Arash Arya - Academia.edu (original) (raw)

Papers by Arash Arya

Research paper thumbnail of Electrophysiologic characteristics and results of radiofrequency catheter ablation in elderly patients with atrioventricular nodal reentrant tachycardia

Background: As in the general population, atrioventricular nodal reentrant tachycardia (AVNRT) is... more Background: As in the general population, atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular supraventricular tachycardia in the elderly patients. We tried to compare electrophysiologic characteristics, efficacy, and risks of the radiofrequency (RF) catheter ablation of the slow pathway in elderly and young patients with AVNRT. Methods: Between April 2001 and March 2005, 268 consecutive patients (190 females;

Research paper thumbnail of Prospective, Multicenter Validation of a Clinical Risk Score for Left Atrial Arrhythmogenic Substrate Based on Voltage Analysis: DR-FLASH Score

Heart Rhythm, 2015

Presence of left atrial low-voltage areas (LVAs) is frequently observed in patients with atrial f... more Presence of left atrial low-voltage areas (LVAs) is frequently observed in patients with atrial fibrillation (AF) and may predict recurrences after catheter ablation. The aim of this study was to develop and validate a clinical tool to identify LVAs that associate with AF recurrence after PVI. In a cohort of 238 patients voltage maps were created during left atrial procedure. LVAs were defined as electrograms amplitudes <0.5 mV. Based on regression analysis, predictors for LA substrate were identified. These parameters were used to establish a dedicated risk score (DR-FLASH score: Diabetes, Renal dysfunction, persistent Form of AF, Left atrial diameter>45mm, Age>65y, female Sex, Hypertension). Consecutively, this risk score was prospectively validated in a multicenter cohort of 180 patients. Moreover, the association of the score with long-term recurrences of atrial arrhythmias after circumferential pulmonary vein isolation (PVI) was tested in retrospective cohort of 484 patients. DR-FLASH score effectively identified LVA substrate (C-statistic, 0.801, p<0.001). In the prospective multicenter validation cohort, the predictive value of DR-FLASH score was confirmed (C-statistic, 0.767, p<0.001). The probability for the presence of LA substrate increased by a factor 2.2 (95%CI, 1.6-2.9, p<0.001) with each point. Furthermore, the risk of AF recurrence after PVI increased by a factor of 1.3 (95%CI, 1.1-1.5, p<0.001) with every additional point and was almost two times higher in patients with DR-FLASH>3 (OR 1.7, 95%CI, 1.1-2.8, p=0.026). The score may be useful to identify patients who may require extensive substrate modification instead of PVI alone.

Research paper thumbnail of Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia

Heart rhythm: the official journal of the Heart Rhythm Society

Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identi... more Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identification of the area of slow conduction. The purpose of this study was to evaluate a new concept for analysis and treatment of macroreentrant tachycardia based on color-coded three-dimensional (3D) entrainment mapping and subsequent placement of strategic lesion lines. Twenty-six patients presented with macroreentrant tachycardia (cycle length 329 +/- 70 ms). Using nonfluoroscopic systems (CARTO 12, NavX 14), sequential mapping of the target atrium was performed. On each mapping point, the 3D location was paired with color-coded entrainment information so that the reentrant circuit could be directly visualized. Procedural duration, fluoroscopy time, and radiofrequency time measured 181 +/- 58, 37 +/- 19, and 31 +/- 17 minutes, respectively. Thirty-nine macroreentrant tachycardias were ablated: perimitral 9, around pulmonary vein ostium 6, through left atrial roof 5, around left atrial ap...

Research paper thumbnail of Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter

Pacing and Clinical Electrophysiology

A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic... more A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus-dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8-mm-tip magnetic catheter to perform RF ablation in patients with AFL. Twenty-six consecutive patients (23 men, mean age 64.6 +/- 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8-mm-tip magnetic catheter (70 degrees C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients. The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and s...

Research paper thumbnail of Steerable Sheath Catheter Navigation for Ablation of Atrial Fibrillation: A Case‐Control Study

Pacing and Clinical Electrophysiology

Background: Lack of stable access to all desired ablation target sites is one of the limitations ... more Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.Methods and Results: In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable shea...

