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Wessel N, Berg K, Kraemer JF, Gapelyuk A, Rietsch K, Hauser T, Kurths J, Wenzel D, Klein N, Kolb C, Belke R, Schirdewan A, Kääb S. Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity. Front Physiol 2020; 11:596844. [PMID: 33363477 PMCID: PMC7752808 DOI: 10.3389/fphys.2020.596844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period. OBJECTIVE To study the association between the risk of de novo device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation. METHODS The registry consists of 234 patients implanted with an ICD, including 10 with de novo long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics. RESULTS No linear HRV was associated with an increased risk of AF (p = n.s.). The only significant approach was derived from symbolic dynamics with the parameter "forbidden words" which distinguished both groups on all 7 days of measurements (p < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the de novo AF group. CONCLUSION Cardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.
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Affiliation(s)
- Niels Wessel
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karsten Berg
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jan F. Kraemer
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrej Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Jürgen Kurths
- Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Centre for Analysis of Complex Systems, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Dave Wenzel
- Clinic for Cardiology and Angiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | | | | | - Stefan Kääb
- Medical Center of Ludwig-Maximilians-University of Munich, Munich, Germany
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Herm J, Schurig J, Martinek MR, Höltgen R, Schirdewan A, Kirchhof P, Wieczorek M, Pürerfellner H, Heuschmann PU, Fiebach JB, Haeusler KG. MRI-detected brain lesions in AF patients without further stroke risk factors undergoing ablation - a retrospective analysis of prospective studies. BMC Cardiovasc Disord 2019; 19:58. [PMID: 30871479 PMCID: PMC6419420 DOI: 10.1186/s12872-019-1035-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/27/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients. METHODS We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data. RESULTS In total, 175 patients (median age 60 (IQR 54-67) years, 32% female, median CHA2DS2-VASc = 1 (IQR 0-2), 33% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8%) out of 48 and 10 (8%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13%) out of 30 AF patients without stroke risk factors and 25 (25%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03). CONCLUSION In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.
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Affiliation(s)
- Juliane Herm
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schurig
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin R Martinek
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Reinhard Höltgen
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Bocholt, Germany
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Marcus Wieczorek
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Bocholt, Germany.,Witten/Herdecke University, School of Medicine, Witten, Germany
| | | | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11 97080, Würzburg, Germany.
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Baumert M, Baier V, Haueisen J, Wessel N, Meyerfeldt U, Schirdewan A, Voss A. Forecasting of Life Threatening Arrhythmias Using the Compression Entropy of Heart Rate. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1633859] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCD prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forthcoming shocks.
Methods:
The last 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquired control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (Hc).
Results:
Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, Hc revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT.
Conclusion:
Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD.
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Brala D, Drephal C, Rudolph JP, Tessin S, Goeing O, Schirdewan A. P336Cryoballoon energy pulmonary vein isolation with and without radiopaque contrast agent injection to control the balloon occlusion of the pulmonary veins: a prospective randomized study. Europace 2017. [DOI: 10.1093/ehjci/eux141.062] [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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Schirdewan A, Herm J, Roser M, Landmesser U, Endres M, Koch L, Haeusler KG. Loop Recorder Detected High Rate of Atrial Fibrillation Recurrence after a Single Balloon- or Basket-Based Ablation of Paroxysmal Atrial Fibrillation: Results of the MACPAF Study. Front Cardiovasc Med 2017; 4:4. [PMID: 28243592 PMCID: PMC5303896 DOI: 10.3389/fcvm.2017.00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/18/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose Pulmonary vein isolation (PVI) is an established approach to treat symptomatic non-permanent atrial fibrillation (AF). Detecting AF recurrence after PVI is important, if discontinuation of oral anticoagulation after ablation is considered. Methods Patients with symptomatic paroxysmal AF were enrolled in the prospective randomized mesh ablator vs. cryoballoon pulmonary vein (PV) ablation of symptomatic paroxysmal AF study, comparing efficacy and safety of the HD Mesh Ablator® (C.R. Bard, Lowell, MA, USA) and the Arctic Front® (Medtronic, Minneapolis, MN, USA) catheter. Rhythm status post-PVI was closely monitored for 1 year using the implantable loop recorder (ILR) Reveal XT® (Medtronic Minneapolis, MN, USA). Results The study was terminated after the first interim analysis due to the inability of the HD Mesh Ablator® to achieve the predefined primary study endpoint, an exit block of all PVs. After a 90-day blanking period, 23 (62.2%) out of 37 study patients (median 63.0 years; 41% females) had at least one episode of AF. AF recurrence was associated with AF episodes during the blanking period {hazard ratios (HR) 5.10 [95% confidence interval (CI) 1.21–21.4]; p = 0.038}, and a common left-sided PV ostium [HR 4.17 (95%CI 1.48–11.8); p = 0.039] but not with catheter type, age, gender, cardiovascular risk profile, or left atrial volume. There was a trend toward AF recurrence in patients without complete PVI of all PV (p = 0.095). Overall, 337 (59.4%) out of 566 ILR-detected episodes represented AF. Comparing patients with AF recurrence to those without, there was no difference in cognitive performance 6 months post-ablation. Conclusion Using an ILR, in more than 60% of all patients with paroxysmal AF, a recurrence of AF was detected within 12 months after ablation. In patients with a common PV ostium, the first generation balloon-based catheter is obviously less effective. Clinical trials http://Clinicaltrials.gov NCT01061931.
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Affiliation(s)
| | - Juliane Herm
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mattias Roser
- Department of Cardiology and Pneumology, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Ulf Landmesser
- Department of Cardiology and Pneumology, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Partner Site, Berlin, Germany; German Center for Cardiovascular Diseases (DZHK), Partner Site, Berlin, Germany
| | - Lydia Koch
- Department of Cardiology, Sana Clinic Lichtenberg , Berlin , Germany
| | - Karl Georg Haeusler
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Fischer C, Seeck A, Schroeder R, Goernig M, Schirdewan A, Figulla HR, Baumert M, Voss A. QT variability improves risk stratification in patients with dilated cardiomyopathy. Physiol Meas 2015; 36:699-713. [PMID: 25799313 DOI: 10.1088/0967-3334/36/4/699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recently it could be demonstrated that systolic and diastolic blood pressure variability (BPV) as well as segmented Poincare plot analysis (SPPA) contribute to risk stratification in patients suffering from dilated cardiomyopathy (DCM). The aim of this study was to improve the risk stratification applying a multivariate technique including QT variability (QTV). We enrolled and significantly separated 56 low risk and 13 high risk DCM patients by nearly all applied BPV and QTV methods, but not with traditional heart rate variability analysis. The optimum set of two indices calculating the multivariate discriminate analysis (DA) included one BPV index calculated by symbolic dynamics method (DBP(Shannon)) and one index calculated from QTV (QTV(log)) achieving an area under the receiver operating characteristics curve (AUC) of 92%, sensitivity of 92.3% and specificity of 89.3%. Performing only electrocardiogram analysis, the optimum multivariate approach including indices from segmented Poincaré plot analysis and QTV still achieved a remarkable AUC of 88.3%. Increasing the number of indices for multivariate DA up to three, we achieved an AUC of 95.7%, sensitivity of 100% and specificity of 85.7% including one clinical, one BPV and one QTV index. Summarizing, we identified DCM patients with an increased risk of sudden cardiac death applying QTV analysis in a multivariate approach.
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Affiliation(s)
- C Fischer
- Department of Medical Engineering and Biotechnology, University of Applied Sciences Jena, Germany
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Schirdewan A, Schmitz D, Konorza T, Wende C, de Ros JO, Brala D, Göing O. Analysis of arrhythmia episodes stored in ICDs with implantable cardioverter-defibrillator lead with a floating atrial sensing dipole. J Electrocardiol 2014. [DOI: 10.1016/j.jelectrocard.2014.08.022] [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: 11/15/2022]
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Brala D, Gapelyuk A, Schirdewan A. Body surface potential mapping and magnetic field mapping in patients with arrhythmogenic right ventricular cardiomyopathy: Different techniques–different results? J Electrocardiol 2014. [DOI: 10.1016/j.jelectrocard.2014.08.028] [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: 10/24/2022]
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Herm J, Fiebach JB, Koch L, Kopp UA, Kunze C, Wollboldt C, Brunecker P, Schultheiss HP, Schirdewan A, Endres M, Haeusler KG. Neuropsychological Effects of MRI-Detected Brain Lesions After Left Atrial Catheter Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:843-50. [DOI: 10.1161/circep.113.000174] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 01/01/2023]
Affiliation(s)
- Juliane Herm
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B. Fiebach
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Lydia Koch
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Ute A. Kopp
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Wollboldt
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Brunecker
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Heinz-Peter Schultheiss
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Schirdewan
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Georg Haeusler
- From the Department of Neurology (J.H., U.A.K., M.E., K.G.H.), Center for Stroke Research Berlin (J.H., J.B.F., C.K., C.W., P.B., M.E., K.G.H.), Department of Cardiology and Pneumology (L.K., H.-P.S., A.S.), and Excellence Cluster NeuroCure (M.E.), Charité–Universitätsmedizin Berlin, Berlin, Germany
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Brala D, Koch L, Nagel P, Schultheiss HP, Schirdewan A. First clinical experience with the new generation cryoballoon technology: acute procedural and long term results. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2326] [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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Haeusler KG, Koch L, Herm J, Kopp UA, Heuschmann PU, Endres M, Schultheiss HP, Schirdewan A, Fiebach JB. 3 Tesla MRI-Detected Brain Lesions after Pulmonary Vein Isolation for Atrial Fibrillation: Results of the MACPAF Study. J Cardiovasc Electrophysiol 2012; 24:14-21. [PMID: 22913568 DOI: 10.1111/j.1540-8167.2012.02420.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koch L, Haeusler KG, Herm J, Safak E, Fischer R, Malzahn U, Werncke T, Heuschmann PU, Endres M, Fiebach JB, Schultheiss HP, Schirdewan A. Mesh ablator vs. cryoballoon pulmonary vein ablation of symptomatic paroxysmal atrial fibrillation: results of the MACPAF study. Europace 2012; 14:1441-9. [PMID: 22523379 DOI: 10.1093/europace/eus084] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Lydia Koch
- Department of Cardiology and Pneumology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12203 Berlin, Germany.
