Duisburg, Germany
Duisburg, Germany

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Waldmller S.,Witten/Herdecke University | Erdmann J.,Universittsklinikum Schleswig Holstein | Binner P.,Witten/Herdecke University | Gelbrich G.,University of Leipzig | And 25 more authors.
European Journal of Heart Failure | Year: 2011

Aims: Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) can both be due to mutations in the genes encoding β-myosin heavy chain (MYH7) or cardiac myosin-binding protein C (MYBPC3). The aim of the present study was to determine the prevalence and spectrum of mutations in both genes in German HCM and DCM patients and to establish novel genotype-to-phenotype correlations. Methods and resultsCoding exons and intron flanks of the two genes MYH7 and MYBPC3 of 236 patients with HCM and 652 patients with DCM were sequenced by conventional and array-based means. Clinical records were established following standard protocols. Mutations were detected in 41 and 11 of the patients with HCM and DCM, respectively. Differences were observed in the frequency of splice site and frame-shift mutations in the gene MYBPC3, which occurred more frequently (P< 0.02, P< 0.001, respectively) in HCM than in DCM, suggesting that cardiac myosin-binding protein C haploinsufficiency predisposes to hypertrophy rather than to dilation. Additional novel genotype-to-phenotype correlations were found in HCM, among these a link between MYBPC3 mutations and a particularly large thickness of the interventricular septum (P 0.04 vs. carriers of a mutation in MYH7). Interestingly, this correlation and a link between MYH7 mutations and a higher degree of mitral valve regurgitation held true for both HCM and DCM, indicating that the gene affected by a mutation may determine the magnitude of structural and functional alterations in both HCM and DCM. ConclusionA large clinical-genetic study has unravelled novel genotype-to-phenotype correlations in HCM and DCM which warrant future investigation of both the underlying mechanisms and the prognostic use. © The Author 2011.


Wieczorek M.,Herzzentrum Duisburg | Salili A.R.,Herzzentrum Duisburg | Kaubisch S.,St. Jude Medical | Hoeltgen R.,Herzzentrum Duisburg
Europace | Year: 2011

Aims Conventional mapping and catheter ablation of non-sustained focal atrial tachycardia (AT) can be challenging and time consuming. We examined the characteristics and clinical outcomes after catheter ablation of recurrent, sustained AT presenting as non-sustained tachycardia during electrophysiological studies (EPSs), using a non-contact mapping system. Methods and results In 9 of 88 consecutive patients undergoing ablation of sustained right AT, the tachycardia was non-sustained during EPSs, precluding conventional mapping. We used a non-contact system to map and guide the catheter ablation of brief induced episodes of AT. Atrial tachycardia originated in the crista terminalis (CT) in three patients, tricuspid annulus (TA) in four, posterior right atrium (RA) in one, and mid cavo-tricuspid isthmus in one patient. A QS morphology of the earliest virtual unipolar electrogram was systematically found at the site of successful catheter ablation. The breakout sites were near the CT in six, TA in three, posterior RA in one and anterior RA in one patient. In two patients, two separate breakout sites were identified. All AT (i) were focal and (ii) propagated preferentially to the breakout site(s) before depolarizing the atria. A mean of 5 ± 2 applications of radiofrequency energy was delivered without complications. Procedural duration and fluoroscopic exposure with the non-contact mapping system were 44 and 12 min, respectively. Over a follow-up of 16 ± 11 months, eight of nine patients remained asymptomatic, while in one patient a 'novel' AT emerged during follow-up. Conclusion Catheter ablation of non-sustained AT, using a non-contact mapping system, was safe and eliminated sustained AT. © The Author 2011.


Beholz S.,Charité - Medical University of Berlin | Repossini A.,University of Brescia | Livi U.,Ospedale S.M. Misericordia | Schepens M.,AZ St. Jan | And 6 more authors.
Journal of Heart Valve Disease | Year: 2010

