Lilian Mantziari | Aristotle University of Thessaloniki (original) (raw)

Papers by Lilian Mantziari

Research paper thumbnail of Differences in management of atrial fibrillation between cardiologists and non-cardiologists in Greece

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

We aimed to assess trends in the management of atrial fibrillation (AF) at various levels of medi... more We aimed to assess trends in the management of atrial fibrillation (AF) at various levels of medical care in Greece and to compare the treatment practices of cardiologists to those of non-cardiologists. From January to May 2007, 500 questionnaires were mailed to cardiologists, internists and general practitioners, randomly selected from regional medical associations. Questions assessed management practices for paroxysmal, persistent and permanent AF. A total of 309 physicians (194 cardiologists and 115 non-cardiologists) responded. Cardiologists showed no preference regarding the site of cardioversion of paroxysmal AF, whereas non-cardiologists tend to cardiovert paroxysmal AF in the emergency department. Intravenous amiodarone is the most frequently used antiarrhythmic agent for cardioversion by both groups (63% vs. 71%, p=NS). Cardiologists utilise propafenone or ibutilide more frequently than non-cardiologists (24% vs. 11%, p<0.05 and 10% vs. 2%, p<0.01 respectively), while...

Research paper thumbnail of Wavelet variability of SA node originated P waves in atrial fibrillation and in signals with ectopic beats

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2012

Abstract Atrial fibrillation (AF) is one of the most common cardiac arrhythmia [1]. Electrical pr... more Abstract Atrial fibrillation (AF) is one of the most common cardiac arrhythmia [1]. Electrical properties of the atrial myocardium may be related to the appearance of this type of arrhythmia. However ectopic beats, occurring normally in healthy people, disturb cardiac rhythm. Those beats arise from fiber outside the region of SA node. With this work we aim at highlighting differences in the atrial activity between healthy subjects, healthy subjects presenting many ectopic events and patients with AF. The XYZ leads of ...

Research paper thumbnail of Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

Cardiology Research and Practice, 2011

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination o... more Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within min. DC-ECV was successful in all patients (100%) within min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.

Research paper thumbnail of Increased right atrial volume index predicts low Duke activity status index in patients with chronic heart failure

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

The aim of the present study was to examine the value of the right atrial volume index (RAVI) as ... more The aim of the present study was to examine the value of the right atrial volume index (RAVI) as predictor of functional capacity in patients with heart failure. A total of 51 patients with stable chronic heart failure of ischaemic or non-ischaemic aetiology were prospectively enrolled. The systolic function of the right ventricle was quantified using the tricuspid annular plane systolic excursion (TAPSE). Right atrial volume was measured in the apical 4-chamber view and was indexed to body surface area. The functional capacity was assessed by the Duke Activity Status Index (DASI). Patients with a low functional capacity (DASI<10) had lower TAPSE (1.4 ± 0.3 cm versus 2.0 ± 0.4 cm, p<0.001), higher RAVI (42 ± 15 ml/m(2) versus 22 ± 9 ml/m(2), p<0.001), higher estimated right ventricular systolic pressure (61 ± 13 mmHg versus 40 ± 16 mmHg, p<0.001), larger right ventricular end-diastolic diameter (4.7 ± 0.8 cm versus 3.6 ± 0.7 cm, p<0.001) and lower left ventricular eje...

Research paper thumbnail of QRS analysis using wavelet transformation for the prediction of response to cardiac resynchronization therapy: A prospective pilot study

Journal of Electrocardiology, 2014

Background: Wider QRS and left bundle branch block morphology are related to response to cardiac ... more Background: Wider QRS and left bundle branch block morphology are related to response to cardiac resynchronization therapy (CRT). A novel time-frequency analysis of the QRS complex may provide additional information in predicting response to CRT. Methods: Signal-averaged electrocardiograms were prospectively recorded, before CRT, in orthogonal leads and QRS decomposition in three frequency bands was performed using the Morlet wavelet transformation. Results: Thirty eight patients (age 65 ± 10 years, 31 males) were studied. CRT responders (n = 28) had wider baseline QRS compared to non-responders and lower QRS energies in all frequency bands. The combination of QRS duration and mean energy in the high frequency band had the best predicting ability (AUC 0.833, 95%CI 0.705-0.962, p = 0.002) followed by the maximum energy in the high frequency band (AUC 0.811, 95%CI 0.663-0.960, p = 0.004). Conclusions: Wavelet transformation of the QRS complex is useful in predicting response to CRT.

