Prädiktoren für ICD-Therapien bei Patienten mit ischämischer und nicht-ischämischer Kardiomyopathie

Der implantierbare Kardioverter-Defibrillator gehört zu der Behandlung von herzinsuffizienten Patienten. In dieser Arbeit wird eine Risikostratifizierung anhand der vorliegenden Grunderkrankung analysiert. Untersucht wurden 330 konsekutive Patienten mit ischämischer oder nicht-ischämischer dilatativer Kardiomyopathie, die zwischen 2009 und 2011 einen ICD erhalten haben. Im Rahmen des Follow-up von 19 ± 9 Monaten erlitten 29 % der Patienten adäquate ICD-Therapien. Als signifikante Risikofaktoren für adäquate Therapien waren die sekundärprophylaktische Implantation bei ICM-Patienten und die Präsenz von Vorhofflimmern bei DCM-Patienten zu beobachten. Die leitliniengerechte CRT-Implantation zeigte eine prophylaktische Wirkung bei ICM-Patienten

Results of catheter ablation of atrial fibrillation in hypertrophied hearts – Comparison between primary and secondary hypertrophy

AbstractBackground and purposeApproximately 20–25% of the patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation (AF) during the clinical course of the disease, a percentage significantly larger than that of the general population. The purpose of the present study was to report on the procedural results of patients with AF and either primary or secondary left ventricular hypertrophy (LVH).Methods and subjectsTwenty-two consecutive HCM patients (55% male, mean age 57±8 years) with symptomatic AF, having undergone AF ablation procedures between September 2009 and July 2012 were compared with respect to procedural outcome and follow-up characteristics with 22 matched controls with secondary cardiac hypertrophy (64% male, 63±10 years) from our prospective AF catheter ablation registry.Results and conclusionRadiofrequency catheter ablation (RFCA) was successful in restoring long-term sinus rhythm in patients with LVH due to HCM and due to secondary etiology. However, patients with HCM needed more RFCA procedures and frequently additional antiarrhythmic drug therapy in order to maintain sinus rhythm

Prädiktoren für ICD-Therapien bei Patienten mit ischämischer und nicht-ischämischer Kardiomyopathie

Der implantierbare Kardioverter-Defibrillator gehört zu der Behandlung von herzinsuffizienten Patienten. In dieser Arbeit wird eine Risikostratifizierung anhand der vorliegenden Grunderkrankung analysiert. Untersucht wurden 330 konsekutive Patienten mit ischämischer oder nicht-ischämischer dilatativer Kardiomyopathie, die zwischen 2009 und 2011 einen ICD erhalten haben. Im Rahmen des Follow-up von 19 ± 9 Monaten erlitten 29 % der Patienten adäquate ICD-Therapien. Als signifikante Risikofaktoren für adäquate Therapien waren die sekundärprophylaktische Implantation bei ICM-Patienten und die Präsenz von Vorhofflimmern bei DCM-Patienten zu beobachten. Die leitliniengerechte CRT-Implantation zeigte eine prophylaktische Wirkung bei ICM-Patienten

Prädiktoren für ICD-Therapien bei Patienten mit ischämischer und nicht-ischämischer Kardiomyopathie

Der implantierbare Kardioverter-Defibrillator gehört zu der Behandlung von herzinsuffizienten Patienten. In dieser Arbeit wird eine Risikostratifizierung anhand der vorliegenden Grunderkrankung analysiert. Untersucht wurden 330 konsekutive Patienten mit ischämischer oder nicht-ischämischer dilatativer Kardiomyopathie, die zwischen 2009 und 2011 einen ICD erhalten haben. Im Rahmen des Follow-up von 19 ± 9 Monaten erlitten 29 % der Patienten adäquate ICD-Therapien. Als signifikante Risikofaktoren für adäquate Therapien waren die sekundärprophylaktische Implantation bei ICM-Patienten und die Präsenz von Vorhofflimmern bei DCM-Patienten zu beobachten. Die leitliniengerechte CRT-Implantation zeigte eine prophylaktische Wirkung bei ICM-Patienten

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Atrial fibrillation (AF) is the most common human arrhythmia. Interventional treatment with catheter ablation is an established technique that is increasingly applied and has become one of the main treatment modalities in patients with AF. Ablation results in significant improvement of symptoms and the quality of life. There is as yet no clear evidence of any impact of the procedure on hard clinical endpoints, except in patients with heart failure, who seem to benefit significantly from ablation. The cornerstone of the procedure is the achievement of pulmonary vein isolation. Radiofrequency energy is the main applied energy source, but cryoballoon ablation has emerged as a safe and effective alternative to radiofrequency ablation. Additional ablation strategies and novel technical features have been proposed but without unequivocal proof of clinical benefit. The most promising of these seems to be substrate mapping of the left atrium with substrate modification in areas with low voltage as an adjunct to pulmonary vein isolation. Complication rates remain considerable despite accumulated experience and can be partly reduced by application of preventive measures

