT devices were more prevalent. Perioperative device complications neither seem to translate into increased in-hospital mortality, nor in increased rates of further device-associated complications, rehospitalizations or death after 1-year follow-up.
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Affiliation(s)
- L Kaiser
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - I Szendey
- Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - F Voss
- Hospital Barmherzigen Bruder Trier, Trier, Germany
| | - G Steinbeck
- Klinikum Starnberg, Zentrum fuer Kardiologie, Starnberg, Germany
| | - M Leschke
- Clinic Esslingen, Esslingen, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - R Becker
- Clinic Wolfsburg, Wolfsburg, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Hakmi
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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12
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Chung D, Hochadel M, Senges J, Kleemann T, Eckhardt L, Brachmann J, Steinbeck G, Larbig R, Butter C, Schulz E, Willems S, Hakmi S. Implantable cardioverter-defibrillator therapy in the very young - Patient characteristics procedural outcome and one-year follow-up - A subgroup analysis of the german DEVICE registry. Europace 2022. [DOI: 10.1093/europace/euac053.456] [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
The implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are well-established and essential therapeutic pillars for patients with heart failure and survivors of sudden cardiac death. The number of young patients receiving ICD or CRT-D has been increasing in the last decades. Understanding the key differences between the typically older ICD population and younger patients is paramount to optimized patient care.
Methods
The DEVICE registry prospectively enrolled patients undergoing ICD/CRT implantation or revision from 50 German centers between 2007–2014. Data on patient characteristics, procedural outcome, adverse events and mortality during the initial stay and follow-up was collected. All patients under the age of 45 years were identified and included into a comparative analysis with the remaining population.
Results
A total number of 4181 patients were enrolled into the registry, of which 236 patients (5.6%) were under the age of 45 years. Median age was 38.0 [31.0; 42.0] vs. 69.0 [60.0; 75.0] years, p<0.001), compared to older patients. Young patients were more likely to receive an ICD (91.5 vs. 69.4%, p<0.001), than CRT device and were less likely to suffer from non-cardiac comorbidities (20.3 vs. 67.4%, p<0.001). Coronary artery disease was less common in young patients (15.7 vs. 63.6%, p<0.001), whereas hypertrophic cardiomyopathy (11.0 vs. 2.5%, p<0.001) and primary cardiac electrical diseases (14.0 vs. 1.6%, p< 0.001) were encountered more often. Mean left-ventricular ejection fractions were 42.4±18.5 vs. 31.5±11.8%, respectively (p<0.001) with less young patients in NYHA functional class III/IV (19.5 vs. 45.3%, p<0.001). Primary symptom at presentation was chronic heart failure for older patients (19.5 vs. 34.8%, p<0.001) and survived sudden cardiac death (30.9 vs. 15.6%, p<0.001) for young patients. Thus, ICD for secondary prevention was more common in young patients (53.8 vs. 43.2%, p<0.001). There were no detectable differences in postoperative complications (3.0 vs. 4.1%, p=0.500) or in-hospital mortality (0.0 vs. 0.3%, p=1.000). Median follow-up time was 514 [398; 669] vs. 458 [391; 563] days (p=0.006). Device-associated complications requiring revision were more common in young patients (16.3 vs. 8.2%, p<0.001) and all-cause 1-year-mortality after implantation was lower (3.1 vs. 7.3%, p=0.029; HR 0.42, 95%CI: 0.19-0.94). Even though there was no difference in rates of rehospitalization between groups (32.1 vs. 32.4%, p=0.93), young patients were re-admitted more often for "cardiac" reasons (82.7 vs. 58.9%, p<0.001).
Conclusion
Rates for procedural complications and in-hospital mortality were very low and without differences between both age groups. However younger patients experienced a higher rate of postoperative complications requiring revision and had higher readmission rates for cardiac reasons, potentially due to a more active lifestyle.