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Parlitz U, Berg S, Luther S, Schirdewan A, Kurths J, Wessel N. Classifying cardiac biosignals using ordinal pattern statistics and symbolic dynamics. Comput Biol Med 2012; 42:319-27. [DOI: 10.1016/j.compbiomed.2011.03.017] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/02/2011] [Accepted: 03/28/2011] [Indexed: 11/30/2022]
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Dartsch T, Fischer R, Gapelyuk A, Weiergraeber M, Ladage D, Schneider T, Schirdewan A, Reuter H, Mueller-Ehmsen J, Zobel C. Aldosterone induces electrical remodeling independent of hypertension. Int J Cardiol 2011; 164:170-8. [PMID: 21764470 DOI: 10.1016/j.ijcard.2011.06.100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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] [Received: 11/16/2010] [Revised: 05/17/2011] [Accepted: 06/18/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Treatment of heart failure patients with aldosterone antagonists has been shown to reduce the occurrence of sudden cardiac death. Therefore we aimed at determining the consequences of chronic exposure to aldosterone and the aldosterone antagonists eplerenone and spironolactone on the electrophysiological properties of the heart in a rat model. METHODS AND RESULTS Male Wistar rats were chronically treated (4weeks) with aldosterone (ALD) via an osmotic minipump. Spironolactone (SPI) or eplerenone (EPL) was administered with the rat chow. ALD treated animals developed left ventricular hypertrophy, prolonged QT-intervals, a higher rate of ventricular premature beats and non-sustained ventricular tachycardia despite normal blood pressure values. Spironolactone and eplerenone were both able to inhibit the alterations. Left-ventricular mRNA expressions of Kv4.2 and Kv4.3 (Ito), Kv1.5 (IKur), Kir2.1 and Kir2.3 (IK1) and of Cav1.2 (L-type Ca(2+) channel) were significantly down-regulated in ALD. Correspondingly, the protein expressions of subunits Kv1.5, Kir2.3 and Cav1.2 were significantly decreased. A diminished calcineurin activity and mRNA expression of the Aß subunit of calcineurin were found in ALD, which was insensitive to aldosterone antagonists. CONCLUSIONS Chronic aldosterone-overload induces blood pressure independent structural and electrical remodeling of the myocardium resulting in an increased risk for malignant ventricular arrhythmias.
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Affiliation(s)
- Theresa Dartsch
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
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Fabbri GMT, Baldasseroni S, Panuccio D, Zoni Berisso M, Scherillo M, Lucci D, Di Pasquale G, Mathieu G, Burazor I, Burazor M, Perisic Z, Atanaskovic V, Erakovic V, Stojkovic A, Vogtmann T, Schoebel C, Sogorski S, Sebert M, Schaarschmidt J, Fietze I, Baumann G, Penzel T, Mornos C, Ionac A, Cozma D, Dragulescu D, Mornos A, Petrescu L, Pescariu L, Brembilla-Perrot B, Khachab H, Lamberti F, Bellini C, Remoli R, Cogliandro T, Nardo R, Bellusci F, Mazzuca V, Gaspardone A, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Quintana R, Dantur J, Inoue K, Ueoka A, Tsubakimoto Y, Sakatani T, Matsuo A, Fujita H, Kitamura M, Wegrzynowska M, Konduracka E, Pietrucha AZ, Mroczek-Czernecka D, Paradowski A, Bzukala I, Nessler J, Igawa O, Adachi M, Atarashi H, Kusama Y, Kodani E, Okazaki R, Nakagomi A, Endoh Y, Baez-Escudero JL, Dave AS, Sasaridis CM, Valderrabano M, Tilz R, Bai R, Di Biase L, Gallinghouse GJ, Gibson D, Pisapia A, Wazni O, Natale A, Arujuna A, Karim R, Rinaldi A, Cooklin M, Rhode K, Razavi R, O'neill M, Gill J, Kusa S, Komatsu Y, Kakita K, Takayama K, Taniguchi H, Otomo K, Iesaka Y, Ammar S, Reents T, Fichtner S, Wu J, Zhu P, Olimulder MAGM, Galjee MA, Van Dessel PFHM, Van Der Palen J, Wilde AAM, Scholten MF, Chouchou F, Poupard L, Philippe C, Court-Fortune I, Kolb C, Barthelemy JC, Roche F, Deshko MS, Snezhitsky VA, Dolgoshey TS, Madekina GA, Stempen TP, Sugiura S, Fujii E, Senga M, Hessling G, Dohi K, Sugiura E, Nakamura M, Ito M, Eitel C, Hindricks G, Sommer P, Gaspar T, Bollmann A, Arya A, Deisenhofer I, Piorkowski C, Mendell J, Lasseter K, Shi M, Urban L, Hatala R, Hlivak P, De Melis M, Garutti C, Corbucci G, Di Biase L, Mlcochova H, Maxian R, Cihak R, Wichterle D, Peichl P, Kautzner J, Arbelo E, Dogac A, Luepkes C, Ploessnig M, Gilbert G, Chronaki C, Hinterbuchner L, Guillen A, Brugada J, Bun SS, Latcu DG, Franceschi F, Prevot S, Koutbi L, Ricard P, Mohanty P, Saoudi N, Deharo JC, Nazari N, Alizadeh A, Sayah S, Hekmat M, Assadian M, Ahmadzadeh A, Pietrucha AZ, Bzukala I, Cunningham J, Wnuk M, Mroczek-Czernecka D, Jedrzejczyk-Spaho J, Kruszelnicka O, Piwowarska W, Nessler J, Fedorowski A, Burri P, Juul-Moller S, Melander O, Metz T, Mitro P, Murin P, Kirsch P, Habalova V, Slaba E, Matyasova E, Barlow MA, Blake RJ, Wnuk M, Pietrucha AZ, Horton R, Rostoff P, Wojewodka Zak E, Mroczek-Czernecka D, Wegrzynowska M, Piwowarska W, Nessler J, Froidevaux L, Sarasin FP, Louis-Simonet M, Hugli O, Gallinghouse GJ, Yersin B, Schlaepfer J, Mischler C, Pruvot E, Occhetta E, Frascarelli F, Piacenti M, Burali A, Dovellini E, Padeletti L, Natale A, Tao S, Yamauchi Y, Okada H, Maeda S, Obayashi T, Isobe M, Chan J, Johar S, Wong T, Markides V, Hussain W, Konstantinidou M, Wissner E, Tilz R, Fuernkranz A, Yoshiga Y, Metzner A, Kuck KH, Ouyang F, Kettering K, Gramley F, Mollnau H, Weiss C, Bardeleben S, Biasco L, Scaglione M, Caponi D, Di Donna P, Sergi D, Cerrato N, Blandino A, Gaita F, Kettering K, Mollnau H, Weiss C, Gramley F, Fiala M, Wichterle D, Sknouril L, Bulkova V, Chovancik J, Nevralova R, Pindor J, Januska J, Choi JI, Ban JE, Yasutsugu N, Park JS, Jung JS, Lim HE, Park SW, Kim YH, Kuhne M, Reichlin T, Ammann P, Schaer B, Osswald S, Sticherling C, Ohe M, Goya M, Hiroshima K, Hayashi K, Makihara Y, Nagashima M, Fukunaga M, An Y, Dorwarth U, Schmidt M, Wankerl M, Krieg J, Straube F, Hoffmann E, Deisenhofer I, Ammar S, Reents T, Fichtner S, Kathan S, Wu J, Kolb C, Hessling G, Kuhne M, Reichlin T, Ammann P, Schaer B, Osswald S, Sticherling C, Defaye P, Mbaye A, Cassagneau R, Gagniere V, Jacon P, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Losik D, Kondo K, Adachi M, Miake J, Yano A, Ogura K, Kato M, Shigemasa C, Sekiguchi Y, Tada H, Yoshida K, Naruse Y, Yamasaki H, Igarashi M, Machino T, Aonuma K, Chen S, Liu S, Chen G, Meng W, Zhang F, Yan Y, Sciarra L, Dottori S, Lanzillo C, De Ruvo E, De Luca L, Minati M, Lioy E, Calo' L, Lin J, Nie Z, Zhu M, Wang X, Zhao J, Hu W, Tao H, Ge J, Johansson B, Houltz B, Edvardsson N, Schersten H, Karlsson T, Wandt B, Berglin E, Hoyt RH, Jenson BP, Trines SAIP, Braun J, Tjon Joek Tjien A, Zeppenfeld K, Tavilla G, Klautz RJM, Schalij MJ, Krausova R, Cihak R, Peichl P, Wichterle D, Kautzner J, Pirk J, Skalsky I, Maly J, Imai K, Sueda T, Orihashi K, Picarra BC, Santos AR, Dionisio P, Semedo P, Matos R, Leitao M, Banha M, Trinca M, Elder DHJ, George J, Jain R, Lang CC, Choy AM, Konert M, Loescher S, Hartmann A, Aversa E, Chirife R, Sztyglic E, Mazzetti H, Mascheroni O, Tentori MC, Pop RM, Margulescu AD, Dulgheru R, Enescu O, Siliste C, Vinereanu D, Menezes Junior A, Castro Carneiro AR, De Oliveira BL, Shah AN, Kantharia B, De Lucia R, Soldati E, Segreti L, Di Cori A, Zucchelli G, Viani S, Paperini L, Bongiorni MG, Kutarski A, Czajkowski M, Pietura R, Malecka B, Heintze J, Eckardt L, Bauer A, Meine M, Van Erven L, Bloch Thomsen PE, Lopez Chicharro MP, Merhi O, Nagashima M, Goya M, Soga Y, Hayashi K, Ohe M, Andou K, Hiroshima K, Nobuyoshi M, Gonzalez-Mansilla A, Martin-Asenjo R, Unzue L, Torres J, Garralda E, Coma RR, Rodriguez Garcia JE, Yaegashi T, Furusho H, Kato T, Chikata A, Takashima S, Usui S, Takamura M, Kaneko S, Kutarski A, Pietura