Research paper thumbnail of Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 7, 2015

Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients wi... more Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients with both ischaemic and non-ischaemic cardiomyopathy by terminating life-threatening arrhythmias. However, such arrhythmic events are unequally distributed among different patient subgroups. We aimed to evaluate predictors of appropriate ICD therapies as a step towards risk stratification in a real-world cohort. The prevalence and predictors of appropriate ICD therapies were analysed in 330 consecutive patients (mean age 65 ± 11, 81% male) with implanted ICDs due to ischaemic (n = 204) or dilated (n = 126) cardiomyopathy. During a mean follow-up of 19 ± 9 months, 1545 appropriate ICD therapies (antitachycardia pacing and shocks) were detected in 94 patients (29%). In multivariate analysis applied on the whole cohort, the presence of atrial fibrillation [AF: odds ratio (OR) = 1.906, confidence interval (CI) = 1.143-3.177, P = 0.013] and secondary prevention indication (OR = 1.963, CI = 1.12...

Research paper thumbnail of Procedural Outcomes and Survival after Catheter Ablation of Ventricular Tachycardia in Relation to Electroanatomical Substrate in Patients with Nonischemic Dilated Cardiomyopathy: The Role of Unipolar Voltage Mapping

Journal of Cardiovascular Electrophysiology, 2015

In patients with ischemic cardiomyopathy the size of bipolar low voltage areas (LVA) in electroan... more In patients with ischemic cardiomyopathy the size of bipolar low voltage areas (LVA) in electroanatomical maps (EAM) was associated with poorer outcomes after catheter ablation (CA) of ventricular tachycardia (VT). However, the effect of LVA size on the survival after VT ablation in patients with nonischemic dilated cardiomyopathy (NIDCM) has not been studied. In 55 patients with NIDCM (48 male, age 61±16 years., ejection fraction 32 ± 13%) an EAM to delineate the bipolar and unipolar LVAs was performed in 52 (94.5%) patients endocardially, in 24 (43.6%) patients epicardially, and in 21 (38.2%) patients on both surfaces. Additionally, activation mapping of the VT was possible in 22 (40%) patients. CA with lines transecting the scar and targeting late potentials was performed in all patients. Complete VT noninducibility at the end was achieved in 40 (72.7%) patients. During the median follow-up of 22 (interquartile range IQR 6, 34) months, VT recurrences were observed in 30 (54.5%) and cardiac death in 14 (25.5%) patients. The ROC analysis revealed that the size of endocardial unipolar LVA (< 8.3 mV) was associated with cardiac death (AUC 0.89, 95%CI 0.79-0.98, P<0.0001). UVA = 145 cm(2) discriminates for cardiac death with 83% sensitivity and 78% specificity. Endocardial UVA >145 cm(2) was a predictor for cardiac death (adjusted HR = 6.9; P = 0.014) and UVA ≥ 54% (of total endocardial LV surface) for VT recurrence (adjusted HR = 3.5; P = 0.016). The size of endocardial unipolar LVA (< 8.3 mV) was a strong and independent predictor for cardiac mortality and VT recurrence in patients with NIDCM. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Journal of Visualized Experiments, 2015

Research paper thumbnail of Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry

Circulation: Arrhythmia and Electrophysiology, 2014

Research paper thumbnail of Catheter Ablation of Ventricular Tachycardia and Mortality in Patients with Nonischemic Dilated Cardiomyopathy: Can Noninducibility after Ablation be a Predictor for Reduced Mortality?

Circulation. Arrhythmia and electrophysiology, Jan 14, 2015

Research paper thumbnail of Presence and extent of coronary artery disease as predictor for AF recurrences after catheter ablation: The Leipzig Heart Center AF Ablation Registry

International journal of cardiology, Jan 15, 2015

Occlusion of the right coronary artery (RCA) may promote atrial fibrillation (AF) by creating a r... more Occlusion of the right coronary artery (RCA) may promote atrial fibrillation (AF) by creating a right atrial substrate. However, the presence and extent of coronary artery disease (CAD) is usually not considered to tailor AF ablation strategies. This study was aimed to analyze the possible association between the presence and extent of CAD and rhythm outcomes of left-atrial AF catheter ablation. 1310 patients (60±10years, 67% males, 63% paroxysmal AF) from The Leipzig Heart Center AF Ablation Registry undergoing de novo AF catheter ablation were included. CAD was defined as stenosis≥50% in the left main coronary artery and ≥70% in one or several of the major coronary arteries. AF recurrences were defined as any atrial arrhythmia lasting >30s and occurring within the first week (early recurrences, ERAF) or between 3 and 12months (late recurrences, LRAF) after ablation and were assessed with serial 7-day Holter ECG. 152 patients (11.6%) had significant CAD; 89 (59%) had one, 35 (23...