Background and aim of the study: The study aim was to investigate the early results, hemodynamics and left ventricular remodeling after aortic valve replacement (AVR) with the Freedom ™ SOLO valve, a bovine pericardial valve bioprosthesis, using a single running suture line in a supra-annular position. Methods: Between July 2004 and September 2006, a total of 256 patients (116 males; 140 females; mean age 74.5 ± 6.4 years; range: 41-89 years) who underwent AVR with the Freedom SOLO valve in nine European institutions were enrolled in the study. The indications for AVR were stenosis in 182 patients, regurgitation in 15, and combined in 57. Preoperatively, 37%, 59% and 4% of the patients were in NYHA classes I-II, III, and IV, respectively. Concomitant procedures were performed in 91 patients (36%). A patient subgroup underwent echocardiography preoperatively (n = 192), and at one (n = 194) and 12 (n = 165) months postoperatively. Results: The early mortality was 2.3% (n = 6). There were 18 late deaths (6.2%/pt-yr). After 12 months, 82% of the patients were in NYHA class MI. Linearized rates were 0.69%/pt-yr for bleeding, 0.34%/pt-yr for thromboembolism, 0.0%/pt-yr for structural degeneration and thrombosis, 1.37%/pt-yr for paravalvular leak, and 2.06%/pt-yr for endocarditis. Five patients required reoperation. Twelvemonth transprosthetic regurgitation was graded as absent in 92% of cases. The mean gradient was 42.3 ± 20.2 mmHg preoperatively, 6.5 ± 3.8 mmHg at one month, and 6.7 ± 4.1 mmHg at 12 months. The effective orifice area was improved from 0.78 ± 0.35 cm2 preoperatively to 1.90 ± 0.56 cm2 at one month and 1.89 ± 0.56 cm2 at 12 months. The left ventricular mass was decreased by 23%, from 217.8 ± 77.2 g/m 2 preoperatively to 167.4 ± 68.2 g/m 2 at one year. The mean left ventricular ejection fraction was 65.5 ± 14.2% preoperatively, and 64.5 ± 12.5% and 66.0 ± 10.6% at one month and at 12 months, respectively. Conclusion: The data obtained suggest that the Freedom SOLO stentless bioprosthesis shows excellent early clinical and hemodynamic results, resulting in a significant regression of left ventricular hypertrophy and improvement in left ventricular systolic function. © Copyright by ICR Publishers 2010.


Bandorski D.,Justus Liebig University | Lotterer E.,Klinikum Wetzlar | Hartmann D.,Klinikum Ludwigshafen | Jakobs R.,Klinikum Ludwigshafen | And 6 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2011

Background & Aims. Capsule endoscopy (CE) is an established tool for the investigation of the small intestine. The Food and Drug Administration, Given Imaging and Olympus have not recommended the use of capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators (ICDs). The aim of this retrospective study was to investigate the safety of capsule endoscopy systems (Given Imaging and Olympus) when applied in patients with different types of pacemakers/ ICDs in vivo. Methods. A standardized questionnaire was sent to high volume centers in Germany and in Austria. The questionnaire covered the age and gender of the examined patients, indication of CE, brand and type of CE, brand and model of pacemaker/ICD, check of the devices before and after CE, monitoring during CE, possible interference between CE and cardiac pacemakers/ICDs and possible adverse events during CE. Results. Data from 62 patients were retrieved for this study. Capsules used were Given Imaging (n=58; M2A, M2Aplus, PillCam SB2), Olympus EndoCapsule (n=3), Given PillCam Colon (n=1). The collective included patients with pacemakers/ICDS from seven brands (Biotronik, Medtronic, St. Jude Medical, Guidant, Boston Scientific, Ela Sorin, Vitatron) with a total of 19/8 (pacemaker/ICD) different types. In two patients interference between capsule endoscopy and telemetry (loss of images/gaps in video) was recorded. None of the cardiac pacemakers or ICDs was impaired in function. No clinically evident event was observed in any of these patients. Conclusions. Clinical use of these CE types is safe in patients with cardiac pacemakers and ICDs. Interference can occur between CE and ECG-telemetry leading to loss of images or impaired quality of video.


Bandorski D.,University of Regensburg | Keuchel M.,Bethesda Krankenhaus Bergedorf | Bruck M.,Klinikum Wetzlar | Hoeltgen R.,Herzzentrum Duisburg | And 2 more authors.
Diagnostic and Therapeutic Endoscopy | Year: 2011

Background and Study Aims. Capsule endoscopy is an established tool for investigation of the small intestine. Because of limited clinical experience in patients with cardiac devices, the Food and Drug Administration and the manufacturer recommended not to use capsule endoscopy in these patients. The vast majority of investigations did not reveal any interference between capsule endoscopy and cardiac devices. Methods. Studies investigating interference between CE and cardiac devices were analysed. For the review we considered studies published in English or German and indexed in Medline, as well as highly relevant abstracts. Results. In vitro and in vivo studies mainly revealed no interference between capsule endoscopy and cardiac devices. Technical data of capsule endoscopy (Given Imaging) reveal that interference with cardiac pacemakers and implantable cardioverter defibrillator is impossible. Telemetry can interfere with CE video. Conclusion. The clinical use of capsule endoscopy (Given Imaging) is unproblematic in patients with cardiac pacemakers. Copyright 2011 Dirk Bandorski et al.