R, Czajkowski M, Chudzik M, Kutarski A, Mitkowski P, Przybylski A, Lewek J, Malecka B, Smukowski T, Maciag A, Castrejon Castrejon S, Perez-Silva A, Estrada A, Doiny D, Ortega M, Lopez-Sendon JL, Merino JL, O'mahony C, Coats C, Cardona M, Garcia A, Calcagnino M, Lachmann R, Hughes D, Elliott PM, Conti S, Pruiti GP, Puzzangara E, Romano SA, Di Grazia A, Ussia GP, Tamburino C, Calvi V, Radinovic A, Sala S, Latib A, Mussardo M, Sora S, Paglino G, Gullace M, Colombo A, Ohlow MAG, Lauer B, Wagner A, Schreiber M, Buchter B, Farah A, Fuhrmann JT, Geller JC, Nascimento Cardoso RM, Batista Sa LA, Campos Filho LFC, Rodrigues SV, Dutra MVF, Borges TRSA, Portilho DR, Deering T, Bernardes A, Veiga A, Gartenlaub O, Goncalves A, Jimenez A, Rousseauplasse A, Deharo JC, Striekwold H, Gosselin G, Sitbon H, Martins V, Molon G, Ayala-Paredes F, Rousseauplasse A, Sancho-Tello MJ, Fazal IA, Brady S, Cronin J, Mcnally S, Tynan M, Plummer CJ, Mccomb JM, Val-Mejias JE, Fazal IA, Tynan M, Plummer CJ, Mccomb JM, Oliveira RM, Costa R, Martinelli Filho M, Silva KR, Menezes LM, Tamaki WT, Mathias W, Stolf NAG, Misawa T, Ohta I, Shishido T, Miyasita T, Miyamoto T, Nitobe J, Watanabe T, Kubota I, Thibault B, Ducharme A, Simpson C, Stuglin C, Gagne CE, Gagne CE, Williams R, Mcnicoll S, Silvetti MS, Drago F, Penela D, Bijnens B, Doltra A, Silva E, Berruezo A, Mont L, Sitges M, Mcintosh R, Baumann O, Raju P, Gurunathan S, Furniss S, Patel N, Sulke N, Lloyd G, Mor M, Dror S, Tsadok Y, Bachner-Hinenzon N, Katz A, Liel-Cohen N, Etzion Y, Mlynarski R, Mlynarska A, Wilczek J, Sosnowski M, Sinha AM, Sinha D, Noelker G, Brachmann J, Weidemann F, Ertl G, Jones M, Searle N, Cocker M, Ilsley E, Foley P, Khiani R, Nelson KE, Turley AJ, Owens WA, James SA, Linker NJ, Velagic V, Cikes M, Pezo Nikolic B, Puljevic D, Separovic-Hanzevacki J, Lovric-Bencic M, Biocina B, Milicic D, Kawata H, Chen L, Phan H, Anand K, Feld G, Birgesdotter-Green U, Fernandez Lozano I, Mitroi C, Toquero Ramos J, Castro Urda V, Monivas Palomero V, Corona Figueroa A, Hernandez Reina L, Alonso Pulpon L, Gate-Martinet A, Da Costa A, Rouffiange P, Cerisier A, Bisch L, Romeyer-Bouchard C, Isaaz K, Morales MA, Bianchini E, Startari U, Faita F, Bombardini T, Gemignani V, Piacenti M, Adhya S, Kamdar RH, Millar LM, Burchardt C, Murgatroyd FD, Klug D, Kouakam C, Guedon-Moreau L, Marquie C, Benard S, Kacet S, Cortez-Dias N, Carrilho-Ferreira P, Silva D, Goncalves S, Valente M, Marques P, Carpinteiro L, Sousa J, Keida T, Nishikido T, Fujita M, Chinen T, Kikuchi T, Nakamura K, Ohira H, Takami M, Anjo D, Meireles A, Gomes C, Roque C, Pinheiro Vieira A, Lagarto V, Reis H, Torres S, Ortega DF, Barja LD, Montes JP, Logarzo E, Bonomini P, Mangani N, Paladino C, Chwyczko T, Smolis-Bak E, Sterlinski M, Maciag A, Pytkowski M, Firek B, Jankowska A, Szwed H, Nakajima I, Noda T, Okamura H, Satomi K, Aiba T, Shimizu W, Aihara N, Kamakura S, Brzozowski W, Tomaszewski A, Kutarski A, Wysokinski A, Bertoldi EG, Rohde LE, Zimerman LI, Pimentel M, Polanczyk CA, Boriani G, Lunati M, Gasparini M, Landolina M, Lonardi G, Pecora D, Santini M, Valsecchi S, Rubinstein BJ, Wang DY, Cabreriza SE, Richmond ME, Rusanov A, Quinn TA, Cheng B, Spotnitz HM, Kristiansen HM, Vollan G, Hovstad T, Keilegavlen H, Faerestrand S, Kawata H, Phan H, Anand K, Feld G, Brigesdotter-Green U, Nawar AMR, Ragab DALIA, Eluhsseiny RANIA, Abdelaziz AHMED, Nof E, Abu Shama R, Buber J, Kuperstein R, Feinberg MS, Barlev D, Eldar M, Glikson M, Badran H, Samir R, Tawfik M, Amin M, Eldamnhoury H, Khaled S, Tolosana JM, Martin AM, Hernandez-Madrid A, Macias A, Fernandez-Lozano I, Osca J, Quesada A, Mont L, Boriani G, Gasparini M, Landolina M, Lunati M, Santini M, Padeletti L, Botto GL, De Santo T, Lunati M, Szwed A, Martinez JG, Degand B, Villani GQ, Leclercq C, Rousseauplasse A, Ritter P, Estrada A, Doiny D, Castrejon Castrejon S, Perez-Silva A, Ortega M, Lopez-Sendon JL, Merino JL, Watanabe I, Nagashima K, Okumura Y, Kofune M, Ohkubo K, Nakai T, Hirayama A, Mikhaylov E, Vander M, Lebedev D, Zarse M, Suleimann H, Bogossian H, Stegelmeyer J, Ninios I, Karosienne Z, Kloppe A, Lemke B, John S, Gaspar T, Rolf S, Sommer P, Hindricks G, Piorkowski C, Berruezo A, Fernandez-Armenta J, Mont LL, Zeljko H, Andreu D, Herzcku C, Boussy T, Brugada J, Yamauchi Y, Okada H, Maeda S, Tao S, Obayahi T, Aonuma K, Hegrenes J, Lim E, Mediratta V, Bautista R, Teplitsky L, Van Huls Van Taxis CFB, Wijnmaalen AP, Gawrysiak M, Schuijf JD, Bax JJ, Schalij MJ, Zeppenfeld K, Huo Y, Richter S, Hindricks G, Arya A, Gaspar T, Bollmann A, Akca F, Bauernfeind T, Schwagten B, De Groot NMS, Jordaens L, Szili-Torok T, Hegrenes J, Miller S, Kastner G, Teplitsky L, Maury P, Della Bella P, Delacretaz E, Sacher F, Maccabelli G, Brenner R, Rollin A, Jais P, Vergara P, Trevisi N, Ricco A, Petracca F, Bisceglia C, Baratto F, Maccabelli G, Della Bella P, Salguero Bodes R, Fontenla Cerezuela A, De Riva Silva M, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Montero Alvarez M, Arribas Ynsaurriaga F, Baszko A, Krzyzanowski K, Bobkowski W, Surmacz R, Zinka E, Siwinska A, Szyszka A, Perez Silva A, Doiny D, Castrejon Castrejon S, Estrada Mucci A, Ortega Molina M, Lopez Sendon JL, Merino Llorens JL, Kaitani K, Hanazawa K, Izumi C, Nakagawa Y, Yamanaka I, Hirahara T, Sugawara Y, Suga C, Ako J, Momomura S, Galizio N, Gonzalez J, Robles F, Palazzo A, Favaloro L, Diez M, Guevara E, Fernandez A, Greenberg S, Epstein A, Deering T, Goldman DS, Sangli C, Keeney JA, Lee K, Piers SRD, Van Rees JB, Thijssen J, Borleffs CJW, Van Der Velde ET, Van Erven L, Schalij MJ, Leclercq CH, Hero M, Mizobuchi M, Enjoji Y, Yazaki Y, Shibata K, Funatsu A, Kobayashi T, Nakamura S, Amit G, Pertzov B, Katz A, Zahger D, Robles F, Galizio N, Gonzalez J, Medesani L, Rana R, Palazzo A, Albano F, Fraguas H, Pedersen SS, Hoogwegt MT, Jordaens L, Theuns DAMJ, Van Den Broek KC, Tekle FB, Habibovic M, Alings M, Van Der Voort P, Denollet J, Vrazic H, Jilek C, Badran H, Lesevic H, Tzeis S, Semmler V, Deisenhofer I, Kolb C, Theuns DAMJ, Gold MR, Burke MC, Bardy GH, Varma N, Pavri B, Stambler B, Michalski J, Investigators TRUST, Safak E, Schmitz D, Konorza T, Wende C, Schirdewan A, Neuzner J, Simmers T, Erglis A, Gradaus R, Alings M, Goetzke J, Coutrot L, Goehl K, Bazan Gelizo V, Grau N, Valles E, Felez M, Sanjuas C, Bruguera J, Marti-Almor J, Chu SY, Li PW, Ding WH, Schukro C, Leitner L, Siebermair J, Stix G, Pezawas T, Kastner J, Wolzt M, Schmidinger H, Behar NATHALIE, Kervio G, Petit B, Maison-Balnche P, Bodi S, Mabo P, Foley PWX, Mutch E, Brashaw-Smith J, Ball L, Leyva F, Kim DH, Lee MJ, Lee WS, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Man S, Algra AM, Schreurs CA, Van Erven L, Van Der Wall EE, Cannegieter SC, Schalij MJ, Swenne CA, Adachi M, Yano A, Miake J, Ogura K, Kato M, Iitsuka K, Kondo T, Zarse M, Goebbert K, Bogossian H, Karossiene Z, Stegelmeyer J, Ninios I, Kloppe A, Lemke B, Goldman D, Kallen B, Kerpi E, Sardo J, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Tsiachris D, Mytas D, Asimakopoulos S, Stefanadis C, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Sideris S, Kartsagoulis E, Mytas D, Stefanadis C, Barbosa O, Marocolo Junior M, Silva Cortes R, Moraes Brandolis RA, Oliveira LF, Pertili Rodrigues De Resende LA, Vieira Da Silva MA, Dias Da Silva VJ, Hegazy RA, Sharaf IA, Fadel F, Bazaraa H, Esam R, Deshko MS, Snezhitsky VA, Stempen TP, Kuroki K, Tada H, Igawa M, Yoshida K, Igarashi M, Sekiguchi Y, Kuga K, Aonuma K, Ferreira Santos L, Dionisio T, Nunes L, Machado J, Castedo S, Henriques C, Matos A, Oliveira Santos J, Kraaier K. Poster Session 3. Europace 2011. [DOI: 10.1093/europace/eur229] [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: 11/14/2022] Open
