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Leipzig, Germany

Sommer P.,Heart Center Leipzig | Richter S.,University of Leipzig | Hindricks G.,University of Leipzig | Rolf S.,University of Leipzig
Journal of Interventional Cardiac Electrophysiology | Year: 2014

A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today's electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution. After reviewing the currently available publications in the field of MG-supported EP procedures, we describe the workflows for (1) ablation of supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia using MG-enabled diagnostic and ablation catheters, as well as (2) implant of cardiac resynchronization therapy (CRT) devices using sensor-equipped delivery tools including sheaths, sub-selectors, and guidewires. As shown in several studies [5-9], MG procedures resulted in similar efficacy as conventional cases but with a significant reduction in fluoroscopy time and dose. In particular, for SVT ablations, the median fluoroscopy time using the MG technology was 0.5 ± 1.4 min compared to 10.2 ± 9.6 min in conventional fluoroscopic settings. Similar reductions were demonstrated for AF ablation procedures from 25 min in conventional settings with electroanatomical mapping systems and live x-ray to 4.6 min with the addition of the MG technology. Recently, it was demonstrated that the application of MG for CRT device implants could successfully result in a median fluoroscopy time of 2.6 min for LV lead deployment. In summary, the first measurable clinical impact of the MG technology on a daily clinical routine is the reduction of fluoroscopy time and radiation exposure for various EP indications. These beneficial effects were achieved without negative consequences on procedural efficacy, complications, or time in more than 600 EP procedures. © 2014 Springer Science+Business Media New York. Source

Kosiuk J.,Heart Center Leipzig
International Journal of Cardiology | Year: 2013

Background The interactions between atrial fibrillation (AF) and left ventricular diastolic dysfunction (LVDD) are complex and not well defined. Despite the high prevalence of LVDD in the AF population, therapies for LVDD remain limited. Previous studies have suggested that restoration of sinus rhythm with catheter ablation has a positive effect on LVDD, but the prevalence and predictors for worsened LVDD are unknown. Methods 70 consecutive patients included in prospective AF catheter ablation registry (61 ± 10 years, 66% male) with paroxysmal (n = 40) or persistent AF (n = 30) were examined by transthoracic echocardiography, before and 12 months after ablation. LVDD was classified according to current guidelines. Rhythm outcome of the ablation was verified by serial 7-day Holter ECG. Results LVDD was present in 27 patients (38%) at baseline and in 33 patients (47%) at 12 months follow-up (p =.327). An improvement of LVDD was observed in 13 patients (19%), an aggravation was found in 19 (27%), while it was unchanged in the remaining 38 patients (54%). In uni- and multivariable regression analysis, total ablation time (OR 1.611 per 10 min ablation time, 95% CI 1.088 - 2.386, p =.017) was associated with LVDD progression, while neither baseline characteristics nor rhythm during follow-up influenced LVDD alterations. There was no association between echocardiographic deterioration and symptoms. Conclusions Catheter ablation of AF can worsen LVDD in a substantial proportion of patients with more aggressive ablation leading to aggravation of LVDD. While there are no apparent negative short-term effects, long-term consequences need to be determined. © 2013 Elsevier Ireland Ltd. Source

Pfannstiel M.A.,Heart Center Leipzig
Healthcare quarterly (Toronto, Ont.) | Year: 2011

In recent years, health clusters have been limited in their ability to meet the demands and serve the interests of population groups and social segments in a comprehensive manner at healthcare sites within health regions. The reasons for this lay in the low degree of willingness of the stakeholders to deal with the growing challenges and resulting outlooks in healthcare. Questions concerning quality in health clusters were left unasked to give weight to the local and regional effectiveness regarding employment and growth. With the focus on ensuring long-term survival and creating value, the strategies for efficiency were given precedence over the strategies for effectiveness in health regions. For instance, the following questions remained unanswered: How can rural areas be included in the regional area of existing health clusters? To what extent are health clusters dependent on the inter-regional periphery and on intra-regional positioning and self-presentation of the individual stakeholders? Which quality indicators are suitable for health regions to reflect the positioning and self-presentation in order to promote their role in healthcare in order to attract clients? This paper aims to clarify which regional qualitative circumstances, preferences and restrictions exist in the immediate environment of the stakeholders; how dependencies can be used to an advantage; and how the appearance and presentation of a region can be strengthened. Health clusters can create quality structures and processes that allow them to offer high-quality health services on site or at a neighbourhood location. To strengthen the structures and processes offered daily, these structures and processes are to be researched and developed through the involvement of customers and regional health partners. Through networking the existing regional health initiatives, an overall strategy and profile are created and developed into an overall health cluster of health services in a region. Source

Girdauskas E.,Central Clinic Bad Berka | Disha K.,Central Clinic Bad Berka | Raisin H.H.,Central Clinic Bad Berka | Secknus M.,Central Clinic Bad Berka | And 2 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012

Objectives: The optimal surgical treatment of patients with bicuspid aortic valve (BAV) disease and ascending aortic aneurysm is controversial. The aim of this study was to evaluate the risk of late aortic events after an isolated aortic valve replacement (AVR) for BAV stenosis with concomitant mild-to-moderate proximal aortic dilation. Methods: A review of our institutional BAV database identified a subgroup of 153 consecutive BAV patients (mean age 54.2 ± 10.5 years, 73% men) with BAV stenosis and concomitant ascending aortic dilation of 40-50 mm who underwent an isolated AVR from 1995 to 2000. All cases of simultaneous aortic surgery (i.e. ascending aorta with a diameter of >50 mm) were excluded. The follow-up (1759 patient-years) was 100% complete. The mean follow-up was 11.5 ± 3.2 years. Adverse aortic events were defined as the need for proximal aortic surgery, the occurrence of aortic dissection/rupture or sudden death during the follow-up. Results: Actuarial survival rates of our study population were 86 and 78% at 10 and 15 years, respectively. Ascending aortic surgery was required in five patients (3%) for progressive ascending aortic aneurysm. Freedom from aortic interventions at 10 and 15 years was 97 and 94%, respectively. No documented aortic dissection or rupture occurred. Freedom from adverse aortic events was 95% at 10 years and 93% at 15 years postoperatively. In a separate group of patients presenting with aortic insufficiency (i.e. root phenotype), freedom from adverse aortic events was significantly lower (88 and 70% at 10 and 15 years, P = 0.009). Conclusions: BAV patients with aortic valve stenosis and concomitant mild-to-moderate ascending aortic dilation are at a considerably low risk of adverse aortic events at 15 years after an isolated AVR. The BAV phenotype should be considered when determining the risk of subsequent adverse aortic events and the need for concomitant aortic replacement. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source

Schroeter T.,Heart Center Leipzig
The Thoracic and cardiovascular surgeon | Year: 2011

Lung hernia following minimally invasive mitral valve surgery is an uncommen entity. We report the case of a male patient who developed a lung hernia as a sequela to limited access mitral valve surgery. Two months after discharge, the patient presented with a bulge in the region of the lateral thoracotomy related to respiration which could be provoked by a Valsalva maneuver. In the night following admission the patient had acute cardiovascular decompensation with worsening dyspnea, pallor and hypotension. The patient was quickly transferred to the ICU, where a chest X-ray revealed the presence of a large hemothorax with compression of the entire right lung. We transferred the patient to the operation room, evacuated the hemothorax and reconstructed the 15-cm long and 3-cm wide dehiscence using a GoreTex patch adapted in a special technique. © Georg Thieme Verlag KG Stuttgart · New York. Source

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