Research paper thumbnail of Patient discomfort following catheter ablation and rhythm device surgery

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 8, 2014

Proper management of post-interventional pain relieves unwarranted patient distress and enhances ... more Proper management of post-interventional pain relieves unwarranted patient distress and enhances patient satisfaction. There have been only a limited number of investigations into patient discomfort following electrophysiological interventions. This study aims to quantify pain after interventional procedures, including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT), as well as implant or explant of pacemakers or implantable cardioverter defibrillators. One-hundred and two consecutive patients (mean age 66 years, 70 men) were asked to quantify post-interventional pain on a numeric rating scale (NRS 0-10) every 2 h during a period of 24 h after their intervention (49 ablations in deep propofol sedation, 53 device surgeries in local anaesthesia with mepivacaine 1%) and to specify the type of pain. Pain was classified as moderate to severe in case of NRS > 3. Post-operative pain medication included non-opioid and opioid analgesics as per the treating physicians&...

Research paper thumbnail of Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long-term outcomes: results from the Heart Center of Leipzig ventricular tachycardia registry

Circulation. Arrhythmia and electrophysiology, 2014

The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardi... more The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardia (VT) on acute success, VT recurrence, and cardiac mortality are unclear. We investigated 300 patients after CA of sustained VT. CA was performed within 30 days after the first documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2), and >1 year after the first VT occurrence in 141 (47%) patients (group 3). The end points were noninducibility of any VT after CA (acute success), VT recurrence and cardiac mortality after 2 years. Acute success was achieved in 66 (88%) patients in group 1, 68 (81%) in group 2, and in 99 (70.2%) in group 3 (P=0.008). During the 2-year follow-up period, VT recurred in 28 (37.3%) patients in group 1, 52 (61.9%) patients in group 2, and 91 (64.5%) patients in group 3 (P<0.0001). Recurrence-free survival was higher in group 1, as compared with group 2 (hazard ratio [HR], 1.85; P=0.009) and group 3 (HR, 2.04;...

Research paper thumbnail of Impact of metabolic syndrome on left atrial electroanatomical remodeling and outcomes after radiofrequency ablation of nonvalvular atrial fibrillation

Circulation. Arrhythmia and electrophysiology, 2014

Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with m... more Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with metabolic syndrome (MetS). However, mechanisms of AF recurrence in MetS remain unclear. We performed pulmonary vein isolation and voltage mapping in 236 patients with AF (age 61±9.6 years; persistent AF 64%; MetS 54%). Left atrial (LA) low voltage areas were semiquantitatively estimated and presented as low voltage index. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III. Follow-up for AF recurrence ≤12 months was performed. LA low voltage areas were observed in 46% of patients with MetS versus 8.2% patients without MetS ; P<0.0001. MetS was an independent predictor of LA low voltage areas: odds ratio, 11.64; 95% confidence interval, 4.381-30.903; P<0.0001. Observed AF recurrence at 12 months was 42.7% in MetS versus 36.1% in the non-MetS group (P=0.303). The presence of LA low voltage areas was a predictor of 12-month AF recurrence: odds...

Research paper thumbnail of Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

BioMed Research International, 2015

Research paper thumbnail of Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias

The American journal of gastroenterology, 2010

Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal da... more Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal damage because of the close proximity between the posterior wall of the left atrium and the esophagus. The aim of this prospective study was to determine the incidence, endoscopic characterization, and endoluminal temperature dependency of esophageal thermal lesions after catheter ablation. In all, 185 consecutive patients with symptomatic atrial fibrillation or left atrial macro-re-entrant tachycardia who underwent left atrial radiofrequency catheter ablation were scheduled for upper gastrointestinal endoscopy. During the ablation procedure, a non-fluoroscopic three-dimensional system for catheter orientation, computed tomography (CT) image integration, and activation mapping was used. The esophagus was intubated with a temperature probe for visualization within the three-dimensional image and for real-time intraluminal temperature monitoring. A total of 27 (14.6%) asymptomatic ulcer-like...