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Affiliation(s)
- D Chung
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - M Hochadel
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - J Senges
- IHF GmbH Institute for Heart Attack Research, Ludwigshafen, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen, Germany
| | - L Eckhardt
- Muenster University Hospital, Cardiac Electrophysiology, Muenster, Germany
| | - J Brachmann
- Cardiac Center of Coburg, RegioMed Medical School, Coburg, Germany
| | | | - R Larbig
- Kliniken Maria Hilf Moenchengladbach, Cardiology, Moenchengladbach, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology, Bernau bei Berlin, Germany
| | - E Schulz
- General Hospital of Celle, Cardiology, Celle, Germany
| | - S Willems
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
| | - S Hakmi
- Asklepios St. Georg Clinic, Cardiology & Critical Care Medicine, Hamburg, Germany
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13
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Grosse Meininghaus D, Freund R, Kleemann T, Christoph Geller J. Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high-power short-duration radiofrequency pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1167-1176. [PMID: 35445476 DOI: 10.1111/jce.15509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Luminal esophageal temperature (LET) monitoring is not associated with reduced esophageal injury following pulmonary vein isolation (PVI). OBJECTIVE Detailed analysis of (the temporal and spatial gradients of) LET measurements may better predict the risk for esophageal injury. METHODS Between January 2020 and December 2021, LET maxima, duration of LET rise above baseline, and area under the LET curve (AUC) were calculated offline and correlated with (endoscopy and endoscopic ultrasound detected) esophageal injury (i.e., mucosal esophageal lesions [ELs], periesophageal edema, and gastric motility disorders) following PVI using moderate-power moderate-duration (MPMD [25-30 W/25-30s]) and high-power short-duration (HPSD [50 W/13s]) radiofrequency (RF) settings. RESULTS 63 patients (69 ± 9 years old, 32 male, 51 MPMD and 12 HPSD) were studied. The esophageal injury was frequent (40% in both groups), mucosal ELs were more common with MPMD, and edema was frequently observed following HPSD. RF-duration, total RF-energy at the left atrial (LA) posterior wall, and distance between LA and esophagus were not different between patients with/without esophageal injury. In contrast, to LET and LET duration above baseline, AUC was the best predictor and significantly increased in patients with esophageal injury (3422 vs. 2444 K. s). CONCLUSION For both ablation strategies, AUC of the LET curves best predicted esophageal injury. HPSD is associated with similar rates of esophageal injury when (mostly subclinical) periesophageal alterations (that are of unclear clinical relevance) are included. Whether integration of these calculated LET parameters is useful to prevent esophageal injury remains to be seen.
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Affiliation(s)
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital, Cottbus, Germany
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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14
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Grosse Meininghaus D, Kleemann T. Impact of preprocedural upper gastrointestinal endoscopy for pulmonary vein isolation - single-center experience of 400 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.029] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
Mucosal esophageal lesions (ELs) are reported in 10-40% after pulmonary vein isolation (PVI) and may be precursors of (almost always lethal) atrio-esophageal fistula (AEF). Although mechanisms of lesion progression are not completely understood, inflammation (e.g. by acidic reflux) is thought to be a major contributor. However, ELs may also be preexisting or due to mechanical instrumentation rather than ablation-induced, and these lesions are not prone to progression. On the other hand, preexisting reflux-induced esophagitis might facilitate lesion generation during ablation.
Therefore, esophagogastroscopy (EGD) before PVI might reveal important information regarding preexisting vulnerability that needs to be considered/is relevant for ablation procedure planning.
Purpose
(1) To study the incidence of preexisting esophageal and upper gastrointestinal pathology detected by EGD in patients undergoing PVI. (2) To assess the impact of preprocedural EGD on procedure planning.
Methods
All consecutive patients undergoing PVI (radiofrequency energy PVI or cryoablation) had routine pre- and post-procedural EGD. The preexisting EGD-findings were analyzed with regard to their impact on PVI planning, postprocedural ELs, and additional endoscopic workup.
Results
From 08/2018 to 08/2021, 396 patients (66 ± 9 years, 58% male) were included. During preprocedural EGD, 207 patients (52%) had esophageal and extraesophageal abnormalities.
In 57 patients, the findings influenced the procedure strategy (e.g. in the presence of inflammation of the lower third of the esophagus, maximum power at the posterior left atrial wall was reduced from 25 to 20 Watts). 9/29 patients with new ELs in postprocedural EGD had preexisting esophagitis.
Ablation was postponed for five patients, thereof two with candida esophagitis, two with gastral and one with duodenal ulcer, respectively). 16 patients received further endoscopic workup with identification of a gastric carcinoma in one. Endoscopic ultrasound identified a patient with a pancreatic head neoplasia. There were no procedure-related complications of EGDs.