Research paper thumbnail of Narrow QRS complex in idiopathic (fascicular) left ventricular tachycardia

Herz, 2013

ABSTRACT A 40-year-old man presented to our hospital with palpitations. His ECG at admission show... more ABSTRACT A 40-year-old man presented to our hospital with palpitations. His ECG at admission showed a narrow QRS (

Research paper thumbnail of Practice patterns of cardiologists, general practitioners, and internists for managing supraventricular tachycardias in Greece

European Journal of Emergency Medicine, 2011

Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not onl... more Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not only cardiologists, but also general practitioners (GPs) and internists are involved to an increasing extent in the acute and long-term management of SVT. We aimed to explore the differences between practice patterns of cardiologists and noncardiologists with regard to SVT management in Greece. A cross-sectional questionnaire survey was conducted among 250 cardiologists and 250 GPs/internists from various areas across Greece. A response rate of 61.8% was obtained. Vagal maneuvers were the initial therapeutic approach for SVT termination; however, 22% of noncardiologists would rather start with an antiarrhythmic drug. Adenosine was the most popular drug for SVT termination, but the GPs/internists would use it less often than the cardiologists (67 vs. 86%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The GPs/internists would keep the patient for at least 24 h or more after SVT termination, while 48% of the cardiologists would discharge the patient within the first 3 h. Noncardiologists would more often suggest a 24-h Holter recording than the cardiologists (73 vs. 55%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005). With regard to the long-term management of SVT, the GPs/internists would prescribe antiarrhythmic drugs earlier than the cardiologists, and seem to be less familiar with the indications for the electrophysiological testing and ablation. Significant differences in practice patterns exist in Greece with regard to SVT management between cardiologists and noncardiologists. The GPs/internists seem to rely more on antiarrhythmic drugs and tend to underestimate the role of ablation therapy for the long-term management of SVT.

Research paper thumbnail of Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

The Open Cardiovascular Medicine Journal, 2010

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudd... more Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention.

Research paper thumbnail of Abstract 14930: Contribution of Remote Magnetic Navigation to Supraventricular Tachycardia Ablation in Complex Congenital Heart Diseases

Circulation, Nov 20, 2012

Research paper thumbnail of NGAL and ST2 levels in ambulatory patients with chronic heart failure. Clinical and echocardiographic correlates

Scandinavian Cardiovascular Journal, 2015

Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1... more Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1 receptor family, are novel biomarkers with a potential role in the diagnosis and risk stratification of patients with chronic heart failure (CHF). There is however scarce data on their relation with clinical characteristics and cardiac function in patients with CHF. Consecutive ambulatory patients with CHF were studied. All patients underwent clinical and echocardiographic assessment, and blood samples were collected for the estimation of ST2 and NGAL serum levels during the same assessment. A total of 76 patients (79% male, mean age: 63 ± 14 years), with CHF and left ventricular ejection fraction of 28 ± 7% were included. Median NGAL was 0.16 (0.09-0.275) mg/L and median ST2 was 0.0125 (0.0071-0.0176) mg/L. No association between NGAL and ST2 was observed. Multivariate analysis revealed tissue Doppler-derived right ventricular systolic velocity as an independent predictor of ST2, and the duration of HF and serum creatinine levels as independent predictors of NGAL. NGAL levels depend on the renal function and the duration of HF, while ST2 levels are affected by the right but not the left ventricular function and show no association with clinical indices of HF.