Research paper thumbnail of Nonfluoroscopic catheter visualization in atrial fibrillation ablation: experience from 375 consecutive procedures

Circulation. Arrhythmia and electrophysiology, 2014

A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tr... more A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tracking. No data on the safety of this technology are yet available in a large cohort of patients. Data from a prospective ablation registry were analyzed. All patients undergoing atrial fibrillation ablation procedures supported by nonfluoroscopic catheter visualization technology were included. Patient characteristics and procedural data and complications within the first 3 months were recorded. Between May 2012 and February 2014, a total of 375 patients underwent atrial fibrillation ablation using nonfluoroscopic catheter visualization technology. The patients were predominantly men (68%); the majority were ablated for the first time (71%); left atrium was 43±6 mm; and left ventricular function was normal (59±9%). The median ablation procedure time was 135 (113-170) minutes, median fluoroscopy time 2.8 (1.5-4.4) minutes, and median radiation dose 789 (470-1466) cGy*cm(2). Regression an...

Research paper thumbnail of Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation

Circulation. Arrhythmia and electrophysiology, 2014

Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a... more Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LV...

Research paper thumbnail of INCIDENCE, CHARACTERISTIC AND RISK FACTORS OF CEREBRAL THROMBOEMBOLIC COMPLICATIONS FOLLOWING HIGH-FREQUENCY CATHETER ABLATION OF ATRIAL FIBRILLATION: EXPERIENCE OF 3,360 PROCEDURES

Research paper thumbnail of THE APPLE SCORE: A NOVEL AND SIMPLE SCORE FOR THE PREDICTION OF RHYTHM OUTCOMES AFTER CATHETER ABLATION OF ATRIAL FIBRILLATION

Research paper thumbnail of Electrophysiologic characteristics and results of radiofrequency catheter ablation in elderly patients with atrioventricular nodal reentrant tachycardia

Background: As in the general population, atrioventricular nodal reentrant tachycardia (AVNRT) is... more Background: As in the general population, atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular supraventricular tachycardia in the elderly patients. We tried to compare electrophysiologic characteristics, efficacy, and risks of the radiofrequency (RF) catheter ablation of the slow pathway in elderly and young patients with AVNRT. Methods: Between April 2001 and March 2005, 268 consecutive patients (190 females;

Research paper thumbnail of Prospective, Multicenter Validation of a Clinical Risk Score for Left Atrial Arrhythmogenic Substrate Based on Voltage Analysis: DR-FLASH Score

Heart Rhythm, 2015

Presence of left atrial low-voltage areas (LVAs) is frequently observed in patients with atrial f... more Presence of left atrial low-voltage areas (LVAs) is frequently observed in patients with atrial fibrillation (AF) and may predict recurrences after catheter ablation. The aim of this study was to develop and validate a clinical tool to identify LVAs that associate with AF recurrence after PVI. In a cohort of 238 patients voltage maps were created during left atrial procedure. LVAs were defined as electrograms amplitudes &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.5 mV. Based on regression analysis, predictors for LA substrate were identified. These parameters were used to establish a dedicated risk score (DR-FLASH score: Diabetes, Renal dysfunction, persistent Form of AF, Left atrial diameter&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;45mm, Age&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;65y, female Sex, Hypertension). Consecutively, this risk score was prospectively validated in a multicenter cohort of 180 patients. Moreover, the association of the score with long-term recurrences of atrial arrhythmias after circumferential pulmonary vein isolation (PVI) was tested in retrospective cohort of 484 patients. DR-FLASH score effectively identified LVA substrate (C-statistic, 0.801, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). In the prospective multicenter validation cohort, the predictive value of DR-FLASH score was confirmed (C-statistic, 0.767, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The probability for the presence of LA substrate increased by a factor 2.2 (95%CI, 1.6-2.9, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) with each point. Furthermore, the risk of AF recurrence after PVI increased by a factor of 1.3 (95%CI, 1.1-1.5, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) with every additional point and was almost two times higher in patients with DR-FLASH&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3 (OR 1.7, 95%CI, 1.1-2.8, p=0.026). The score may be useful to identify patients who may require extensive substrate modification instead of PVI alone.

