Heidi Estner - Academia.edu (original) (raw)
Papers by Heidi Estner
Prehospital and Disaster Medicine, 2005
Prehospital and Disaster Medicine, 2005
Scientific Reports, 2019
Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to e... more Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation do...
Herzschrittmachertherapie + Elektrophysiologie
MMW - Fortschritte der Medizin
Prehospital and Disaster Medicine
Another aim of practice, was to improve the cooperation and communication with the technical resc... more Another aim of practice, was to improve the cooperation and communication with the technical rescue team, such as the fire brigade. The teams were given sufficient opportunities for discussion with the tutors. No model solution was proposed to the teams in order to allow several different ways of solution to be found. Results: The analysis of the trauma training provided interesting results. Overall, the participants were enthusiastic about the performance. On a range of marks from 1 to 5, the average total mark was 1.2. All participants would recommend it to others. The professional benefit was stated as being very high (mark: 1.1). To the effect of a quality process, all persons seriously injured now are recorded within the rescue service area. The first results also show an increased application of the subjects taught in the real situation. Conclusion: Thus, it can be shown that quality management leads to higher quality standards also in the rescue service, significantly improving the medical care provided to the population.
Prehospital and Disaster Medicine
Prehospital and Disaster Medicine
MMW - Fortschritte der Medizin
The International Journal of Cardiovascular Imaging
Circulation. Arrhythmia and electrophysiology, 2018
Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar re... more Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar regions. We set out to assess the VT circuit in greater detail than has hitherto been possible, using ultra-high-density mapping. All ultra-high-density mapping guided VT ablation cases from 6 high-volume European centers were assessed. Maps were analyzed offline to generate activation maps of tachycardia circuits. Topography, conduction velocity, and voltage of the VT circuit were analyzed in complete maps. Thirty-six tachycardias in 31 patients were identified, 29 male and 27 ischemic. VT circuits and isthmuses were complex, 11 were single loop and 25 double loop; 3 had 2 entrances, 5 had 2 exits, and 15 had dead ends of activation. Isthmuses were defined by barriers, which included anatomic obstacles, lines of complete block, and slow conduction (in 27/36 isthmuses). Median conduction velocity was 0.08 m/s in entrance zones, 0.29 m/s in isthmus regions ( P<0.001), and 0.11 m/s in exi...
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, 2018
Despite the huge progress made in the both understanding the mechanisms and the management of atr... more Despite the huge progress made in the both understanding the mechanisms and the management of atrial fibrillation (AF) this arrhythmia still represents an important health and social burden. Atrial fibrillation is increasing in frequency and is a major cause of death, stroke, heart failure, cognitive decline, and hospitalizations. New data have emerged emphasizing the multidisciplinary approach to better management of this common arrhythmia. Despite the availability of AF management guidelines, practice among European centres may differ from the current guideline recommendations. The scope of the current European Heart Rhythm Association (EHRA) survey is to evaluate the extent of the disparities between clinical practice and the 2016 AF European Society of Cardiology (ESC) guidelines. Our survey examined important topics such as screening for AF, initial therapy, rhythm strategy, and stroke and bleeding risk assessment. In general, there was a high adherence to the new ESC AF guidel...
JACC. Clinical electrophysiology, 2018
This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysio... more This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). A...
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2017
In some patients, both an electrophysiological examination (EPS) and a coronary angiography (CA) ... more In some patients, both an electrophysiological examination (EPS) and a coronary angiography (CA) are necessary. It might be preferable to choose a combined approach of EPS and CA versus performing them consecutively. The purpose of this study is to evaluate the type and rate of adverse events between both approaches. Patients were eligible if they underwent a CA and an EPS in a combined approach or in a time interval of at most 2 months. In all patients, clinical adverse events were recorded. A total of 1184 patients were included. CA and EPS were performed in a combined procedure (comb) in 492 patients, whereas they were performed consecutively in 692 patients (cons). The acute major complication rate was 0.67%, showing no differences between both groups. In the comb 6.9% and in the cons 6.6% of vascular complications were observed (p = 0.20). The rates of AV fistula and hematoma needing transfusion showed a significantly higher rate in the cons group (p = 0.018 and p = 0.045, resp...