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Haeusler KG, Koch L, Ueberreiter J, Coban N, Safak E, Kunze C, Villringer K, Endres M, Schultheiss HP, Fiebach JB, Schirdewan A. Safety and reliability of the insertable Reveal XT recorder in patients undergoing 3 Tesla brain magnetic resonance imaging. Heart Rhythm 2011; 8:373-6. [PMID: 21070885 DOI: 10.1016/j.hrthm.2010.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
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Spencker S, Coban N, Koch L, Schirdewan A, Mueller D. Comparison of skin adhesive and absorbable intracutaneous suture for the implantation of cardiac rhythm devices. Europace 2010; 13:416-20. [PMID: 21075757 DOI: 10.1093/europace/euq394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Wound healing is a major determent in the post-surgical course of patients (pts) after pacemaker (PM) and implantable cardioverter defibrillator (ICD) implantation. Insufficient closure may lead to serious complications with pocket infections leading to the device's explantation as the worst case scenario. In addition to the different types of suture and suture clips, a novel topical skin adhesive containing 2-octyl-cyanoacrylate is commercially available. METHODS AND RESULTS Over a period of 18 months, we prospectively assigned all cases of PM, ICD, and loop recorder implants either to skin adhesive (Group 1) or to absorbable intracutaneous polydioxanon suture (Group 2). Data were analysed with respect to operation time, wound infections, and healing disorders. One hundred and eighty-three pts were randomized into Group 1 [71 PMs, 60 ICD, 15 cardiac resynchronization therapy (CRT), 11 loop recorders, and 26 generator replacements]. One hundred and eighty-five pts were assigned to Group 2 (62 PMs, 70 ICD, 30 CRT, 7 loop recorders, and 16 generator replacements). There were no differences regarding sex, diabetes, renal insufficiency, corticosteroid therapy, oral anticoagulants, and acetylsalicylic asa/clopidogrel (P = n.s.). For the significantly higher amount of CRT devices (P < 0.05) in Group 2, the procedure times are given for surgeries except CRT. It was 49.1 ± 27.7 min for Group 1 and 53.4 ± 31.9 min for Group 2 (P = n.s.). Adverse events as insufficient closure, major and minor bleeding, pocket haematoma, erythema, incrustation, dehiscence, keloid, and explantation due to infection occurred significantly more often in the adhesive group (P = 0.02). The greatest impact on this result had early adverse events as insufficient closure, wound incrustation, and inflammation (9.3 vs. 6.0%; P = 0.02). We did not find any difference in long-term adverse events, infections in particular (2.7 vs. 1.6%; P = 0.47). CONCLUSION This study shows no benefit using skin adhesive in comparison to absorbable intracutaneous suture regarding surgery times for the implantation of cardiac rhythm devices. The rate of early adverse events after wound closure is higher after skin adhesive but no difference in long-term adverse events occurred.
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Affiliation(s)
- Sebastian Spencker
- Division of Cardiology, DRK Kliniken Berlin I Köpenick, Medizinische Klinik I, Salvador-Allende-Str. 2-8, D-12559 Berlin, Germany.
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Spencker S, Coban N, Koch L, Schirdewan A, Müller D. Limitations of the past and latest evolutions of home monitoring: arrhythmia electrograms transmitted automatically improve the efficacy of remote monitoring. Aging Clin Exp Res 2010; 22:459-65. [PMID: 19996708 DOI: 10.1007/bf03337741] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Telemetric surveillance systems are part of a well-accepted and evolving field in the care of cardiac patients. Especially in patients with implanted cardioverter-defibrillators (ICD), they are well established and their usefulness and reliability have been shown in several clinical trials. Currently, three generations of Home Monitoring™ (HM, Biotronik GmbH & Co. KG, Berlin, Germany) are commercially available. METHODS This paper presents three cases demonstrating the various limitations of the first and second generations of HM and the way they can be overcome by the third generation. RESULTS In the first case, atrial flutter was misinterpreted by the device and classified as ventricular tachycardia (VT). Thus, in the online IEGM, supraventricular tachycardia was identified, and the short IEGM strip and lack of transmitted atrial signals of the dual-chamber device necessitated an appointment for ICD interrogation, to clarify the diagnosis and propose further treatment. The second case is that of a patient in whom a VT was ineffectively treated by anti-tachycardia pacing (ATP) and continued with longer cycle length, leading to syncope. A second-generation HM device with online- IEGM misleadingly appears to indicate successful treatment. The third case demonstrates correct detection and therapy of a fast VT by an ICD of third-generation HM type. The online IEGM now gives all information needed for complete telemetric assessment. CONCLUSIONS Home Monitoring (HM) is a helpful remote surveillance tool for the early detection of both arrhythmias and technical problems. As shown, the first two generations had limitations which the patient must take into account when using the system. These limitations have been overcome in the third generation, making Home Monitoring more self-sufficient and reliable.
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Affiliation(s)
- Sebastian Spencker
- Division of Cardiology, DRK Kliniken Berlin I Köpenick, Salvador-Allende-Str. 2-8, D-12559 Berlin, Germany.
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Gapelyuk A, Schirdewan A, Fischer R, Wessel N. Cardiac magnetic field mapping quantified by Kullback-Leibler entropy detects patients with coronary artery disease. Physiol Meas 2010; 31:1345-54. [PMID: 20720289 DOI: 10.1088/0967-3334/31/10/004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac magnetic field mapping (CMFM) is a noninvasive method to determine cardiac electrical activity. We analysed the utility of CMFM for the detection of patients with coronary artery disease (CAD) without subjecting them to stress. We studied 59 healthy control subjects and 101 patients with CAD without previous myocardial infarction (MI). The heart's magnetic field was recorded over the anterior chest wall using a multichannel magnetic measurement system with axial second-order gradiometers. The evaluation of CMFM was based on comparison of the 'ideal' group mean maps of young healthy subjects and maps of examined individuals. Three measures of similarity were considered: Kullback-Leibler (KL) entropy, normalized residual magnetic field strength and deviations in the magnetic field map orientation. The mean values of these parameters during the depolarization and repolarization were used for further classification with the help of logistic regression. The feature set based on the KL-entropy demonstrated the best classification results (sensitivity/specificity of 85/80%), followed by the residual feature (85/75%) and the magnetic field orientation feature (80/73%) sets. The forward stepwise technique was applied to select the best set of features from the combined feature set. Two parameters were selected, namely the KL-entropy for the repolarization period and the residual parameter for the depolarization period. The classification based on these parameters demonstrated a sensitivity of 88% and a specificity of 88% for the distinction of CAD patients from the control subjects. The area under the receiver operator curve was 94%. Hence, we suggest that CMFM evaluation based on KL-entropy is a promising technique to identify patients with CAD.