Discussion and Conclusion
In an unselected cohort, preprocedural EGD showed incidental findings in a half of the patients, and one-fourth of these were considered to be relevant for procedural aspects of PVI. Of particular interest is the absence of inflammation of the esophageal wall. Ulcer do not affect the safety of the PVI directly, but have impact on anticoagulation issues. EGD before PVI merits consideration. Abstract Figure. EGD-findings before PVI
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Affiliation(s)
| | - T Kleemann
- Carl-Thiem-Hospital, Department of Gastroenterology, Cottbus, Germany
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15
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Kuellmer A, Mangold T, Bettinger D, Maruschke L, Wannhoff A, Caca K, Wedi E, Hosseini ASA, Kleemann T, Schulz T, Jung C, Thimme R, Schmidt A. Over-the-scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding-A propensity score matched analysis. United European Gastroenterol J 2021; 9:1048-1056. [PMID: 34432392 PMCID: PMC8598957 DOI: 10.1002/ueg2.12135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/02/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) or surgery are standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-the-scope clips (OTSC) have shown superiority to standard endoscopic treatment. OBJECTIVE To compare OTSC treatment to TAE in refractory peptic ulcer bleeding. PATIENTS AND METHODS In this retrospective, multicenter study, 128 patients treated with OTSC (n = 66) or TAE (n = 62) for refractory PUB between 2009 and 2019 in four academic centers were analyzed. Primary endpoint was clinical success (hemostasis + no rebleeding within 7 days). Secondary endpoints were adverse events, length of ICU stay, and mortality. Propensity score matching was performed to adjust for differences in baseline characteristics. RESULTS Patients characteristics were similar in both groups but ulcers in the TAE group were larger, more often located in the duodenal bulb (85.5% vs. 65.2%; p = 0.014), and that the proportion of Forrest Ia bleedings was higher (38.7% vs. 19.7%; p = 0.018). Clinical success was comparable in both groups (74.2% vs. 59.7%; p = 0.092). Stay on the intensive care unit (ICU) was significantly longer in the TAE group (mean 8.0 vs. 4.7 days; p = 0.002). Serious adverse events after re-therapy (12.9% vs. 1.5%; p = 0.042) and in-hospital mortality were significantly higher in the TAE group (9.1 vs. 22.6%, OR 2.92 [95% CI 1.04-8.16]; p = 0.05). After propensity score matching, the differences found regarding ICU stay (4.9± 5.9 and 9.2 ± 11.2; p = 0.009) and in-hospital mortality (5% vs. 22.5%; OR 5.52 [95% CI: 1.11-27.43]; p = 0.048) stayed significant. CONCLUSIONS OTSC treatment for refractory PUB was superior to TAE in terms of ICU stay and in-hospital mortality.
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Affiliation(s)
- Armin Kuellmer
- Department of Medicine IIMedical CenterFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Tobias Mangold
- Department of Medicine IIMedical CenterFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Dominik Bettinger
- Department of Medicine IIMedical CenterFaculty of MedicineUniversity of FreiburgFreiburgGermany
- Berta‐Ottenstein‐ProgrammeUniversity of FreiburgFreiburgGermany
| | - Lars Maruschke
- Department of RadiologySt.‐Josef HospitalRkK‐KlinikumFreiburgGermany
| | - Andreas Wannhoff
- Department of Internal Medicine and GastroenterologyHospital LudwigsburgLudwigsburgGermany
| | - Karel Caca
- Department of Internal Medicine and GastroenterologyHospital LudwigsburgLudwigsburgGermany
| | - Edris Wedi
- Medizinische Klinik II / IVSana Klinikum OffenbachOffenbachGermany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional RadiologyUniversity Medical Center GöttingenGöttingenGermany
| | - Tobias Kleemann
- Medinische Klinik IVCarl‐Thiem‐Klinikum CottbusCottbusGermany
| | - Thomas Schulz
- Institut für RadiologieCarl‐Thiem‐Klinikum CottbusCottbusGermany
| | - Carlo Jung
- Gastroenterology and Digestive Endoscopy UnitForlì‐Cesena HospitalsAUSL RomagnaForlì‐CesenaItaly
| | - Robert Thimme
- Department of Medicine IIMedical CenterFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Arthur Schmidt
- Department of Medicine IIMedical CenterFaculty of MedicineUniversity of FreiburgFreiburgGermany