Herzschrittmachertherapie & Elektrophysiologie, 2016
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/10... more The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
Prehospital and Disaster Medicine, 2005
Objective: This study describes the clinical and epidemiological characteristics of patients with... more Objective: This study describes the clinical and epidemiological characteristics of patients with a cardiac arrest diagnosis attended by out-of-hospital emergency teams and later discharged from the hospital in Almeria (Andalusia, Spain), over a one-year period, as well as a one-month follow-up regarding quality of life. Methods: All consecutive cases of cardiac arrest from 01 January-31 December 2003, in which emergency medical services (EMS) responded and attempted resuscitation, were reported and followed until discharged from the hospital, and later were followed-up after one month to check the quality of life of these patients. Results: The out-of-hospital emergency teams attended to 96 patients with cardiac arrest. Of these, 23 patients (24%) were admitted to the hospital alive and 73 (76%) died in an out-of-hospital setting. Nine patients (9.3%) were discharged from the hospital: eight males (89%) and one female (11%). The average age of the patients was 61 years old. The initial rhythms included five with electromechanical dissociation (56%), two with asystole (22%), and two with ventricular fibrillation (22%). The out-of-hospital crew witnessed four of the cardiac arrests. Advanced life support (ALS) was performed in one case (11%). The average of the time interval between cardiac arrest and the initiation of ALS was 3 minutes, 30 seconds. Six patients (67%) had cardiac etiology. Three patients (33%) had noncardiac etiology. In the one-month follow-up, all nine patients still were alive (100%). Eight patients (89%) reported good quality of life, and one patient (11%) had bad quality of life (coma). Conclusion: Survival rates reported were similar to other studies, although the number of patients is limited. These survival rates can be explained in part by the short time intervals between calls being received by the emergency dispatch center to the arrival of EMS on the scene. Cardiac etiology was predominant. Half of cardiac arrests were crew witnessed. For survivors, the quality of life was good.
Prehospital and Disaster Medicine, 2001
Another aim of practice, was to improve the cooperation and communication with the technical resc... more Another aim of practice, was to improve the cooperation and communication with the technical rescue team, such as the fire brigade. The teams were given sufficient opportunities for discussion with the tutors. No model solution was proposed to the teams in order to allow several different ways of solution to be found. Results: The analysis of the trauma training provided interesting results. Overall, the participants were enthusiastic about the performance. On a range of marks from 1 to 5, the average total mark was 1.2. All participants would recommend it to others. The professional benefit was stated as being very high (mark: 1.1). To the effect of a quality process, all persons seriously injured now are recorded within the rescue service area. The first results also show an increased application of the subjects taught in the real situation. Conclusion: Thus, it can be shown that quality management leads to higher quality standards also in the rescue service, significantly improving the medical care provided to the population.
... Nierentransplantation sowie Patienten mit infektiösen Komplikationen Dissertation zum Erwerb ... more ... Nierentransplantation sowie Patienten mit infektiösen Komplikationen Dissertation zum Erwerb des Doktorgrades der Medizin an der Medizinischen Fakultät der Ludwig-Maximilians-Universität zu München vorgelegt von Heidi Luise Estner aus München 2002 Page 2. ...
Prehospital and Disaster Medicine, 2005
Prehospital and Disaster Medicine, 2005
Scientific Reports, 2019
Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to e... more Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation do...
Herzschrittmachertherapie + Elektrophysiologie
MMW - Fortschritte der Medizin
Prehospital and Disaster Medicine
Another aim of practice, was to improve the cooperation and communication with the technical resc... more Another aim of practice, was to improve the cooperation and communication with the technical rescue team, such as the fire brigade. The teams were given sufficient opportunities for discussion with the tutors. No model solution was proposed to the teams in order to allow several different ways of solution to be found. Results: The analysis of the trauma training provided interesting results. Overall, the participants were enthusiastic about the performance. On a range of marks from 1 to 5, the average total mark was 1.2. All participants would recommend it to others. The professional benefit was stated as being very high (mark: 1.1). To the effect of a quality process, all persons seriously injured now are recorded within the rescue service area. The first results also show an increased application of the subjects taught in the real situation. Conclusion: Thus, it can be shown that quality management leads to higher quality standards also in the rescue service, significantly improving the medical care provided to the population.
Prehospital and Disaster Medicine
Prehospital and Disaster Medicine
MMW - Fortschritte der Medizin
The International Journal of Cardiovascular Imaging
Circulation. Arrhythmia and electrophysiology, 2018
Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar re... more Ventricular tachycardia (VT) with structural heart disease is dependent on reentry within scar regions. We set out to assess the VT circuit in greater detail than has hitherto been possible, using ultra-high-density mapping. All ultra-high-density mapping guided VT ablation cases from 6 high-volume European centers were assessed. Maps were analyzed offline to generate activation maps of tachycardia circuits. Topography, conduction velocity, and voltage of the VT circuit were analyzed in complete maps. Thirty-six tachycardias in 31 patients were identified, 29 male and 27 ischemic. VT circuits and isthmuses were complex, 11 were single loop and 25 double loop; 3 had 2 entrances, 5 had 2 exits, and 15 had dead ends of activation. Isthmuses were defined by barriers, which included anatomic obstacles, lines of complete block, and slow conduction (in 27/36 isthmuses). Median conduction velocity was 0.08 m/s in entrance zones, 0.29 m/s in isthmus regions ( P<0.001), and 0.11 m/s in exi...