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Affiliation(s)
- A Gapelyuk
- Department of Physics, Humboldt-Universität zu Berlin, Robert-Koch-Platz 4, D-10115 Berlin, Germany
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Haeusler KG, Koch L, Ueberreiter J, Endres M, Schultheiss HP, Heuschmann PU, Schirdewan A, Fiebach JB. Stroke risk associated with balloon based catheter ablation for atrial fibrillation: Rationale and design of the MACPAF Study. BMC Neurol 2010; 10:63. [PMID: 20663131 PMCID: PMC2919504 DOI: 10.1186/1471-2377-10-63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 07/21/2010] [Indexed: 02/03/2023] Open
Abstract
Background Catheter ablation of the pulmonary veins has become accepted as a standard therapeutic approach for symptomatic paroxysmal atrial fibrillation (AF). However, there is some evidence for an ablation associated (silent) stroke risk, lowering the hope to limit the stroke risk by restoration of rhythm over rate control in AF. The purpose of the prospective randomized single-center study "Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation" (MACPAF) is to compare the efficacy and safety of two balloon based pulmonary vein ablation systems in patients with symptomatic paroxysmal AF. Methods/Design Patients are randomized 1:1 for the Arctic Front® or the HD Mesh Ablator® catheter for left atrial catheter ablation (LACA). The predefined endpoints will be assessed by brain magnetic resonance imaging (MRI), neuro(psycho)logical tests and a subcutaneously implanted reveal recorder for AF detection. According to statistics 108 patients will be enrolled. Discussion Findings from the MACPAF trial will help to balance the benefits and risks of LACA for symptomatic paroxysmal AF. Using serial brain MRIs might help to identify patients at risk for LACA-associated cerebral thromboembolism. Potential limitations of the study are the single-center design, the existence of a variety of LACA-catheters, the missing placebo-group and the impossibility to assess the primary endpoint in a blinded fashion. Trial registration clinicaltrials.gov NCT01061931
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Voss A, Wessel N, Hasart A, Hähnel H, Prasse G, Schirdewan A, Osterziel KJ. Analyse von Kurzzeit-Blutdruck- und Herzfrequenzvariabilität. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1998.43.s1.106] [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: 11/15/2022]
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Boyé P, Abdel-Aty H, Zacharzowsky U, Schirdewan A, Dietz R, Schulz-Menger J. Contrast enhanced cardiovascular magnetic resonance imaging prior to prophylactic implantation of a cardioverter/defibrillator identifies patients with increased risk for ventricular arrhythmias. J Cardiovasc Magn Reson 2009. [PMID: 19208198 PMCID: PMC7852503 DOI: 10.1186/1532-429x-11-s1-o1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Spencker S, Coban N, Koch L, Schirdewan A, Müller D. Potential role of home monitoring to reduce inappropriate shocks in implantable cardioverter-defibrillator patients due to lead failure. Europace 2008; 11:483-8. [PMID: 19103654 DOI: 10.1093/europace/eun350] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [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
AIMS Lead dysfunctions in implantable cardioverter-defibrillator (ICD) patients can lead to inappropriate shocks or even complete loss of function of the device. Home monitoring (HM) systems are capable of daily data transmissions regarding the device and the lead integrity as well as information concerning anti-arrhythmic therapies. We therefore analysed the data from the Biotronik HM system whether it enables physicians to react quickly on serious ICD malfunctions and to avoid inappropriate shocks. METHODS AND RESULTS Fifty-four patients who had to undergo resurgery due to malfunctions of the ICD lead were included. Eleven of them were on HM interrogating the device every night at 3 am. If any adverse event was detected, a fax alert was sent to the clinic and the patients were asked for in-hospital ICD interrogation. The rate of inappropriate shocks and symptomatic pacemaker inhibition due to oversensing was compared with the 43 patients without remote surveillance. HM sent alert messages in 91% of all incidents. All lead failures became obvious because of oversensing of high frequency artefacts. Only in 18%, changes in the pacing impedance were noticed, in all cases preceded by oversensing. Eighty per cent of the patients were asymptomatic at the first onset of oversensing. Only one patient suffered an inappropriate shock as first manifestation of lead failure. Compared with the patients without HM, inappropriate shocks occurred in 27.3% in the HM group vs. 46.5% (P = n.s.). This trend gains statistical significance, if the compound endpoint of symptomatic lead failure consisting of inappropriate shocks and symptomatic pacemaker inhibition due to oversensing is focused: 27.3% event in the HM group vs. 53.4% in the group without HM (P = 0.04). Event messages were despatched in a mean of 54 days after the last ICD interrogation and 56 days before next scheduled visit. Thus, 56 days of reaction time are gained to avoid adverse events. CONCLUSION In 91% of all lead-related ICD complications, the diagnosis could be established correctly by an alert of the HM system. Mostly, the first incident sent was oversensing of artefacts, falsely detected as ventricular fibrillation-the VF zone. The automatic HM surveillance system enables physicians to detect severe lead problems early and to react quickly; thus, it might have a potential to avoid inappropriate shocks due to lead failure and T-wave oversensing.
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Affiliation(s)
- Sebastian Spencker
- Division of Cardiology, Charité-Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Fischer R, Dechend R, Qadri F, Markovic M, Feldt S, Herse F, Gapelyuk A, Safak E, Zacharzowsky U, Heuser A, Schirdewan A, Luft F, Schunck WH, Muller D. ω-3 polyunsaturated fatty acids and direct renin inhibition—2 ways to improve electrical remodeling. J Electrocardiol 2008. [DOI: 10.1016/j.jelectrocard.2008.08.025] [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: 11/28/2022]
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Schirdewan A, Gapelyuk A, von Tscharner V, Koch L, Wessel N, Spencker S, Schultheiss HP. Changing of cardiac repolarization pattern in response to thoracic electrical shock application. J Electrocardiol 2008. [DOI: 10.1016/j.jelectrocard.2008.08.017] [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: 11/30/2022]
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Boyé P, Zacharzowsky U, Abdel-Aty H, Schirdewan A, Dietz R, Schulz-Menger J. 1008 Contrast enhanced cardiovascular magnetic resonance imaging prior to prophylactic implantation of a cardioverter/defibrillator identifies patients with increased risk for ventricular arrhythmias. J Cardiovasc Magn Reson 2008. [DOI: 10.1186/1532-429x-10-s1-a133] [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: 11/10/2022] Open
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Lisewski U, Shi Y, Wrackmeyer U, Fischer R, Chen C, Schirdewan A, Jüttner R, Rathjen F, Poller W, Radke MH, Gotthardt M. The tight junction protein CAR regulates cardiac conduction and cell–cell communication. J Biophys Biochem Cytol 2008. [DOI: 10.1083/jcb1826oia13] [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: 11/22/2022] Open
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Lisewski U, Shi Y, Wrackmeyer U, Fischer R, Chen C, Schirdewan A, Jüttner R, Rathjen F, Poller W, Radke MH, Gotthardt M. The tight junction protein CAR regulates cardiac conduction and cell-cell communication. ACTA ACUST UNITED AC 2008; 205:2369-79. [PMID: 18794341 PMCID: PMC2556793 DOI: 10.1084/jem.20080897] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Coxsackievirus-adenovirus receptor (CAR) is known for its role in virus uptake and as a protein of the tight junction. It is predominantly expressed in the developing brain and heart and reinduced upon cardiac remodeling in heart disease. So far, the physiological functions of CAR in the adult heart are largely unknown. We have generated a heart-specific inducible CAR knockout (KO) and found impaired electrical conduction between atrium and ventricle that increased with progressive loss of CAR. The underlying mechanism relates to the cross talk of tight and gap junctions with altered expression and localization of connexins that affect communication between CAR KO cardiomyocytes. Our results indicate that CAR is not only relevant for virus uptake and cardiac remodeling but also has a previously unknown function in the propagation of excitation from the atrium to the ventricle that could explain the association of arrhythmia and Coxsackievirus infection of the heart.
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Affiliation(s)
- Ulrike Lisewski
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine (MDC), 13122 Berlin-Buch, Germany
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Hubner N, Monti J, Fischer J, Paskas S, Heinig M, Schulz H, Goesele C, Heuser A, Fischer R, Schmidt C, Schirdewan A, Gross V, Hummel O, Maatz H, Patone G, Saar K, Vingron M, Weldon SM, Hammock BD, Rohde K, Dietz R, Cook SA, Schunck W, Luft FC. Soluble epoxide hydrolase (Ephx2) is a susceptibility gene for heart failure in a rat model of human disease 3044. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.479.10] [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: 11/11/2022]
Affiliation(s)
| | - Jan Monti
- Department of Clinical and Molecular CardiologyFranz‐Volhard ClinicHelios Clinics GmbHCharité Universitaetsmedizin BerlinBerlinGermany
| | | | | | | | | | | | - Arnd Heuser
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | | | | | - Alexander Schirdewan
- Department of Clinical and Molecular CardiologyFranz‐Volhard ClinicHelios Clinics GmbHCharité Universitaetsmedizin BerlinBerlinGermany
| | - Volkmar Gross
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | - Oliver Hummel
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | - Henrike Maatz
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | | | - Kathrin Saar
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | - Martin Vingron
- Department of BioinformaticsMax‐Planck‐Institute for Molecular GeneticsBerlinGermany
| | | | - Bruce D. Hammock
- Departments of Entomology and Nutrition and Cancer Research CenterUC DavisSacramentoCA
| | - Klaus Rohde
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | - Rainer Dietz
- Max‐Delbruck‐Center for Molecular MedicineBerlinGermany
| | - Stuart A. Cook
- MRC Clinical Sciences Centre Faculty of MedicineImperial CollegeLondonUnited Kingdom
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Fischer R, Dechend R, Qadri F, Markovic M, Feldt S, Herse F, Park JK, Gapelyuk A, Schwarz I, Zacharzowsky UB, Plehm R, Safak E, Heuser A, Schirdewan A, Luft FC, Schunck WH, Muller DN. Dietary n-3 Polyunsaturated Fatty Acids and Direct Renin Inhibition Improve Electrical Remodeling in a Model of High Human Renin Hypertension. Hypertension 2008; 51:540-6. [DOI: 10.1161/hypertensionaha.107.103143] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the effect n-3 polyunsaturated fatty acids (PUFAs) with direct renin inhibition on electrophysiological remodeling in angiotensin II–induced cardiac injury. We treated double-transgenic rats expressing the human renin and angiotensinogen genes (dTGRs) from week 4 to 7 with n-3 PUFA ethyl-esters (Omacor; 25-g/kg diet) or a direct renin inhibitor (aliskiren; 3 mg/kg per day). Sprague-Dawley rats were controls. We performed electrocardiographic, magnetocardiographic, and programmed electrical stimulation. Dietary n-3 PUFAs increased the cardiac content of eicosapentaenoic and docosahexaenoic acid. At week 7, mortality in dTGRs was 31%, whereas none of the n-3 PUFA- or aliskiren-treated dTGRs died. Systolic blood pressure was modestly reduced in n-3 PUFA-treated (180±3 mm Hg) compared with dTGRs (208±5 mm Hg). Aliskiren-treated dTGRs and Sprague-Dawley rats were normotensive (110±3 and 119±6 mm Hg, respectively). Both n-3 PUFA–treated and untreated dTGRs showed cardiac hypertrophy and increased atrial natriuretic peptide levels. Prolonged QRS and QT
c
intervals and increased T-wave dispersion in dTGRs were reduced by n-3 PUFAs or aliskiren. Both treatments reduced arrhythmia induction from 75% in dTGRs to 17% versus 0% in Sprague-Dawley rats. Macrophage infiltration and fibrosis were reduced by n-3 PUFAs and aliskiren. Connexin 43, a mediator of intermyocyte conduction, was redistributed to the lateral cell membranes in dTGRs. n-3 PUFAs and aliskiren restored normal localization to the intercalated disks. Thus, n-3 PUFAs and aliskiren improved electrical remodeling, arrhythmia induction, and connexin 43 expression, despite a 70-mm Hg difference in blood pressure and the development of cardiac hypertrophy.