Research paper thumbnail of Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia

Heart rhythm: the official journal of the Heart Rhythm Society

Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identi... more Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identification of the area of slow conduction. The purpose of this study was to evaluate a new concept for analysis and treatment of macroreentrant tachycardia based on color-coded three-dimensional (3D) entrainment mapping and subsequent placement of strategic lesion lines. Twenty-six patients presented with macroreentrant tachycardia (cycle length 329 +/- 70 ms). Using nonfluoroscopic systems (CARTO 12, NavX 14), sequential mapping of the target atrium was performed. On each mapping point, the 3D location was paired with color-coded entrainment information so that the reentrant circuit could be directly visualized. Procedural duration, fluoroscopy time, and radiofrequency time measured 181 +/- 58, 37 +/- 19, and 31 +/- 17 minutes, respectively. Thirty-nine macroreentrant tachycardias were ablated: perimitral 9, around pulmonary vein ostium 6, through left atrial roof 5, around left atrial ap...

Research paper thumbnail of Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter

Pacing and Clinical Electrophysiology

A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic... more A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus-dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8-mm-tip magnetic catheter to perform RF ablation in patients with AFL. Twenty-six consecutive patients (23 men, mean age 64.6 +/- 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8-mm-tip magnetic catheter (70 degrees C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients. The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and s...

Research paper thumbnail of Steerable Sheath Catheter Navigation for Ablation of Atrial Fibrillation: A Case‐Control Study

Pacing and Clinical Electrophysiology

Background: Lack of stable access to all desired ablation target sites is one of the limitations ... more Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.Methods and Results: In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable shea...

Research paper thumbnail of Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 7, 2015

Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients wi... more Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients with both ischaemic and non-ischaemic cardiomyopathy by terminating life-threatening arrhythmias. However, such arrhythmic events are unequally distributed among different patient subgroups. We aimed to evaluate predictors of appropriate ICD therapies as a step towards risk stratification in a real-world cohort. The prevalence and predictors of appropriate ICD therapies were analysed in 330 consecutive patients (mean age 65 ± 11, 81% male) with implanted ICDs due to ischaemic (n = 204) or dilated (n = 126) cardiomyopathy. During a mean follow-up of 19 ± 9 months, 1545 appropriate ICD therapies (antitachycardia pacing and shocks) were detected in 94 patients (29%). In multivariate analysis applied on the whole cohort, the presence of atrial fibrillation [AF: odds ratio (OR) = 1.906, confidence interval (CI) = 1.143-3.177, P = 0.013] and secondary prevention indication (OR = 1.963, CI = 1.12...

Research paper thumbnail of Procedural Outcomes and Survival after Catheter Ablation of Ventricular Tachycardia in Relation to Electroanatomical Substrate in Patients with Nonischemic Dilated Cardiomyopathy: The Role of Unipolar Voltage Mapping

Journal of Cardiovascular Electrophysiology, 2015

In patients with ischemic cardiomyopathy the size of bipolar low voltage areas (LVA) in electroan... more In patients with ischemic cardiomyopathy the size of bipolar low voltage areas (LVA) in electroanatomical maps (EAM) was associated with poorer outcomes after catheter ablation (CA) of ventricular tachycardia (VT). However, the effect of LVA size on the survival after VT ablation in patients with nonischemic dilated cardiomyopathy (NIDCM) has not been studied. In 55 patients with NIDCM (48 male, age 61±16 years., ejection fraction 32 ± 13%) an EAM to delineate the bipolar and unipolar LVAs was performed in 52 (94.5%) patients endocardially, in 24 (43.6%) patients epicardially, and in 21 (38.2%) patients on both surfaces. Additionally, activation mapping of the VT was possible in 22 (40%) patients. CA with lines transecting the scar and targeting late potentials was performed in all patients. Complete VT noninducibility at the end was achieved in 40 (72.7%) patients. During the median follow-up of 22 (interquartile range IQR 6, 34) months, VT recurrences were observed in 30 (54.5%) and cardiac death in 14 (25.5%) patients. The ROC analysis revealed that the size of endocardial unipolar LVA (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 8.3 mV) was associated with cardiac death (AUC 0.89, 95%CI 0.79-0.98, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). UVA = 145 cm(2) discriminates for cardiac death with 83% sensitivity and 78% specificity. Endocardial UVA &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;145 cm(2) was a predictor for cardiac death (adjusted HR = 6.9; P = 0.014) and UVA ≥ 54% (of total endocardial LV surface) for VT recurrence (adjusted HR = 3.5; P = 0.016). The size of endocardial unipolar LVA (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 8.3 mV) was a strong and independent predictor for cardiac mortality and VT recurrence in patients with NIDCM. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