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Grosse Meininghaus D, Blembel K, Waniek C, Kruells-Muench J, Ernst H, Kleemann T, Geller JC. Temperature monitoring and temperature-driven irrigated radiofrequency energy titration do not prevent thermally induced esophageal lesions in pulmonary vein isolation: A randomized study controlled by esophagoscopy before and after catheter ablation. Heart Rhythm 2021; 18:926-934. [PMID: 33561587 DOI: 10.1016/j.hrthm.2021.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoscopically detected esophageal lesions (EDELs) are common following pulmonary vein isolation (PVI) and may progress to atrioesophageal fistula (AEF). OBJECTIVE The purpose of this study was to study (1) the benefit of luminal esophageal temperature (LET) monitoring and (2) the impact of esophagogastroduodenoscopy (EGD) in detecting EDEL and defining pre-existing lesions. The primary endpoint was the number of ablation-induced lesions. METHODS Patients with atrial fibrillation were randomized to PVI with LET monitoring (LET[+]) or without LET monitoring (LET[-]). All patients underwent EGD before and after PVI. Ablation power at the left atrial (LA) posterior wall was limited to 25 W in all patients and was titrated to a minimum of 10 W guided by esophageal temperature in the LET[+] group. RESULTS Eighty-six patients (age 67 ± 10 years; 57% male) were included (44 LET[+], 42 LET[-]). PVI was achieved in all, and additional linear LA lesions were done in 50%. Eight patients developed EDEL (6 LET[+], 2 LET[-]; P = NS). Whereas LET <41°C did not differentiate with regard to EDEL formation, temperature overshooting ≥42°C was associated with a higher risk for new EDEL. Two-thirds of patients showed incidental findings (esophagitis, gastric ulcer) on preprocedural EGD; 8 esophageal lesions were pre-existing. Four patients in the LET[+] group developed epistaxis following insertion of the probe. CONCLUSION Monitoring of LET does not prevent ablation-induced esophageal lesions. Patients without temperature surveillance were not at higher risk, but temperatures ≥42°C were associated with increased likelihood of mucosal lesions.
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Affiliation(s)
| | - Kai Blembel
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Germany
| | - Claudia Waniek
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Germany; Thiem Research, Carl-Thiem-Hospital Cottbus, Germany
| | | | - Helmut Ernst
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Germany
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik Bad Berka, Germany; Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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Lerchbaumer MH, Kleemann T, Jung EM, Nagel S, Hamm B, Fischer T. Vascular pattern and diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in spleen alterations. Clin Hemorheol Microcirc 2020; 75:177-188. [PMID: 31929153 DOI: 10.3233/ch-190758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to clarify rare focal splenic lesions (FSL). CEUS is a safe and cost-effective modality for assessment of perfusion. OBJECTIVE To validate contrast enhancement pattern and evaluate the diagnostic accuracy of CEUS in unclear FSL. METHODS CEUS examinations of the spleen in 50 patients between 2012 and 2018 were included in the study. Examinations were performed using B-mode, colour-coded Doppler ultrasound (CCDS) and CEUS after injection of sulphur hexafluoride microbubbles and interpreted in consensus by two experienced radiologists. Reference standard was defined as histopathological report and clinical course (treatment response, long term follow up). RESULTS All patients were successfully examined by CEUS without an adverse reaction. CEUS presented the correct differentiation of benign and malignant alterations in 49/50 (98%). Lesion washout was found in all malignant but also 16.7% of all benign lesions. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 100% (95% -CI, 57-100), a specificity of 98% (95% -CI, 88-100), a positive predictive value (PPV) of 83% (95% -CI, 44-97) and a negative predictive value (NPV) of 100% (95% -CI, 92-100). CONCLUSION CEUS may provide additional information by visualization of dynamic contrast enhancement pattern to differentiate benign and malignant lesions. Nevertheless, established criteria for malignancy (early enhancement or washout) in FSL should be considered with caution since they are also found in benign lesions.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Tobias Kleemann
- Carl-Thiem-Klinikum, Department of Gastroenterology, Cottbus, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Sebastian Nagel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Thomas Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Kleemann T. [Which way does modern pacemaker therapy go?]. Herz 2018; 43:583. [PMID: 30361836 DOI: 10.1007/s00059-018-4759-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. 3296Benefit and harm during 10-year ICD-therapy: temporal trends during the last 25 years. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleemann T, Nonnenmacher F, Kouraki K, Strauss M, Werner N, Zahn R. P4859Long-term performance data of modern ICD leads compared to older ICD lead models. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - F Nonnenmacher