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Affiliation(s)
- Robert Fischer
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Ralf Dechend
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Fatimunnisa Qadri
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Marija Markovic
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Sandra Feldt
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Florian Herse
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Joon-Keun Park
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Andrej Gapelyuk
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Ines Schwarz
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Udo B. Zacharzowsky
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Ralph Plehm
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Erdal Safak
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Arnd Heuser
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Alexander Schirdewan
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Friedrich C. Luft
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Wolf-Hagen Schunck
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
| | - Dominik N. Muller
- From the Medical Faculty of the Charité (R.F., R.D., S.F., F.H., A.G., I.S., U.B.Z., E.S., A.S., F.C.L., D.N.M.), Experimental and Clinical Research Center, Franz Volhard Clinic and HELIOS Klinikum Berlin-Buch, Berlin, Germany; Max-Delbrueck-Center for Molecular Medicine (F.Q., M.M., R.P., A.H., F.C.L., W-H.S., D.N.M.), Berlin-Buch, Germany; Medical School of Hannover (J-K.P.), Hannover, Germany
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Fischer R, von Tscharner V, Gapelyuk A, Zacharzowsky U, Schutt H, Schirdewan A. Automated determination of spatial QT interval distribution in cardiac magnetic field mapping reveals repolarization inhomogeneities in high-risk patients. J Electrocardiol 2007. [DOI: 10.1016/j.jelectrocard.2007.08.045] [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: 10/22/2022]
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Voss A, Schroeder R, Truebner S, Goernig M, Schirdewan A, Figulla HR. Spontaneous heart rate turbulence in patients with dilated cardiomyopathy. Conf Proc IEEE Eng Med Biol Soc 2007; 2006:6426-9. [PMID: 17946766 DOI: 10.1109/iembs.2006.260072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parameters of heart rate turbulence (HRT) and blood pressure turbulence (BPT) reflect the baroreflex mediated transient acceleration-deceleration response of the sinus node triggered by a premature ventricular complex (PVC) and are known to be useful risk markers in different cardiac diseases. However, the analyses of HRT and BPT are based on the prevalence of PVC. In this study the spontaneous HRT and BPT after most premature normal beats (MPNB) was investigated in comparison to HRT and BPT after PVC. ECG and blood pressure were recorded from 91 patients with dilated cardiomyopathy (DCM) and 45 healthy subjects (REF). In 69% of DCM and 33% of REF data sets PVCs were present. HRT and BPT were determined for all patients with PVC as well as in all patients triggered by MPNB. Univariate statistical analysis of the comparison between DCM and REF revealed similar results for HRT/BPT after PVC and MPNB. In conclusion, HRT and BPT triggered by PVC might be substituted by spontaneous HRT and BPT after MPNB. In contrast to the HRT and BPT after PVC, an increased number of data sets can be included in the analysis and may lead to an enhancement in risk stratification in different cardiac diseases.
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Affiliation(s)
- A Voss
- Dept. of Med. Eng., Univ. of Appl. Sci. Jena, Germany.
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Gapelyuk A, Wessel N, Fischer R, Zacharzowsky U, Koch L, Selbig D, Schütt H, Sawitzki B, Luft FC, Dietz R, Schirdewan A. Detection of patients with coronary artery disease using cardiac magnetic field mapping at rest. J Electrocardiol 2007; 40:401-7. [PMID: 17531250 DOI: 10.1016/j.jelectrocard.2007.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
We studied the use of cardiac magnetic field mapping to detect patients with CAD without subjecting them to stress. Fifty-nine healthy control subjects and 101 patients with CAD without previous MI were included. The optimal positions for detecting CAD were located in the left superior parasternal and in the inferior midsternal area. Values for ST slope, ST shift, T peak amplitude, ST-T integral, and magnetic field map orientation differed significantly between the 2 groups. Three parameters together in a multivariate analysis yielded a sensitivity of 84% and a specificity of 83% in distinguishing patients with CAD from control subjects. We suggest that cardiac magnetic field mapping is a promising technique to identify patients with CAD.
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Affiliation(s)
- Andrej Gapelyuk
- Medical Faculty of the Charité, Franz Volhard Klinik, Helios Klinikum-Berlin, Berlin, Germany
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Fischer R, Dechend R, Gapelyuk A, Shagdarsuren E, Gruner K, Gruner A, Gratze P, Qadri F, Wellner M, Fiebeler A, Dietz R, Luft FC, Muller DN, Schirdewan A. Angiotensin II-induced sudden arrhythmic death and electrical remodeling. Am J Physiol Heart Circ Physiol 2007; 293:H1242-53. [PMID: 17416596 DOI: 10.1152/ajpheart.01400.2006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [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: 12/13/2022]
Abstract
Rats harboring the human renin and angiotensinogen genes (dTGR) feature angiotensin (ANG) II/hypertension-induced cardiac damage and die suddenly between wk 7 and 8. We observed by electrocardiogram (ECG) telemetry that ventricular tachycardia (VT) is a common terminal event in these animals. Our aim was to investigate electrical remodeling. We used ECG telemetry, noninvasive cardiac magnetic field mapping (CMFM) at wk 5 and 7, and performed in vivo programmed electrical stimulation at wk 7. We also investigated whether or not losartan (Los; 30 mg x kg(-1) x day(-1)) would prevent electrical remodeling. Cardiac hypertrophy and systolic blood pressure progressively increased in dTGR compared with Sprague-Dawley (SD) controls. Already by wk 5, untreated dTGR showed increased perivascular and interstitial fibrosis, connective tissue growth factor expression, and monocyte infiltration compared with SD rats, differences that progressed through time. Left-ventricular mRNA expression of potassium channel subunit Kv4.3 and gap-junction protein connexin 43 were significantly reduced in dTGR compared with Los-treated dTGR and SD. CMFM showed that depolarization and repolarization were prolonged and inhomogeneous. Los ameliorated all disturbances. VT could be induced in 88% of dTGR but only in 33% of Los-treated dTGR and could not be induced in SD. Untreated dTGR show electrical remodeling and probably die from VT. Los treatment reduces myocardial remodeling and predisposition to arrhythmias. ANG II target organ damage induces VT.
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MESH Headings
- Angiotensin II/metabolism
- Angiotensin II Type 1 Receptor Blockers/pharmacology
- Angiotensin II Type 1 Receptor Blockers/therapeutic use
- Angiotensinogen/genetics
- Angiotensinogen/metabolism
- Animals
- Animals, Genetically Modified
- Blood Pressure
- Cardiac Pacing, Artificial
- Cardiomegaly/complications
- Cardiomegaly/etiology
- Cardiomegaly/metabolism
- Cardiomegaly/pathology
- Cardiomegaly/physiopathology
- Cardiomegaly/prevention & control
- Connexin 43/genetics
- Connexin 43/metabolism
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Disease Models, Animal
- Electrocardiography
- Heart Conduction System/drug effects
- Heart Conduction System/metabolism
- Heart Conduction System/physiopathology
- Hypertension/complications
- Hypertension/drug therapy
- Hypertension/metabolism
- Hypertension/pathology
- Hypertension/physiopathology
- Losartan/pharmacology
- Losartan/therapeutic use
- Male
- Myocardium/metabolism
- Myocardium/pathology
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley/genetics
- Renin/genetics
- Renin/metabolism
- Shal Potassium Channels/genetics
- Shal Potassium Channels/metabolism
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/metabolism
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/prevention & control
- Telemetry
- Time Factors
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Robert Fischer
- Medical Faculty of the Charité, Franz Volhard Clinic HELIOS Klinikum, Wiltberg Strasse 50, 13125 Berlin, Germany.
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35
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Schirdewan A, Gapelyuk A, Fischer R, Koch L, Schütt H, Zacharzowsky U, Dietz R, Thierfelder L, Wessel N. Cardiac magnetic field map topology quantified by Kullback-Leibler entropy identifies patients with hypertrophic cardiomyopathy. Chaos 2007; 17:015118. [PMID: 17411275 DOI: 10.1063/1.2432059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a common primary inherited cardiac muscle disorder, defined clinically by the presence of unexplained left ventricular hypertrophy. The detection of affected patients remains challenging. Genetic testing is limited because only in 50%-60% of all HCM diagnoses an underlying mutation can be found. Furthermore, the disease has a varied clinical course and outcome, with many patients having little or no discernible cardiovascular symptoms, whereas others develop profound exercise limitation and recurrent arrhythmias or sudden cardiac death. Therefore prospective screening of HCM family members is strongly recommended. According to the current guidelines this includes serial echocardiographic and electrocardiographic examinations. In this study we investigated the capability of cardiac magnetic field mapping (CMFM) to detect patients suffering from HCM. We introduce for the first time a combined diagnostic approach based on map topology quantification using Kullback-Leibler (KL) entropy and regional magnetic field strength parameters. The cardiac magnetic field was recorded over the anterior chest wall using a multichannel-LT-SQUID system. CMFM was calculated based on a regular 36 point grid. We analyzed CMFM in patients with confirmed diagnosis of HCM (HCM, n=33, 43.8+/-13 years, 13 women, 20 men), a control group of healthy subjects (NORMAL, n=57, 39.6+/-8.9 years; 22 women and 35 men), and patients with confirmed cardiac hypertrophy due to arterial hypertension (HYP, n=42, 49.7+/-7.9 years, 15 women and 27 men). A subgroup analysis was performed between HCM patients suffering from the obstructive (HOCM, n=19) and nonobstructive (HNCM, n=14) form of the disease. KL entropy based map topology quantification alone identified HCM patients with a sensitivity of 78.8% and specificity of 86.9% (overall classification rate 84.8%). The combination of the KL parameters with a regional field strength parameter improved the overall classification rate to 87.9% (sensitivity: 84.8%, specificity: 88.9%, area under ROC curve: 0.94). KL measures applied to discriminate between HOCM and HNCM patients showed a correct classification of 78.8%. The combination of one KL and one regional parameter again improved the overall classification rate to 97%. A preliminary prospective analysis in two HCM families showed the feasibility of this diagnostic approach with a correct diagnosis of all 22 screened family members (1 HOCM, 4 HNCM, 17 normal). In conclusion, Cardiac Magnetic Field Mapping including KL entropy based topology quantifications is a suitable tool for HCM screening.