Research paper thumbnail of Clinical applications of intravascular ultrasound (IVUS): experience from an academic high volume centre of Northern Greece

Hippokratia, 2011

Intravascular ultrasound (IVUS) has become a valuable tool adjunctive to coronary angiography due... more Intravascular ultrasound (IVUS) has become a valuable tool adjunctive to coronary angiography due to its ability to directly image atheroma and the vessel wall. We aimed to evaluate the use of IVUS during diagnostic angiography and coronary interventions in a coronary intervention academic high volume center of northern Greece. IVUS studies have been retrospectively retrieved from 2005 to 2008 from the archives of the catheterization laboratory of our department. IVUS was performed in 403 patients (294 male) of mean age 62±6 years. Indications for coronary angiography +/- intervention were acute coronary syndromes (49%), stable angina (46%) and previous coronary angioplasty evaluation (5%). Forty eight per cent of the IVUS studies were performed in left anterior descending artery (LAD), 25% in right coronary artery (RCA), 18% in left circumflex artery (LCx), and the rest (9%) in left main coronary artery (LMCA) or in coronary branches. Indications for performing an IVUS study were a...

Research paper thumbnail of Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease: A Single-Center Experience in 116 Patients

Circulation: Arrhythmia and Electrophysiology, 2013

Background -Remote magnetic navigation (RMN)-guided ablation with three-dimensional (3D)-image in... more Background -Remote magnetic navigation (RMN)-guided ablation with three-dimensional (3D)-image integration could provide maximum benefit in patients with complex anatomy. We reviewed supraventricular tachycardia (SVT) ablation in adult congenital heart disease (ACHD) patients to assess the contribution of these technologies.

Research paper thumbnail of Successful ablation of two right atrial tachycardias on either side of the lateral tunnel patch in a patient with double inlet left ventricle and total cavopulmonary connection: Two sites and two mechanisms

Global Cardiology Science and Practice, 2013

Research paper thumbnail of Utility of Noninvasive Arrhythmia Mapping in Patients with Adult Congenital Heart Disease

Cardiac Electrophysiology Clinics, 2015

Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on ma... more Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; single-center experience.

Research paper thumbnail of Advanced ablation strategies for management of post-surgical atrial arrhythmias

Global Cardiology Science and Practice, 2013

Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surger... more Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.

Research paper thumbnail of Arrhythmogenic Right Ventricle in Left Ventricular Non-compaction - In Response to the Letter to the Editor "Diagnostic Dilemmas for Underlying Pathophysiology of Arrhythmias Originating from the Right Ventricle

Indian pacing and electrophysiology journal, 2014

We welcome Dr Finsterer's and Dr Stollberger's interest in our manuscript and their insightful ob... more We welcome Dr Finsterer's and Dr Stollberger's interest in our manuscript and their insightful observations. We have recently reported [1] a case of successful mapping and ablation of ventricular tachyarrhythmia in a patient with left ventricular non-compaction (LVNC). The arrhythmia proved to have a rather unusual and unexpected origin, located within a structurally normal right ventricle (RV). Our patient was followed up for one year following his procedure and had no recurrence of symptoms, documented ventricular ectopy (VE) or ventricular tachycardia on Holter monitoring.

Research paper thumbnail of The Use of Transtelephonic Loop Recorders for the Assessment of Symptoms and Arrhythmia Recurrence After Radiofrequency Catheter Ablation

Telemedicine and e-Health, 2010

Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patient... more Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patients often remain symptomatic after the procedure. We aimed to assess the arrhythmia recurrence after successful RFA in relation to patients' symptoms using transtelephonic loop recorders. Thirty-six consecutive patients (age 50 -14 years, 17 males/19 females) were enrolled after successful RFA for atrioventricular (AV) nodal reentrant tachycardia (n ¼ 21), AV reentrant tachycardia (n ¼ 8), atrial tachycardia (n ¼ 2), atrial fibrillation/flutter (n ¼ 4), and ventricular tachycardia (n ¼ 1). During 23 -6 days of follow-up, 679 events were recorded, 246 of which were true arrhythmic events, mostly (56%) asymptomatic. The vast majority of these true arrhythmic events were due to trivial arrhythmias (extrasystoles or sinus tachycardia), equally distributed among symptomatic and asymptomatic episodes.