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Mohammad O, Kouraki K, Strauss M, Zeymer U, Zahn R, Kleemann T. P6234Prognostic value of elevated electromagnetic QRS-fragmentation index on 5-year outcome in patients with acute myocardial infarction undergoing cardiac magnet field imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Mohammad
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - K Kouraki
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - M Strauss
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P439Incidence and causes of stroke in ICD-patients. Europace 2018. [DOI: 10.1093/europace/euy015.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P1221Prognostic relevance of new onset arrhythmia and ICD shocks in primary prophylactic ICD patients. Europace 2018. [DOI: 10.1093/europace/euy015.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Bogossian H, Hochadel M, Ince H, Spitzer SG, Eckardt L, Maier S, Kleemann T, Brachmann J, Stellbrink C, Gonska BD, Kaab S, Senges J, Lemke B. 1075Single chamber implantable cardioverter defibrillator compared to dual chamber implantable cardioverter defibrillator. Less is more. Data from the German Device Registry. Europace 2018. [DOI: 10.1093/europace/euy015.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Bogossian
- Maerkische Klinken GmbH / Witten-Herdecke University, Cardiology and Angiology, Lüdenscheid/ Witten-Herdecke, Germany
| | - M Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - H Ince
- Vivantes Klinikum am Urban, Cardiology, Berlin, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | - L Eckardt
- University Medical Center, Münster, Germany
| | - S Maier
- Krankenhaus St. Elisabeth, Straubing, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | | | - B D Gonska
- St. Vincentius-Kliniken, Karlsruhe, Germany
| | - S Kaab
- University Hospital of Munich, Munich, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - B Lemke
- Märkische Kliniken GmbH, Klinikum Lüdenscheid, Luedenscheid, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P463Risk assessment for primary prophylactic ICD implantation in hypertrophic cardiomyopathy using the risk calculator: discrepancy between theory and clinical practice? Europace 2018. [DOI: 10.1093/europace/euy015.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleemann T, Strauss M, Kouraki K, Schmidt K, Werner N, Zahn R. P1740Prognostic significance of new onset atrial fibrillation in ICD patients. Europace 2017. [DOI: 10.1093/ehjci/eux161.050] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Veltmann C, Woehrle A, Busch M, Elsaesser A, Kleemann T, Geller JC. 657Reduction of inappropriate shocks of ICDs with enhanced SVT discriminators. First results from the ReduceIT study. Europace 2017. [DOI: 10.1093/ehjci/eux145.008] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kleemann T, Kouraki K, Strauss M, Schmidt K, Werner N, Zahn R. P1714Clinical implications for patients with persistent phrenic nerve palsy after cryoballoon ablation of pulmonary veins. Europace 2017. [DOI: 10.1093/ehjci/eux161.024] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Strauss M, Kouraki K, Weisse U, Zahn R, Kleemann T. Comparison of a new quadripolar coronary sinus lead with the conventional bipolar coronary sinus lead in patients undergoing CRT-ICD therapy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3191] [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: 11/14/2022] Open
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Park SJ, Lee SH, Byeon KM, On YK, Huh J, Kim JS, Berezin A, Kremzer A, Kouraki K, Strauss M, Skarlos A, Zeymer U, Zahn R, Kleemann T, Rosengarten JA, Dima SM, Panagiotou C, Scott PA, Chui KHO, Mazomenos EB, Maharatna K, Curzen NP, Morgan J. Oral Abstract Session: Novel non-invasive risk marker. Europace 2013. [DOI: 10.1093/europace/eut166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Palm F, Kleemann T, Dos Santos M, Urbanek C, Buggle F, Safer A, Hennerici MG, Becher H, Zahn R, Grau AJ. Stroke due to atrial fibrillation in a population-based stroke registry (Ludwigshafen Stroke Study) CHADS2, CHA2DS2-VASc score, underuse of oral anticoagulation, and implications for preventive measures. Eur J Neurol 2012; 20:117-23. [PMID: 22788384 DOI: 10.1111/j.1468-1331.2012.03804.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 05/29/2012] [Indexed: 12/01/2022]
Affiliation(s)