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, 2018
Despite the huge progress made in the both understanding the mechanisms and the management of atr... more Despite the huge progress made in the both understanding the mechanisms and the management of atrial fibrillation (AF) this arrhythmia still represents an important health and social burden. Atrial fibrillation is increasing in frequency and is a major cause of death, stroke, heart failure, cognitive decline, and hospitalizations. New data have emerged emphasizing the multidisciplinary approach to better management of this common arrhythmia. Despite the availability of AF management guidelines, practice among European centres may differ from the current guideline recommendations. The scope of the current European Heart Rhythm Association (EHRA) survey is to evaluate the extent of the disparities between clinical practice and the 2016 AF European Society of Cardiology (ESC) guidelines. Our survey examined important topics such as screening for AF, initial therapy, rhythm strategy, and stroke and bleeding risk assessment. In general, there was a high adherence to the new ESC AF guidel...
JACC. Clinical electrophysiology, 2018
This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysio... more This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). A...
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2017
In some patients, both an electrophysiological examination (EPS) and a coronary angiography (CA) ... more In some patients, both an electrophysiological examination (EPS) and a coronary angiography (CA) are necessary. It might be preferable to choose a combined approach of EPS and CA versus performing them consecutively. The purpose of this study is to evaluate the type and rate of adverse events between both approaches. Patients were eligible if they underwent a CA and an EPS in a combined approach or in a time interval of at most 2 months. In all patients, clinical adverse events were recorded. A total of 1184 patients were included. CA and EPS were performed in a combined procedure (comb) in 492 patients, whereas they were performed consecutively in 692 patients (cons). The acute major complication rate was 0.67%, showing no differences between both groups. In the comb 6.9% and in the cons 6.6% of vascular complications were observed (p = 0.20). The rates of AV fistula and hematoma needing transfusion showed a significantly higher rate in the cons group (p = 0.018 and p = 0.045, resp...
Herzschrittmachertherapie & Elektrophysiologie, 2016
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/10... more The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
Prehospital and Disaster Medicine, 2005
Objective: This study describes the clinical and epidemiological characteristics of patients with... more Objective: This study describes the clinical and epidemiological characteristics of patients with a cardiac arrest diagnosis attended by out-of-hospital emergency teams and later discharged from the hospital in Almeria (Andalusia, Spain), over a one-year period, as well as a one-month follow-up regarding quality of life. Methods: All consecutive cases of cardiac arrest from 01 January-31 December 2003, in which emergency medical services (EMS) responded and attempted resuscitation, were reported and followed until discharged from the hospital, and later were followed-up after one month to check the quality of life of these patients. Results: The out-of-hospital emergency teams attended to 96 patients with cardiac arrest. Of these, 23 patients (24%) were admitted to the hospital alive and 73 (76%) died in an out-of-hospital setting. Nine patients (9.3%) were discharged from the hospital: eight males (89%) and one female (11%). The average age of the patients was 61 years old. The initial rhythms included five with electromechanical dissociation (56%), two with asystole (22%), and two with ventricular fibrillation (22%). The out-of-hospital crew witnessed four of the cardiac arrests. Advanced life support (ALS) was performed in one case (11%). The average of the time interval between cardiac arrest and the initiation of ALS was 3 minutes, 30 seconds. Six patients (67%) had cardiac etiology. Three patients (33%) had noncardiac etiology. In the one-month follow-up, all nine patients still were alive (100%). Eight patients (89%) reported good quality of life, and one patient (11%) had bad quality of life (coma). Conclusion: Survival rates reported were similar to other studies, although the number of patients is limited. These survival rates can be explained in part by the short time intervals between calls being received by the emergency dispatch center to the arrival of EMS on the scene. Cardiac etiology was predominant. Half of cardiac arrests were crew witnessed. For survivors, the quality of life was good.
Prehospital and Disaster Medicine, 2001
Another aim of practice, was to improve the cooperation and communication with the technical resc... more Another aim of practice, was to improve the cooperation and communication with the technical rescue team, such as the fire brigade. The teams were given sufficient opportunities for discussion with the tutors. No model solution was proposed to the teams in order to allow several different ways of solution to be found. Results: The analysis of the trauma training provided interesting results. Overall, the participants were enthusiastic about the performance. On a range of marks from 1 to 5, the average total mark was 1.2. All participants would recommend it to others. The professional benefit was stated as being very high (mark: 1.1). To the effect of a quality process, all persons seriously injured now are recorded within the rescue service area. The first results also show an increased application of the subjects taught in the real situation. Conclusion: Thus, it can be shown that quality management leads to higher quality standards also in the rescue service, significantly improving the medical care provided to the population.
... Nierentransplantation sowie Patienten mit infektiösen Komplikationen Dissertation zum Erwerb ... more ... Nierentransplantation sowie Patienten mit infektiösen Komplikationen Dissertation zum Erwerb des Doktorgrades der Medizin an der Medizinischen Fakultät der Ludwig-Maximilians-Universität zu München vorgelegt von Heidi Luise Estner aus München 2002 Page 2. ...