Research paper thumbnail of Use of Asymmetric Bidirectional Catheters with Different Curvature Radius for Catheter Ablation of Cardiac Arrhythmias

Pacing and Clinical Electrophysiology, 2013

The impact of recently introduced asymmetric bidirectional ablation catheters on procedural param... more The impact of recently introduced asymmetric bidirectional ablation catheters on procedural parameters and acute success rates of ablation procedures is unknown. We retrospectively analyzed data regarding ablations using a novel bidirectional catheter in a tertiary cardiac center and compared these in 1:5 ratio with a control group of procedures matched for age, gender, operator, and ablation type. A total of 50 cases and 250 controls of median age 60 (50-68) years were studied. Structural heart disease was equally prevalent in both groups (39%) while history of previous ablations was more common in the study arm (54% vs 30%, P = 0.001). Most of the ablation cases were for atrial fibrillation (46%), followed by atrial tachycardia (28%), supraventricular tachycardia (12%), and ventricular tachycardia (14%). Median procedure duration was 128 (52-147) minutes with the bidirectional, versus 143 (105-200) minutes with the conventional catheter (P = 0.232), and median fluoroscopy time was 17 (10-34) minutes versus 23 (12-39) minutes, respectively (P = 0.988). There was a trend toward a lower procedure duration for the atrial tachycardia ablations, 89 (52-147) minutes versus 130 (100-210) minutes, P = 0.064. The procedure was successfully completed in 96% of the bidirectional versus 84% of the control cases (P = 0.151). A negative correlation was observed between the relative fluoroscopy duration and the case number (r = -0.312, P = 0.028), reflecting the learning curve for the bidirectional catheter. The introduction of the bidirectional catheter resulted in no prolongation of procedure parameters and similar success rates, while there was a trend toward a lower procedure duration for atrial tachycardia ablations.

Research paper thumbnail of Wavelet-based analysis of P waves identifies patients with lone atrial fibrillation: A cross-sectional pilot study

International Journal of Cardiology, 2014

Research paper thumbnail of Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: The Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) Trial

International Journal of Cardiology, 2014

Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (... more Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high-versus low-dose furosemide with or without low-dose dopamine infusion in this patient population. Methods and results: 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n = 50, 20 mg/h), b) low-dose furosemide and lowdose dopamine (LDFD, n = 56, 5 mg/h and 5 μg kg −1 min −1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P = 0.74) or at one year (38.1%, 33.9% and 32.7%, P = 0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P = 0.55) or one year (60.0%, 50.0%, and 47%, P = 0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P b 0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P = 0.27). No significant differences in adverse events were noted. Conclusions: In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high-vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.

Research paper thumbnail of Differences in management of atrial fibrillation between cardiologists and non-cardiologists in Greece

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

We aimed to assess trends in the management of atrial fibrillation (AF) at various levels of medi... more We aimed to assess trends in the management of atrial fibrillation (AF) at various levels of medical care in Greece and to compare the treatment practices of cardiologists to those of non-cardiologists. From January to May 2007, 500 questionnaires were mailed to cardiologists, internists and general practitioners, randomly selected from regional medical associations. Questions assessed management practices for paroxysmal, persistent and permanent AF. A total of 309 physicians (194 cardiologists and 115 non-cardiologists) responded. Cardiologists showed no preference regarding the site of cardioversion of paroxysmal AF, whereas non-cardiologists tend to cardiovert paroxysmal AF in the emergency department. Intravenous amiodarone is the most frequently used antiarrhythmic agent for cardioversion by both groups (63% vs. 71%, p=NS). Cardiologists utilise propafenone or ibutilide more frequently than non-cardiologists (24% vs. 11%, p<0.05 and 10% vs. 2%, p<0.01 respectively), while...

Research paper thumbnail of Wavelet variability of SA node originated P waves in atrial fibrillation and in signals with ectopic beats

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2012

Abstract Atrial fibrillation (AF) is one of the most common cardiac arrhythmia [1]. Electrical pr... more Abstract Atrial fibrillation (AF) is one of the most common cardiac arrhythmia [1]. Electrical properties of the atrial myocardium may be related to the appearance of this type of arrhythmia. However ectopic beats, occurring normally in healthy people, disturb cardiac rhythm. Those beats arise from fiber outside the region of SA node. With this work we aim at highlighting differences in the atrial activity between healthy subjects, healthy subjects presenting many ectopic events and patients with AF. The XYZ leads of ...

Research paper thumbnail of Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

Cardiology Research and Practice, 2011

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination o... more Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within min. DC-ECV was successful in all patients (100%) within min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.