Journal of Visualized Experiments, 2015

Research paper thumbnail of Comparison of CHADS2, R2CHADS2, and CHA2DS2-VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry

Circulation: Arrhythmia and Electrophysiology, 2014

Research paper thumbnail of Catheter Ablation of Ventricular Tachycardia and Mortality in Patients with Nonischemic Dilated Cardiomyopathy: Can Noninducibility after Ablation be a Predictor for Reduced Mortality?

Circulation. Arrhythmia and electrophysiology, Jan 14, 2015

Research paper thumbnail of Presence and extent of coronary artery disease as predictor for AF recurrences after catheter ablation: The Leipzig Heart Center AF Ablation Registry

International journal of cardiology, Jan 15, 2015

Occlusion of the right coronary artery (RCA) may promote atrial fibrillation (AF) by creating a r... more Occlusion of the right coronary artery (RCA) may promote atrial fibrillation (AF) by creating a right atrial substrate. However, the presence and extent of coronary artery disease (CAD) is usually not considered to tailor AF ablation strategies. This study was aimed to analyze the possible association between the presence and extent of CAD and rhythm outcomes of left-atrial AF catheter ablation. 1310 patients (60±10years, 67% males, 63% paroxysmal AF) from The Leipzig Heart Center AF Ablation Registry undergoing de novo AF catheter ablation were included. CAD was defined as stenosis≥50% in the left main coronary artery and ≥70% in one or several of the major coronary arteries. AF recurrences were defined as any atrial arrhythmia lasting >30s and occurring within the first week (early recurrences, ERAF) or between 3 and 12months (late recurrences, LRAF) after ablation and were assessed with serial 7-day Holter ECG. 152 patients (11.6%) had significant CAD; 89 (59%) had one, 35 (23...

Research paper thumbnail of Patient discomfort following catheter ablation and rhythm device surgery

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 8, 2014

Proper management of post-interventional pain relieves unwarranted patient distress and enhances ... more Proper management of post-interventional pain relieves unwarranted patient distress and enhances patient satisfaction. There have been only a limited number of investigations into patient discomfort following electrophysiological interventions. This study aims to quantify pain after interventional procedures, including ablation of atrial fibrillation (AF) or ventricular tachycardia (VT), as well as implant or explant of pacemakers or implantable cardioverter defibrillators. One-hundred and two consecutive patients (mean age 66 years, 70 men) were asked to quantify post-interventional pain on a numeric rating scale (NRS 0-10) every 2 h during a period of 24 h after their intervention (49 ablations in deep propofol sedation, 53 device surgeries in local anaesthesia with mepivacaine 1%) and to specify the type of pain. Pain was classified as moderate to severe in case of NRS > 3. Post-operative pain medication included non-opioid and opioid analgesics as per the treating physicians&...

Research paper thumbnail of Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long-term outcomes: results from the Heart Center of Leipzig ventricular tachycardia registry

Circulation. Arrhythmia and electrophysiology, 2014

The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardi... more The effects of time to referral for catheter ablation (CA) of scar-related ventricular tachycardia (VT) on acute success, VT recurrence, and cardiac mortality are unclear. We investigated 300 patients after CA of sustained VT. CA was performed within 30 days after the first documented VT in 75 (25%) patients (group 1), between 1 month and 1 year in 84 (28%) patients (group 2), and >1 year after the first VT occurrence in 141 (47%) patients (group 3). The end points were noninducibility of any VT after CA (acute success), VT recurrence and cardiac mortality after 2 years. Acute success was achieved in 66 (88%) patients in group 1, 68 (81%) in group 2, and in 99 (70.2%) in group 3 (P=0.008). During the 2-year follow-up period, VT recurred in 28 (37.3%) patients in group 1, 52 (61.9%) patients in group 2, and 91 (64.5%) patients in group 3 (P<0.0001). Recurrence-free survival was higher in group 1, as compared with group 2 (hazard ratio [HR], 1.85; P=0.009) and group 3 (HR, 2.04;...