Albanese M.,Herzzentrum Duisburg | Neofytou M.,Herzzentrum Duisburg | Ouarrak T.,Stiftung Institute For Herzinfarktforschung | Schneider S.,Stiftung Institute For Herzinfarktforschung | Schols W.,Herzzentrum Duisburg
European Journal of Clinical Pharmacology | Year: 2016

Purpose: The purpose of this study was to evaluate the measurement of heart rate undertaken in clinical studies by (1) assessing the repeatability and reproducibility of heart rate measurements by various methods and under various conditions and (2) determining whether a single heart rate measurement at rest is representative of the circadian and inter-day variation of heart rate. Methods: Prospective cohort study in 102 patients with various types of heart disease at Duisburg Heart Center, Germany between 2011 and 2012. The heart rate measurements were based on self-assessment, ECG tracings at rest, and bicycle stress ECG in the office as well as 24-h Holter ECG. Results: Office measurements and self-assessment at rest as well as 24-h Holter ECG and self-assessment at rest are highly correlated, but no correlation between self-assessment and office recordings/24 h recordings under exercise conditions was seen. Coefficient of variability was below 10 % for the self-assessment and for office measurements at rest. There were no differences in coefficient of variability during the day and within the 6 days for self-assessment of heart rate at rest and circadian variation was normal. Conclusions: At rest heart rate measurements by various methods agree sufficiently and inter-day/circadian variation is adequately represented. Under exercise conditions self-assessment of heart rate is not valuable and use of 24 h Holter as well as stress ECG recordings is necessary. Thus, self-reported heart rate measurements by the patient at rest seem to be reliable, but should be used in clinical studies only for heart rate assessment at rest. © 2016, The Author(s).


PubMed | Stiftung Institute For Herzinfarktforschung and Herzzentrum Duisburg
Type: Journal Article | Journal: European journal of clinical pharmacology | Year: 2016

The purpose of this study was to evaluate the measurement of heart rate undertaken in clinical studies by (1) assessing the repeatability and reproducibility of heart rate measurements by various methods and under various conditions and (2) determining whether a single heart rate measurement at rest is representative of the circadian and inter-day variation of heart rate.Prospective cohort study in 102 patients with various types of heart disease at Duisburg Heart Center, Germany between 2011 and 2012. The heart rate measurements were based on self-assessment, ECG tracings at rest, and bicycle stress ECG in the office as well as 24-h Holter ECG.Office measurements and self-assessment at rest as well as 24-h Holter ECG and self-assessment at rest are highly correlated, but no correlation between self-assessment and office recordings/24h recordings under exercise conditions was seen. Coefficient of variability was below 10% for the self-assessment and for office measurements at rest. There were no differences in coefficient of variability during the day and within the 6days for self-assessment of heart rate at rest and circadian variation was normal.At rest heart rate measurements by various methods agree sufficiently and inter-day/circadian variation is adequately represented. Under exercise conditions self-assessment of heart rate is not valuable and use of 24h Holter as well as stress ECG recordings is necessary. Thus, self-reported heart rate measurements by the patient at rest seem to be reliable, but should be used in clinical studies only for heart rate assessment at rest.


Wieczorek M.,Herzzentrum Duisburg | Hoeltgen R.,Herzzentrum Duisburg | Brueck M.,Clinic of Wetzlar | Bandorski D.,Clinic of Wetzlar | And 2 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2010