Research paper thumbnail of Increased right atrial volume index predicts low Duke activity status index in patients with chronic heart failure

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

The aim of the present study was to examine the value of the right atrial volume index (RAVI) as ... more The aim of the present study was to examine the value of the right atrial volume index (RAVI) as predictor of functional capacity in patients with heart failure. A total of 51 patients with stable chronic heart failure of ischaemic or non-ischaemic aetiology were prospectively enrolled. The systolic function of the right ventricle was quantified using the tricuspid annular plane systolic excursion (TAPSE). Right atrial volume was measured in the apical 4-chamber view and was indexed to body surface area. The functional capacity was assessed by the Duke Activity Status Index (DASI). Patients with a low functional capacity (DASI<10) had lower TAPSE (1.4 ± 0.3 cm versus 2.0 ± 0.4 cm, p<0.001), higher RAVI (42 ± 15 ml/m(2) versus 22 ± 9 ml/m(2), p<0.001), higher estimated right ventricular systolic pressure (61 ± 13 mmHg versus 40 ± 16 mmHg, p<0.001), larger right ventricular end-diastolic diameter (4.7 ± 0.8 cm versus 3.6 ± 0.7 cm, p<0.001) and lower left ventricular eje...

Research paper thumbnail of QRS analysis using wavelet transformation for the prediction of response to cardiac resynchronization therapy: A prospective pilot study

Journal of Electrocardiology, 2014

Background: Wider QRS and left bundle branch block morphology are related to response to cardiac ... more Background: Wider QRS and left bundle branch block morphology are related to response to cardiac resynchronization therapy (CRT). A novel time-frequency analysis of the QRS complex may provide additional information in predicting response to CRT. Methods: Signal-averaged electrocardiograms were prospectively recorded, before CRT, in orthogonal leads and QRS decomposition in three frequency bands was performed using the Morlet wavelet transformation. Results: Thirty eight patients (age 65 ± 10 years, 31 males) were studied. CRT responders (n = 28) had wider baseline QRS compared to non-responders and lower QRS energies in all frequency bands. The combination of QRS duration and mean energy in the high frequency band had the best predicting ability (AUC 0.833, 95%CI 0.705-0.962, p = 0.002) followed by the maximum energy in the high frequency band (AUC 0.811, 95%CI 0.663-0.960, p = 0.004). Conclusions: Wavelet transformation of the QRS complex is useful in predicting response to CRT.

Research paper thumbnail of Narrow QRS complex in idiopathic (fascicular) left ventricular tachycardia

Herz, 2013

ABSTRACT A 40-year-old man presented to our hospital with palpitations. His ECG at admission show... more ABSTRACT A 40-year-old man presented to our hospital with palpitations. His ECG at admission showed a narrow QRS (

Research paper thumbnail of Practice patterns of cardiologists, general practitioners, and internists for managing supraventricular tachycardias in Greece

European Journal of Emergency Medicine, 2011

Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not onl... more Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not only cardiologists, but also general practitioners (GPs) and internists are involved to an increasing extent in the acute and long-term management of SVT. We aimed to explore the differences between practice patterns of cardiologists and noncardiologists with regard to SVT management in Greece. A cross-sectional questionnaire survey was conducted among 250 cardiologists and 250 GPs/internists from various areas across Greece. A response rate of 61.8% was obtained. Vagal maneuvers were the initial therapeutic approach for SVT termination; however, 22% of noncardiologists would rather start with an antiarrhythmic drug. Adenosine was the most popular drug for SVT termination, but the GPs/internists would use it less often than the cardiologists (67 vs. 86%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The GPs/internists would keep the patient for at least 24 h or more after SVT termination, while 48% of the cardiologists would discharge the patient within the first 3 h. Noncardiologists would more often suggest a 24-h Holter recording than the cardiologists (73 vs. 55%, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005). With regard to the long-term management of SVT, the GPs/internists would prescribe antiarrhythmic drugs earlier than the cardiologists, and seem to be less familiar with the indications for the electrophysiological testing and ablation. Significant differences in practice patterns exist in Greece with regard to SVT management between cardiologists and noncardiologists. The GPs/internists seem to rely more on antiarrhythmic drugs and tend to underestimate the role of ablation therapy for the long-term management of SVT.