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Affiliation(s)
- A Schirdewan
- Medical Faculty of the Charité, Franz-Volhard-Klinik, Helios Klinikum-Berlin, Wiltbergstr. 50, D-13125 Berlin, Germany.
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36
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Park JK, Fischer R, Dechend R, Shagdarsuren E, Gapeljuk A, Wellner M, Meiners S, Gratze P, Al-Saadi N, Feldt S, Fiebeler A, Madwed JB, Schirdewan A, Haller H, Luft FC, Muller DN. p38 Mitogen-Activated Protein Kinase Inhibition Ameliorates Angiotensin II–Induced Target Organ Damage. Hypertension 2007; 49:481-9. [PMID: 17224470 DOI: 10.1161/01.hyp.0000256831.33459.ea] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated whether or not p38 mitogen-activated protein kinase inhibition ameliorates angiotensin II–induced target organ damage. We used double transgenic rats harboring both human renin and angiotensinogen genes (dTGRs). dTGR, with or without p38 inhibitor (BIRB796; 30 mg/kg per day in the diet), and nontransgenic Sprague–Dawley rats were studied in 2 protocols. In protocol 1 (week 7), systolic blood pressure of untreated dTGRs was 204±4 mm Hg, but partially reduced after BIRB796 treatment (166±7 mm Hg), whereas Sprague–Dawley rats were normotensive. The cardiac hypertrophy index was unchanged in untreated and BIRB796-treated dTGRs. The β-myosin heavy chain expression of BIRB796-treated hearts was significantly lower in BIRB796 compared with dTGRs, indicating a delayed switch to the fetal isoform. BIRB796 treatment significantly reduced cardiac fibrosis, connective tissue growth factor, tumor necrosis factor-α, interleukin-6, and macrophage infiltration. Albuminuria was not reduced in BIRB796-treated dTGRs. Tubular and glomerular damage with tumor necrosis factor-α expression was unaltered, although serum creatinine and cystatin C were normalized. Renal macrophage infiltration, fibrosis, and vessel damage were reduced. In protocol 2 (week 8), we focused on mortality and arrhythmogenic electrical remodeling. Mortality of untreated dTGRs was 100% but was reduced to 10% in the BIRB796 group. Cardiac magnetic field mapping showed prolongation of depolarization and repolarization in untreated dTGRs compared with Sprague–Dawley rats with a partial reduction by BIRB796. Programmed electrical stimulation elicited ventricular tachycardias in 81% of untreated dTGRs but only in 48% of BIRB796-treated dTGRs. In conclusion, BIRB796 improved survival, target organ damage, and arrhythmogenic potential in angiotensin II–induced target organ damage.
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Affiliation(s)
- Joon-Keun Park
- Medical Faculty of the Charité, Franz Volhard Clinic, HELIOS Klinikum, Berlin, Germany
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37
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Voss A, Schroeder R, Truebner S, Goernig M, Figulla HR, Schirdewan A. Comparison of nonlinear methods symbolic dynamics, detrended fluctuation, and Poincare plot analysis in risk stratification in patients with dilated cardiomyopathy. Chaos 2007; 17:015120. [PMID: 17411277 DOI: 10.1063/1.2404633] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Dilated cardiomyopathy (DCM) has an incidence of about 20100 000 new cases per annum and accounts for nearly 10 000 deaths per year in the United States. Approximately 36% of patients with dilated cardiomyopathy (DCM) suffer from cardiac death within five years after diagnosis. Currently applied methods for an early risk prediction in DCM patients are rather insufficient. The objective of this study was to investigate the suitability of short-term nonlinear methods symbolic dynamics (STSD), detrended fluctuation (DFA), and Poincare plot analysis (PPA) for risk stratification in these patients. From 91 DCM patients and 30 healthy subjects (REF), heart rate and blood pressure variability (HRV, BPV), STSD, DFA, and PPA were analyzed. Measures from BPV analysis, DFA, and PPA revealed highly significant differences (p<0.0011) discriminating REF and DCM. For risk stratification in DCM patients, four parameters from BPV analysis, STSD, and PPA revealed significant differences between low and high risk (maximum sensitivity: 90%, specificity: 90%). These results suggest that STSD and PPA are useful nonlinear methods for enhanced risk stratification in DCM patients.
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Affiliation(s)
- Andreas Voss
- Department of Medical Engineering, University of Applied Sciences Jena, Carl-Zeiss-Promenade 2, D-07745 Jena, Germany.
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38
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Abstract
In this paper we use the concept of large-scale dimension densities to analyze heart rate variability data. This method uses a normalized Grassberger-Procaccia algorithm and estimates the dimension in the rather large scales of the system. This enables us to analyze very short data. First we re-analyze data from the CIC 2002 challenge and can completely distinguish between real data and computer-generated data using only one parameter. We then analyze unfiltered data for 15 patients with atrial fibrillation (AF), 15 patients with congestive heart failure (CHF), 15 elderly healthy subjects, and 18 young healthy subjects. This method can completely separate the AF group from the other groups and the CHF patients show significant differences compared to the young and elderly healthy volunteers. Furthermore, differences are evident in the dimensionality between day and night for healthy persons, but not for the CHF patients. Finally, the results are compared to standard heart rate variability parameters.
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Affiliation(s)
- Corinna Raab
- Institute of Physics, University of Potsdam, Potsdam, Germany
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39
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Baumert M, Wessel N, Schirdewan A, Voss A, Abbott D. Scaling Characteristics of Heart Rate Time Series Before the Onset of Ventricular Tachycardia. Ann Biomed Eng 2006; 35:201-7. [PMID: 17171301 DOI: 10.1007/s10439-006-9220-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 10/16/2006] [Indexed: 11/25/2022]
Abstract
Ventricular tachycardia (VT) provokes sudden cardiac death (SCD), which is a major cause of mortality in developed countries. Implantable cardioverter-defibrillators (ICDs) are an efficient therapy for SCD prevention. In this study we analyze heart rate variability (HRV) in data stored by ICDs. In 29 patients exhibiting VT episodes, the last 1000 normal beat-to-beat intervals are analyzed and compared to an individually acquired control time series (CON). HRV analysis is performed with standard parameters of time and frequency domain as suggested by the HRV Task Force. For scaling analyses of heart rate time series, the fractal dimension is analysed, applying Higuchi's algorithm (HFD). Furthermore, detrended fluctuation analysis (DFA) is performed. None of the standard HRV parameters shows significant differences between CON and VT. Before the onset of VT, the scaling characteristics by means of HFD and DFA are significantly changed. In conclusion, scaling analysis reveals changes in autonomic heart rate modulation preceding VT.
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Affiliation(s)
- Mathias Baumert
- Centre for Biomedical Engineering (CBME), The University of Adelaide, Adelaide, SA 5005, Australia.
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40
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Fischer R, Schirdewan A, Kumar A, Gapelyuk A, Schulz-Menger J, Dietz R. Cardiac Magnetic Resonance and Cardiac Magnetic Field Mapping in a Patient with Stress-Induced Cardiomyopathy (Tako-Tsubo). Pacing Clin Electro 2006; 29:1442-4. [PMID: 17201856 DOI: 10.1111/j.1540-8159.2006.00561.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We encountered a 65-year-old woman with typical electrocardiogram (ECG) changes and new-onset left ventricular dysfunction with apical ballooning that exhibited typical changes of tako-tsubo-like cardiomyopathy. We used cardiac magnetic resonance (CMR) and cardiac magnetic field mapping (CMFM) to detect changes in structural, mechanical, and electrophysiological myocardial properties during follow-up. CMR displayed an acute myocardial injury, but neither fibrosis nor necrosis. CMFM exhibited severely disturbed repolarization with an inhomogeneous magnetic field. These pathological findings persisted much longer than the abnormalities detected by CMR and the ECG.
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Affiliation(s)
- Robert Fischer
- Franz-Volhard-Klinik, Helios-Klinikum Berlin-Buch, Charité Campus Buch, Humboldt-Universität Zu Berlin, Berlin, Germany.
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41
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Raab C, Wessel N, Schirdewan A, Kurths J. Large-scale dimension densities for heart rate variability analysis. Phys Rev E Stat Nonlin Soft Matter Phys 2006; 73:041907. [PMID: 16711836 DOI: 10.1103/physreve.73.041907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Indexed: 05/09/2023]
Abstract
In this work, we reanalyze the heart rate variability (HRV) data from the 2002 Computers in Cardiology (CiC) Challenge using the concept of large-scale dimension densities and additionally apply this technique to data of healthy persons and of patients with cardiac diseases. The large-scale dimension density (LASDID) is estimated from the time series using a normalized Grassberger-Procaccia algorithm, which leads to a suitable correction of systematic errors produced by boundary effects in the rather large scales of a system. This way, it is possible to analyze rather short, nonstationary, and unfiltered data, such as HRV. Moreover, this method allows us to analyze short parts of the data and to look for differences between day and night. The circadian changes in the dimension density enable us to distinguish almost completely between real data and computer-generated data from the CiC 2002 challenge using only one parameter. In the second part we analyzed the data of 15 patients with atrial fibrillation (AF), 15 patients with congestive heart failure (CHF), 15 elderly healthy subjects (EH), as well as 18 young and healthy persons (YH). With our method we are able to separate completely the AF (rho (mu/ls) = 0.97 +/- 0.02) group from the others and, especially during daytime, the CHF patients show significant differences from the young and elderly healthy volunteers (CHF, 0.65 +/- 0.13; EH, 0.54 +/- 0.05; YH, 0.57 +/- 0.05; p < 0.05 for both comparisons). Moreover, for the CHF patients we find no circadian changes in rho (mu/ls) (day, 0.65 +/- 0.13; night, 0.66 +/- 0.12; n.s.) in contrast to healthy controls (day, 0.54 +/- 0.05; night, 0.61 +/- 0.05; p=0.002). Correlation analysis showed no statistical significant relation between standard HRV and circadian LASDID, demonstrating a possibly independent application of our method for clinical risk stratification.