Background: The electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation strategy of paroxysmal atrial fibrillation (PAF). Circumferential antral ablation with a conventional ablation technique using a steerable ablation catheter is sometimes difficult to perform and does not always result in isolation of the targeted PV. Methods: Patients with symptomatic PAF were treated with a novel circular mapping/ablation catheter (PVAC). Ablation was performed in the antral region of the PV with a power-modulated bipolar/unipolar RF generator using 8-10 W until isolation of the vein was achieved. Seven-day Holter monitor recordings were performed off antiarrhythmic drugs at 3 and 6 months after the initial procedure. A subgroup of patients had received an implantable recorder before ablation, and the device was interrogated at the same time. The primary objective of this study is acute isolation of the targeted PV, and the second objective is clinical efficacy with a short-term follow-up. Results: In 73 patients, 290 PV could be reached with the PVAC. Antral ablation was performed in 244 PV showing PV potentials. Acutely, 243 PV (99%) were isolated with the PVAC after 21±7 energy applications per patient with a mean fluoroscopy time of 20±11 min. Total procedure time was 122±27 min. No complications were observed. Follow-up at 3 and 6 months showed freedom from AF in 61 of 73 (84%) patients and 38 of 45 patients (85%), respectively, off antiarrhythmic drugs. Conclusions: PV isolation by duty-cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Clinical results at 3 and 6 months after ablation are encouraging with the need for longer follow-up intervals. © 2009 Springer Science+Business Media, LLC.


Wieczorek M.,Herzzentrum Duisburg | Hoeltgen R.,Herzzentrum Duisburg | Akin E.,Herzzentrum Duisburg | Salili A.R.,Herzzentrum Duisburg | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2010

PV Isolation Using Bipolar/Unipolar RF Energy. Background: Electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation of paroxysmal atrial fibrillation (AF). Antral ablation using a conventional steerable ablation catheter often is technically challenging and time consuming. Methods: Eighty-eight patients (mean age 58 ± 11 years) with symptomatic paroxysmal AF underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of the PVs with a power-modulated bipolar/unipolar radiofrequency (RF) generator using 8-10 W delivered simultaneously through 2-10 electrodes, as selected by the operator. Seven-day Holter monitor recordings were performed off antiarrhythmic drugs at 3-, 6-, and 12-month follow-up, and patients were requested to visit the hospital in the event of ongoing palpitations. All follow-up patients were divided into 2 groups: Group 1 with a follow-up of less than 1 year and group 2 patients completing a 1-year follow-up. Results: Overall, 338 of 339 targeted PVs (99%) were isolated with the PVAC with a mean of 24 ± 9 RF applications per patient, a mean total procedure time of 125 ± 28 minutes, and a mean fluoroscopy time of 21 ± 13 minutes. Freedom from AF off antiarrhythmic drugs was found in 82 and 79% of group 1 and group 2 patients, respectively. No procedure-related complications were observed. Conclusion: PV isolation by duty-cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Twelve-month follow-up data compare favorably with early postablation results, indicating stable effects over time. (J Cardiovasc Electrophysiol, Vol. 21, pp. 399-405, April 2010) © 2009 Wiley Periodicals, Inc.


Wieczorek M.,Herzzentrum Duisburg | Hoeltgen R.,Herzzentrum Duisburg | Akin E.,Herzzentrum Duisburg | Salili A.R.,Herzzentrum Duisburg
Journal of Interventional Cardiac Electrophysiology | Year: 2010

Introduction: An increasing number of patients undergo left atrial ablation procedures, since several approaches have proven efficacy in the treatment of atrial fibrillation. Although transseptal catheterization was generally shown be a safe technique, it harbors the principal risk of cardiac injury. Therefore, there is a need for a safe and effective tool to enable transseptal puncture in difficult cases as well. Methods and Results: In 158 consecutive patients, a transseptal puncture was intended for mapping and ablation of left atrial tachycardias. In seven patients of this series transseptal puncture using different sheaths and needle designs, the operators failed to cross the interatrial septum as a result of severe tenting. Three patients were known to have a septal aneurysm; a redo procedure was performed in two patients. In the remaining patients, there was no obvious explanation for the difficulty in crossing the interatrial septum conventionally. In all seven patients, a 120-cm-long nitinol guidewire ("needle wire") with a 0.014-inch diameter was used to cross the atrial septum with the following idea: after tenting the fossa ovalis with the transseptal dilator and the Brockenbrough needle positioned just inside the tip, effortless advancement of the needle wire perforates the membranous fossa. Unsupported by the needle and dilator, the tip of the wire immediately assumes a "J" shape, rendering it incapable of further tissue penetration after its entry into the left atrium. In all seven patients, the needle wire could be placed into a left pulmonary vein. In five patients, a single attempt was sufficient to reach the left atrium with the wire, two patients needed two and three attempts, respectively. No complications occurred. Conclusions: Additional use of a needle wire to perform transseptal puncture in a subset of patients at higher risk for complications appears safe and effective. © 2010 Springer Science+Business Media, LLC.

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