Research paper thumbnail of Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

The Open Cardiovascular Medicine Journal, 2010

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudd... more Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention.

Research paper thumbnail of Abstract 14930: Contribution of Remote Magnetic Navigation to Supraventricular Tachycardia Ablation in Complex Congenital Heart Diseases

Circulation, Nov 20, 2012

Research paper thumbnail of NGAL and ST2 levels in ambulatory patients with chronic heart failure. Clinical and echocardiographic correlates

Scandinavian Cardiovascular Journal, 2015

Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1... more Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1 receptor family, are novel biomarkers with a potential role in the diagnosis and risk stratification of patients with chronic heart failure (CHF). There is however scarce data on their relation with clinical characteristics and cardiac function in patients with CHF. Consecutive ambulatory patients with CHF were studied. All patients underwent clinical and echocardiographic assessment, and blood samples were collected for the estimation of ST2 and NGAL serum levels during the same assessment. A total of 76 patients (79% male, mean age: 63 ± 14 years), with CHF and left ventricular ejection fraction of 28 ± 7% were included. Median NGAL was 0.16 (0.09-0.275) mg/L and median ST2 was 0.0125 (0.0071-0.0176) mg/L. No association between NGAL and ST2 was observed. Multivariate analysis revealed tissue Doppler-derived right ventricular systolic velocity as an independent predictor of ST2, and the duration of HF and serum creatinine levels as independent predictors of NGAL. NGAL levels depend on the renal function and the duration of HF, while ST2 levels are affected by the right but not the left ventricular function and show no association with clinical indices of HF.

Research paper thumbnail of Clinical applications of intravascular ultrasound (IVUS): experience from an academic high volume centre of Northern Greece

Hippokratia, 2011

Intravascular ultrasound (IVUS) has become a valuable tool adjunctive to coronary angiography due... more Intravascular ultrasound (IVUS) has become a valuable tool adjunctive to coronary angiography due to its ability to directly image atheroma and the vessel wall. We aimed to evaluate the use of IVUS during diagnostic angiography and coronary interventions in a coronary intervention academic high volume center of northern Greece. IVUS studies have been retrospectively retrieved from 2005 to 2008 from the archives of the catheterization laboratory of our department. IVUS was performed in 403 patients (294 male) of mean age 62±6 years. Indications for coronary angiography +/- intervention were acute coronary syndromes (49%), stable angina (46%) and previous coronary angioplasty evaluation (5%). Forty eight per cent of the IVUS studies were performed in left anterior descending artery (LAD), 25% in right coronary artery (RCA), 18% in left circumflex artery (LCx), and the rest (9%) in left main coronary artery (LMCA) or in coronary branches. Indications for performing an IVUS study were a...

Research paper thumbnail of Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease: A Single-Center Experience in 116 Patients

Circulation: Arrhythmia and Electrophysiology, 2013

Background -Remote magnetic navigation (RMN)-guided ablation with three-dimensional (3D)-image in... more Background -Remote magnetic navigation (RMN)-guided ablation with three-dimensional (3D)-image integration could provide maximum benefit in patients with complex anatomy. We reviewed supraventricular tachycardia (SVT) ablation in adult congenital heart disease (ACHD) patients to assess the contribution of these technologies.

Research paper thumbnail of Successful ablation of two right atrial tachycardias on either side of the lateral tunnel patch in a patient with double inlet left ventricle and total cavopulmonary connection: Two sites and two mechanisms

Global Cardiology Science and Practice, 2013

Research paper thumbnail of Utility of Noninvasive Arrhythmia Mapping in Patients with Adult Congenital Heart Disease

Cardiac Electrophysiology Clinics, 2015

Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on ma... more Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; single-center experience.

Research paper thumbnail of Advanced ablation strategies for management of post-surgical atrial arrhythmias

Global Cardiology Science and Practice, 2013

Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surger... more Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.