Validation of the VT-LVAD score for prediction of late VAs in LVAD recipients

International audienceObjectives This study sought to validate the performance of the VT-LVAD risk model in predicting late ventricular arrhythmias (VAs) in patients after left ventricular assist device (LVAD) implantation. Background The need for implantable cardioverter-defibrillator (ICD)-implantation in LVAD recipients is not well studied. A better selection of the patients with high risk for late VAs could lead to a more targeted ICD-implantation or replacement. Methods The study evaluated the performance of the VT-LVAD prognostic score (VAs prior LVAD, no ACE-inhibitor in medication, heart failure duration > 12 months, early VAs post-LVAD implantation, atrial fibrillation prior LVAD, idiopathic dilated cardiomyopathy) for the endpoint of the occurrence of late VAs in 357 LVAD patients in Heart Centre of Leipzig. Results From the initial 460 patients, 357 (age: 58 +/- 10 years; left ventricular ejection fraction: 20 +/- 6%; HeartWare: 50%; HeartMate III: 42%) were assigned to four risk groups according to their VT-LVAD score varying from low risk to very high risk. After 25 months, late VAs occurred in 130 patients. The VT-LVAD score was an independent predictor of late VAs (multivariate analysis; p = < .001; goodness-of-tip p = .347; odds ratio: 4.8). While there was no statistically significant difference between the low- and intermediate-risk group, risk stratification for patients with high risk and very high risk performed more accurately (pairwise comparison p = .005 and p < .001, respectively). Conclusions The VT-LVAD score predicted accurately the occurrence of late VAs in high-risk LVAD recipients in a large external cohort of LVAD recipients supporting its utility for more targeted ICD implantations

Role of assist device implantation and heart transplantation in the long-term outcome of patients with structural heart disease after catheter ablation of ventricular tachycardia

Introduction!#!Ablation of ventricular tachycardias (VTs) in patients with structural heart disease (SHD) has been associated with advanced heart failure and poor survival.!##!Methods and results!#!This matched case-control study sought to assess the difference in survival after left ventricular assist device (LVAD) implantation and/or heart transplantation (HTX) in SHD patients undergoing VT ablation. From the initial cohort of 309 SHD patients undergoing VT ablation (187 ischemic cardiomyopathy, mean age 64 ± 12 years, ejection fraction of 34 ± 13%), 15 patients received an LVAD and nine patients HTX after VT ablation during a follow-up period of 44 ± 33 months. Long-term survival after LVAD did not differ from the matched control group (p = 0.761), although the cause of lethal events was different. All post-HTX patients survived during follow-up.!##!Conclusion!#!In this matched case-control study on patients with SHD undergoing VT ablation, patients that received LVAD implantation had similar survival compared to the control group after 4‑year follow-up, while the patients with HTX had a significantly better outcome

High Specificity Wearable Device With Photoplethysmography and Six-Lead Electrocardiography for Atrial Fibrillation Detection Challenged by Frequent Premature Contractions: DoubleCheck-AF

Background: Consumer smartwatches have gained attention as mobile health (mHealth) tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement artifacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead signal and is limited in asymptomatic cases. Objective: DoubleCheck-AF is a validation study of a wrist-worn device dedicated to providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with particular emphasis on the challenge of frequent premature beats. Methods and Results: We performed a prospective, non-randomized study of 344 participants including 121 patients in AF. To challenge the specificity of the device two control groups were selected: 95 patients in stable SR and 128 patients in SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG tracings were labeled by two independent diagnosis-blinded cardiologists as “AF,” “SR” or “Cannot be concluded.” In case of disagreement, a third cardiologist was consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACs per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the wearable and combination of both yielded sensitivity and specificity of 94.2 and 96.9%; 99.2 and 99.1%; 94.2 and 99.6%, respectively. All seven false-positive PPGbased cases were from the frequent PVCs/PACs group compared to none from the stable SR group (P < 0.001). In the majority of these cases (6/7) cardiologists were able to correct the diagnosis to SR with the help of the ECG of the device (P = 0.012). Conclusions: This is the first wearable combining PPG-based AF detection algorithm for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm confirmation. The system maintained high specificity despite a remarkable amount of frequent single or multiple premature contraction