- F. Palm
- Department of Neurology; Klinikum Ludwigshafen; Ludwigshafen Germany
| | - T. Kleemann
- Department of Cardiology; Klinikum Ludwigshafen; Ludwigshafen Germany
| | - M. Dos Santos
- Department of Neurology; Klinikum Ludwigshafen; Ludwigshafen Germany
| | - C. Urbanek
- Department of Neurology; Klinikum Ludwigshafen; Ludwigshafen Germany
| | - F. Buggle
- Department of Neurology; Klinikum Ludwigshafen; Ludwigshafen Germany
| | - A. Safer
- Institute of Public Health; University of Heidelberg; Heidelberg Germany
| | - M. G. Hennerici
- Department of Neurology; Universitätsklinikum Mannheim; University of Heidelberg; Mannheim Germany
| | - H. Becher
- Institute of Public Health; University of Heidelberg; Heidelberg Germany
| | | | - A. J. Grau
- Department of Neurology; Klinikum Ludwigshafen; Ludwigshafen Germany
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Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, Hennerici M, Inselmann G, Hagar M, Safer A, Becher H, Grau A. Etiology, Risk Factors and Sex Differences in Ischemic Stroke in the Ludwigshafen Stroke Study, a Population-Based Stroke Registry. Cerebrovasc Dis 2012; 33:69-75. [DOI: 10.1159/000333417] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 09/05/2011] [Indexed: 11/19/2022] Open
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Biffi M, Exner D, Crossley G, Ramza B, Coutu B, Tomassoni GF, Kranig W, Voss F, Teo KM, Stuart AG, Tomassoni G, Baker J, Corbisiero R, Love C, Martin D, Niazi I, Sheppard R, Worley S, Jurkuvenas P, Sedlacek K, Malek I, Hoskova L, Kautzner J, Landolina M, Lunati M, Gasparini M, Santini M, Giannola G, Ammirati F, Ricci R, Valsecchi S, Folino AF, Vaccari D, Zanotto G, Marras E, Bertaglia M, Chiusso F, Buja G, Veneto Region HMSG, Strunk-Mueller C, Meyer Zu Vilsendorf D, Stellbrink C, Senges J, Schwab JO, Gordon BJ, Fazal IA, Plummer CJ, Mccomb JM, Kleemann T, Strauss M, Hochadel M, Seidl K, Zahn R. Hot topics: CRT and ICD therapy. Europace 2011. [DOI: 10.1093/europace/eur219] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Strauss M, Kleemann T, Weisse U, Sack FU, Zahn R. Additional coronary sinus defibrillation lead with a right pectoral ICD and high DFT : a case report. Herzschrittmacherther Elektrophysiol 2011; 22:121-3. [PMID: 21479600 DOI: 10.1007/s00399-011-0134-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
We report the case of a 63-year-old man with ischemic cardiomyopathy having an implantable cardioverter defibrillator (ICD) implanted for repeated ventricular tachycardia (VT). After several revisions of the ICD lead, a thrombosis of the left venous system was diagnosed. A right pectoral ICD device was implanted, and a sufficient defibrillation threshold (DFT) could not be achieved during the operation. Thus, a further defibrillation lead was implanted into the coronary sinus, which successfully terminated ventricular fibrillation.
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Affiliation(s)
- M Strauss
- Arrhythmia Institute at the Heart Center Ludwigshafen, Cardiology, Deutschland.
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Abstract
Patients who survive out-of-hospital cardiac arrest or symptomatic ventricular tachyarrhythmias are at considerable risk of recurrence of these events and ultimately death. The implantation of an implantable cardioverter defibrillator (ICD) in patients with previous sustained ventricular tachyarrhythmias (VT) is considered secondary prevention of sudden cardiac death. The purpose of this review is to summarize the most important trials on secondary prevention with an ICD. The results from a meta-analysis showed a relative-risk reduction of 28% in overall mortality. Compared with amiodarone, an ICD provided maximal benefit for those patients with an ejection fraction between 20% and 35%. The results of the ICD trial demonstrate that there is clear evidence for the effectiveness of an ICD in patients with unstable VT; however, for patients with stable VT the results are less clear. Data on older patients are scant, and whether the survival benefit observed in the middle aged and younger-old also extend to older elderly patients with a more limited life span is less clear. Therefore, as the population becomes older, it is important to evaluate the safety, effectiveness, and the cost effectiveness of ICD implantation in this population. Guidelines are important and helpful to guide clinical decisions, but the indication for an ICD still remains an individual decision after evaluation of the risks and benefits for the individual patient. However, the patient needs to be involved, which emphasizes the importance of dialogue between the patient and physician.