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Affiliation(s)
- Corinna Raab
- Center for Dynamics of Complex Systems, Institute of Physics, University of Potsdam, Potsdam, Germany.
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42
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Wessel N, Malberg H, Bauernschmitt R, Schirdewan A, Kurths J. Nonlinear additive autoregressive model-based analysis of short-term heart rate variability. Med Biol Eng Comput 2006; 44:321-30. [PMID: 16937173 DOI: 10.1007/s11517-006-0038-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 02/27/2006] [Indexed: 12/19/2022]
Abstract
In this contribution we test the hypothesis that nonlinear additive autoregressive model-based data analysis improves the diagnostic ability based on short-term heart rate variability. For this purpose, a nonlinear regression approach, namely, the maximal correlation method is applied to the data of 37 patients with dilated cardiomyopathy as well as of 37 age- and sex-matched healthy subjects. We find that this approach is a powerful tool in discriminating both groups and promising for further model-based analyses.
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Affiliation(s)
- Niels Wessel
- Institute of Physics, University of Potsdam, Am Neuen Palais 10, 14415, Potsdam, Germany.
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43
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44
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Baumert M, Baier V, Truebner S, Schirdewan A, Voss A. Short- and Long-Term Joint Symbolic Dynamics of Heart Rate and Blood Pressure in Dilated Cardiomyopathy. IEEE Trans Biomed Eng 2005; 52:2112-5. [PMID: 16366235 DOI: 10.1109/tbme.2005.857636] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Autonomic cardiovascular control involves complex interactions of heart rate and blood pressure. In patients with dilated cardiomyopathy (DCM), this control is impaired and parameters for its quantification might be of prognostic importance. In this paper, we introduce methods based on joint symbolic dynamics (JSD) for the enhanced analysis of heart rate and blood pressure interactions. To assess the coarse-grained dynamics beat-to-beat changes of heart rate and blood pressure are encoded in symbol strings. Subsequently, the distribution properties of short symbol sequences (words) as well as the scaling properties of the whole symbol string are assessed. The comparison of joint symbolic heart rate and blood pressure dynamics in DCM (n = 75) with those in healthy controls (n = 75) showed significant changes. Both, the distribution of words and the scaling properties indicate a loss in heart rate dynamics associated with blood pressure regulation in DCM. In conclusion, the analyses of short- and long-term JSDs provide insights into complex physiological heart rate and blood pressure interactions and furthermore reveal patho-physiological cardiovascular control in DCM.
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Affiliation(s)
- Mathias Baumert
- Department of Medical Engineering, University of Applied Sciences Jena, 07745 Jena, Germany
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45
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Malberg H, Bauernschmitt R, Meyerfeldt U, Schirdewan A, Wessel N. Short-term heart rate turbulence analysis versus variability and baroreceptor sensitivity in patients with dilated cardiomyopathy. Indian Pacing Electrophysiol J 2004; 4:162-75. [PMID: 16943930 PMCID: PMC1540702] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
New methods for the analysis of arrhythmias and their hemodynamic consequences have been applied in risk stratification, in particular to patients after myocardial infarction. This study investigates the suitability of short-term heart rate turbulence (HRT) analysis in comparison to heart rate and blood pressure variability as well as baroreceptor sensitivity analyses to characterise the regulatory differences between patients with dilated cardiomyopathy (DCM) and healthy controls. In this study, 30 minutes data of non-invasive continuous blood pressure and ECGs of 37 DCM patients and 167 controls measured under standard resting conditions were analysed. The results show highly significant differences between DCM patients and controls in heart rate and blood pressure variability as well as in baroreceptor sensitivity parameters. Applying a combined heart rate-blood pressure trigger, ventricular premature beats were detected in 24.3% (9) of the DCM patients and 11.3% (19) of the controls. This fact demonstrates the limited applicability of short-term HRT analyses. However, the HRT parameters showed significant differences in this subgroup with ventricular premature beats (turbulence onset: DCM: 1.80+/-2.72, controls: - 4.34+/-3.10, p<0.001; turbulence slope: DCM: 6.75+/-5.50, controls: 21.30+/-17.72, p=0.021). Considering all (including HRT) parameters in the subgroup with ventricular beats, a discrimination rate between DCM patients and controls of 88.0% was obtained (max. 6 parameters). The corresponding value obtained for the total group was 86.3% (without HRT parameters). Comparable classification rates and high correlations between heart rate turbulence and variability and baroreflex parameters point to a more universal applicability of the latter methods.
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Affiliation(s)
- Hagen Malberg
- Forschungszentrum Karlsruhe GmbH (Karlsruhe Research Center), Institute for Applied Computer Science, P.O. Box 3640, D-76021 Karlsruhe, Germany.
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46
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Schirdewan A, Meyerfeldt U, Wessel N, Bondke HJ, Schreiber P, Sadowski R, Kamke W, Wiedemann M. 1091-211 Heart rate dynamics before the onset of ventricular tachyarrhythmias: Results of the cardioverter defibrillator registry MARITA. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90527-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Baumert M, Baier V, Haueisen J, Wessel N, Meyerfeldt U, Schirdewan A, Voss A. Forecasting of life threatening arrhythmias using the compression entropy of heart rate. Methods Inf Med 2004; 43:202-6. [PMID: 15136870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVES Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCD prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forth-coming shocks. METHODS The last 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquired control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (Hc). RESULTS Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, Hc revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT. CONCLUSION Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD.
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Affiliation(s)
- M Baumert
- University of Applied Sciences Jena, Department of Medical Engineering, Carl-Zeiss-Promenade 2, 07745 Jena, Germany
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48
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Wessel N, Schirdewan A, Kurths J. Intermittently decreased beat-to-beat variability in congestive heart failure. Phys Rev Lett 2003; 91:119801-119802. [PMID: 14525464 DOI: 10.1103/physrevlett.91.119801] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2002] [Indexed: 05/24/2023]
Affiliation(s)
- Niels Wessel
- Institute of Physics, University of PotsdamAm Neuen Palais 10, Potsdam 14415, Germany.
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49
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Malberg H, Bauernschmitt R, Meyerfeldt U, Schirdewan A, Wessel N. [Short-term heart rate turbulence analysis versus variability and baroreceptor sensitivity in patients with dilated cardiomyopathy]. Z Kardiol 2003; 92:547-57. [PMID: 12883839 DOI: 10.1007/s00392-003-0946-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2002] [Accepted: 03/06/2003] [Indexed: 11/26/2022]
Abstract
New methods for the analysis of arrhythmias and their hemodynamic consequences have been applied in risk stratification, particularly to patients after myocardial infarction. This study investigates the suitability of shortterm heart rate turbulence (HRT) in comparison to heart rate and blood pressure variability as well as baroreceptor sensitivity analyses to characterize the regulatory differences in patients with dilated cardiomyopathy (DCM) and healthy controls. In this study, 30 minutes data from noninvasive continuous blood pressure and ECG of 37 DCM patients and 167 controls under standard resting conditions were analyzed. The results showed highly significant differences between DCM patients and controls in heart rate and blood pressure variability as well as baroreceptor sensitivity parameters. Applying a combined heart rate-blood pressure trigger, in 24.3% (9) of the DCM patients and in 11.3% (19) of the controls ventricular premature beats were detected. This fact demonstrates the constricted applicability of short-term HRT analyses. However, the HRT parameters showed significant differences in this subgroup with ventricular premature beats (Turbulence Onset: DCM: 1.80+/-2.72, CONTROLS: -4.34+/-3.10, p<0.001; Turbulence Slope: DCM: 6.75+/-5.50, CONTROLS: 21.30+/-17.72, p = 0.021). Considering all (including HRT) parameters in the subgroup with ventricular beats, a discrimination rate between DCM patients and controls of 88.0% was obtained (max. 6 parameters). In comparison, in the total group this rate was 86.3% (without HRT parameters). The comparable classification rates and the high correlations between heart rate turbulence and variability and baroreflex parameters point to a more universal applicability of the last-mentioned methods.
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Affiliation(s)
- H Malberg
- Forschungszentrum Karlsruhe GmbH Institut für Angewandte Informatik, PF 36 40, 76021 Karlsruhe, Germany.
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50
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Wessel N, Malberg H, Meyerfeldt U, Schirdewan A, Kurths J. Model based analysis of the heart rate and blood pressure relationship. BIOMED ENG-BIOMED TE 2003; 47 Suppl 1 Pt 2:543-6. [PMID: 12465231 DOI: 10.1515/bmte.2002.47.s1b.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The main intention of this contribution is to measure the coupling between bivariate time series using the dual sequence method to estimate the baroreflex as well as a nonlinear regression approach, namely the maximal correlation method, to get a better understanding of the underlying processes. The data we analyse are heart rate and blood pressure variability time series from 27 patients with dilated cardiomyopathy as well as from a control group of 27 age- and sex-matched healthy subjects. The results strongly indicate and confirm the mechanisms of respiratory sinus arrhythmia in heart rate. Revealing the coupling direction and the strength of coupling between heart rate and blood pressure via optimal transformations in addition to the baroreflex estimation seems to be a very promising approach.
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Affiliation(s)
- N Wessel
- Institute of Physics, University of Potsdam, Germany
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