Research paper thumbnail of Arrhythmogenic Right Ventricle in Left Ventricular Non-compaction - In Response to the Letter to the Editor "Diagnostic Dilemmas for Underlying Pathophysiology of Arrhythmias Originating from the Right Ventricle

Indian pacing and electrophysiology journal, 2014

We welcome Dr Finsterer's and Dr Stollberger's interest in our manuscript and their insightful ob... more We welcome Dr Finsterer's and Dr Stollberger's interest in our manuscript and their insightful observations. We have recently reported [1] a case of successful mapping and ablation of ventricular tachyarrhythmia in a patient with left ventricular non-compaction (LVNC). The arrhythmia proved to have a rather unusual and unexpected origin, located within a structurally normal right ventricle (RV). Our patient was followed up for one year following his procedure and had no recurrence of symptoms, documented ventricular ectopy (VE) or ventricular tachycardia on Holter monitoring.

Research paper thumbnail of The Use of Transtelephonic Loop Recorders for the Assessment of Symptoms and Arrhythmia Recurrence After Radiofrequency Catheter Ablation

Telemedicine and e-Health, 2010

Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patient... more Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patients often remain symptomatic after the procedure. We aimed to assess the arrhythmia recurrence after successful RFA in relation to patients' symptoms using transtelephonic loop recorders. Thirty-six consecutive patients (age 50 -14 years, 17 males/19 females) were enrolled after successful RFA for atrioventricular (AV) nodal reentrant tachycardia (n ¼ 21), AV reentrant tachycardia (n ¼ 8), atrial tachycardia (n ¼ 2), atrial fibrillation/flutter (n ¼ 4), and ventricular tachycardia (n ¼ 1). During 23 -6 days of follow-up, 679 events were recorded, 246 of which were true arrhythmic events, mostly (56%) asymptomatic. The vast majority of these true arrhythmic events were due to trivial arrhythmias (extrasystoles or sinus tachycardia), equally distributed among symptomatic and asymptomatic episodes.

Research paper thumbnail of Use of Asymmetric Bidirectional Catheters with Different Curvature Radius for Catheter Ablation of Cardiac Arrhythmias

Pacing and Clinical Electrophysiology, 2013

The impact of recently introduced asymmetric bidirectional ablation catheters on procedural param... more The impact of recently introduced asymmetric bidirectional ablation catheters on procedural parameters and acute success rates of ablation procedures is unknown. We retrospectively analyzed data regarding ablations using a novel bidirectional catheter in a tertiary cardiac center and compared these in 1:5 ratio with a control group of procedures matched for age, gender, operator, and ablation type. A total of 50 cases and 250 controls of median age 60 (50-68) years were studied. Structural heart disease was equally prevalent in both groups (39%) while history of previous ablations was more common in the study arm (54% vs 30%, P = 0.001). Most of the ablation cases were for atrial fibrillation (46%), followed by atrial tachycardia (28%), supraventricular tachycardia (12%), and ventricular tachycardia (14%). Median procedure duration was 128 (52-147) minutes with the bidirectional, versus 143 (105-200) minutes with the conventional catheter (P = 0.232), and median fluoroscopy time was 17 (10-34) minutes versus 23 (12-39) minutes, respectively (P = 0.988). There was a trend toward a lower procedure duration for the atrial tachycardia ablations, 89 (52-147) minutes versus 130 (100-210) minutes, P = 0.064. The procedure was successfully completed in 96% of the bidirectional versus 84% of the control cases (P = 0.151). A negative correlation was observed between the relative fluoroscopy duration and the case number (r = -0.312, P = 0.028), reflecting the learning curve for the bidirectional catheter. The introduction of the bidirectional catheter resulted in no prolongation of procedure parameters and similar success rates, while there was a trend toward a lower procedure duration for atrial tachycardia ablations.

Research paper thumbnail of Wavelet-based analysis of P waves identifies patients with lone atrial fibrillation: A cross-sectional pilot study

International Journal of Cardiology, 2014

Research paper thumbnail of Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: The Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) Trial

International Journal of Cardiology, 2014

Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (... more Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high-versus low-dose furosemide with or without low-dose dopamine infusion in this patient population. Methods and results: 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n = 50, 20 mg/h), b) low-dose furosemide and lowdose dopamine (LDFD, n = 56, 5 mg/h and 5 μg kg −1 min −1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P = 0.74) or at one year (38.1%, 33.9% and 32.7%, P = 0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P = 0.55) or one year (60.0%, 50.0%, and 47%, P = 0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P b 0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P = 0.27). No significant differences in adverse events were noted. Conclusions: In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high-vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.