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Affiliation(s)
- K Seidl
- Zentrum für Herzrhythmusstörungen Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
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Kleemann T, Becker T, Strauss M, Dyck N, Weisse U, Saggau W, Burkhardt U, Seidl K. Prevalence of bacterial colonization of generator pockets in implantable cardioverter defibrillator patients without signs of infection undergoing generator replacement or lead revision. Europace 2009; 12:58-63. [DOI: 10.1093/europace/eup334] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Kleemann T, Becker T, Strauss M, Schneider S, Seidl K. Prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast in patients with atrial fibrillation and low CHADS2 score. European Journal of Echocardiography 2009; 10:383-8. [DOI: 10.1093/ejechocard/jen256] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kleemann T, Becker T, Dönges K, Vater M, Gut B, Schneider S, Senges J, Seidl K. The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease. Clin Res Cardiol 2006; 96:103-8. [PMID: 17115325 DOI: 10.1007/s00392-006-0466-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 10/02/2006] [Indexed: 11/26/2022]
Abstract
The aim of the study was to evaluate the prognostic impact of successful cardioversion (CV) compared to failed CV in patients with atrial fibrillation (AF) and organic heart disease. A total of 471 consecutive patients with organic heart disease from the prospective single center anticoagulation registry ANTIK who underwent CV of AF or atrial flutter were analyzed. 417 patients (89%) could be successfully cardioverted. In 54 patients (11%) CV failed, these patients remained in AF. After 5 years there were 92 (24%) deaths among patients with restored sinus rhythm at index admission and 20 (38%) deaths among those who remained in AF after CV (unadjusted OR 1.9, 95% CI 1.1-3.6). After adjustment for age, gender and ejection fraction, successful CV was not associated with a beneficial effect on mortality (OR 0.72, 95% CI 0.43-1.21). Thus, successful CV is not an independent predictor of mortality on multivariate analysis. However, it remains a marker for a better prognosis in patients with organic heart disease as these patients have a lower unadjusted longterm mortality.
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Affiliation(s)
- T Kleemann
- Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Medizinische Klinik B, Germany.
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Taubert G, Kottmann T, Gitt AK, Winkler R, Bergmeier C, Kleemann T, Seidl K, Senges J. [1998 prognosis of left ventricular dysfunction in a maximum care non-university hospital. Analysis of the Ludwigshafen LVD Registry]. Z Kardiol 1999; 88:14-22. [PMID: 11021272 DOI: 10.1007/s003920050258] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prognostic data on heart failure rely on epidemiological studies or large clinical trials. These data are not to transfer easily on everyday practice. OBJECTIVE To assess the prognosis of left ventricular dysfunction under the therapeutic conditions of the 1990s. SETTING Nonuniversity tertiary care hospital. PATIENTS AND METHODS Since January 1995 consecutive and complete registry of all inpatients presenting with a left ventricular dysfunction (EF < 45%). No exclusion criteria. RESULTS n = 512, mean age 64 years, 77% male, mean NYHA class 2.5, left ventricular EF 31%. ETIOLOGY 58% coronary heart disease, 28% dilated cardiomyopathy. Medical treatment consisting of 91% ACE inhibitors, ACE inhibitor dosage 52% of the recommended dose, 42% beta-blockers, 70% diuretics, and 63% digitalis. Follow-up completeness 95.5%. One-year mortality 64/489 patients (13.9%). Determinants of mortality: NYHA III/IV, EF < 30%, malignant disease, age > 75 years. CONCLUSION In spite of the aforementioned medical treatment and a proportion of 14.8% implanted defibrillators in 1998, the one-year mortality of ventricular dysfunction is as high as 13.9%. In everyday practice the prognostic effect of ACE inhibition and beta-blockade is not completely utilized.
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Wagner F, Kleemann T, Zahn W. Microbial transformation of hydrocarbons. II. Growth constants and cell composition of microbial cells derived from n-alkanes. Biotechnol Bioeng 1969; 11:393-408. [PMID: 5821407 DOI: 10.1002/bit.260110311] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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