Research paper thumbnail of Impact of metabolic syndrome on left atrial electroanatomical remodeling and outcomes after radiofrequency ablation of nonvalvular atrial fibrillation

Circulation. Arrhythmia and electrophysiology, 2014

Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with m... more Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with metabolic syndrome (MetS). However, mechanisms of AF recurrence in MetS remain unclear. We performed pulmonary vein isolation and voltage mapping in 236 patients with AF (age 61±9.6 years; persistent AF 64%; MetS 54%). Left atrial (LA) low voltage areas were semiquantitatively estimated and presented as low voltage index. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III. Follow-up for AF recurrence ≤12 months was performed. LA low voltage areas were observed in 46% of patients with MetS versus 8.2% patients without MetS ; P<0.0001. MetS was an independent predictor of LA low voltage areas: odds ratio, 11.64; 95% confidence interval, 4.381-30.903; P<0.0001. Observed AF recurrence at 12 months was 42.7% in MetS versus 36.1% in the non-MetS group (P=0.303). The presence of LA low voltage areas was a predictor of 12-month AF recurrence: odds...

Research paper thumbnail of Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

BioMed Research International, 2015

Research paper thumbnail of Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias

The American journal of gastroenterology, 2010

Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal da... more Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal damage because of the close proximity between the posterior wall of the left atrium and the esophagus. The aim of this prospective study was to determine the incidence, endoscopic characterization, and endoluminal temperature dependency of esophageal thermal lesions after catheter ablation. In all, 185 consecutive patients with symptomatic atrial fibrillation or left atrial macro-re-entrant tachycardia who underwent left atrial radiofrequency catheter ablation were scheduled for upper gastrointestinal endoscopy. During the ablation procedure, a non-fluoroscopic three-dimensional system for catheter orientation, computed tomography (CT) image integration, and activation mapping was used. The esophagus was intubated with a temperature probe for visualization within the three-dimensional image and for real-time intraluminal temperature monitoring. A total of 27 (14.6%) asymptomatic ulcer-like...

Research paper thumbnail of Nonfluoroscopic catheter visualization in atrial fibrillation ablation: experience from 375 consecutive procedures

Circulation. Arrhythmia and electrophysiology, 2014

A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tr... more A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tracking. No data on the safety of this technology are yet available in a large cohort of patients. Data from a prospective ablation registry were analyzed. All patients undergoing atrial fibrillation ablation procedures supported by nonfluoroscopic catheter visualization technology were included. Patient characteristics and procedural data and complications within the first 3 months were recorded. Between May 2012 and February 2014, a total of 375 patients underwent atrial fibrillation ablation using nonfluoroscopic catheter visualization technology. The patients were predominantly men (68%); the majority were ablated for the first time (71%); left atrium was 43±6 mm; and left ventricular function was normal (59±9%). The median ablation procedure time was 135 (113-170) minutes, median fluoroscopy time 2.8 (1.5-4.4) minutes, and median radiation dose 789 (470-1466) cGy*cm(2). Regression an...

Research paper thumbnail of Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation

Circulation. Arrhythmia and electrophysiology, 2014

Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a... more Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LV...

Research paper thumbnail of INCIDENCE, CHARACTERISTIC AND RISK FACTORS OF CEREBRAL THROMBOEMBOLIC COMPLICATIONS FOLLOWING HIGH-FREQUENCY CATHETER ABLATION OF ATRIAL FIBRILLATION: EXPERIENCE OF 3,360 PROCEDURES

Research paper thumbnail of THE APPLE SCORE: A NOVEL AND SIMPLE SCORE FOR THE PREDICTION OF RHYTHM OUTCOMES AFTER CATHETER ABLATION OF ATRIAL FIBRILLATION