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Biomedical subjects

B Lüderitz

Publications and source records attributed to B Lüderitz.

At least 19 recordsLinked to original sources
PubMed2006

Atrial fibrillation - patients at high risk for cerebral embolism.

OBJECTIVE: Patients with atrial fibrillation (AF) have a risk of cerebral embolism. Echocardiographic parameters elevate this risk significantly. However, there is little knowledge about the long-term fate and the rate of clinically silent cerebral embolism under continued oral anticoagulation. The aims of our study were to assess prognosis of patients with AF and determine a high risk group with an increased risk of cerebral embolism under oral anticoagulation. METHODS: Consecutive patients with persistent or permanent AF and left atrial (LA) thrombi, dense spontaneous echo contrast (SEC) and/or reduced LA appendage peak emptying velocities (LAAv) were included in the study (N = 128). Patients with AF and without echocardiographic risk factors (N = 114) served as controls. All patients were examined with transesophageal echocardiography, cranial magnetic resonance imaging and clinically during a period of three years. RESULTS: During the three-year follow-up period 6 (5%) of the high risk patients had cerebral embolism with neurological deficits. 4 (3%) patients died due to embolic events and 17 (13%) patients had silent embolism as documented on MRI. In the control group 8 (7%) patients had embolic events (n = 1 clinically apparent and n = 7 silent embolism) documented on MRI, one was clinically apparent. Study patients with an event had more commonly previous thromboembolism (p < 0.0001). CONCLUSIONS: Patients with peristent or permanent AF and LA thrombi, dense SEC or reduced LAAv have an explicitly increased risk of cerebral embolism (21%) despite oral anticoagulation. Previous thromboembolic event is another important predictor for an event.

Atrial Fibrillation↗
PubMed2006

NT-pro-BNP in obstructive sleep apnea syndrome is decreased by nasal continuous positive airway pressure.

OBJECTIVE: The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) on B-type natriuretic peptide (BNP) and to determine the effect of nasal continuous positive airway pressure (nCPAP) treatment on BNP levels. BACKGROUND: Increased sympathetic activity, repetitive rises in blood pressure, and apnea-induced wall stress may contribute as a trigger to release BNP in OSAS. However, there is uncertainty about whether OSAS affects BNP and whether application of nasal continuous positive airway pressure (nCPAP) ventilation affects release of BNP. PATIENTS AND METHODS: A prospective study in 69 consecutive patients with suspected sleep disordered breathing referred to our sleep laboratory was conducted. OSAS was confirmed in 26 normotensive and 34 hypertensive patients and ruled out in nine normotensive patients (controls) by polysomnography (PSG). RESULTS: Baseline N-terminal fragment of BNP prohormone (NT-pro-BNP) did not differ significantly between OSAS patients (hypertensive: mean +/-SEM 60.8+/-9.9 pg/ml, normotensive: 43.2+/-6.8 pg/ml) and controls (36.5+/-8.5 pg/ml). Application of CPAP resulted in a significant decrease of NT-pro-BNP in hypertensive (60.8+/-9.9 pg/ml to 47.6+/-7.4 pg/ml, p=0.023) and normotensive OSAS (43.2+/-6.8 pg/ml to 29.6+/-5.3 pg/ml, p=0.0002). In contrast, controls showed no significant differences in NT-pro-BNP after a second PSG (36.5+/-8.5 pg/ml to 40.7+/-12.3 pg/ml, p=0.597). CONCLUSIONS: Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP. Application of nCPAP decreased NT-pro-BNP levels significantly in normotensive and, in particular, hypertensive OSAS. These findings may provide further evidence of the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.

Continuous Positive Airway Pressure↗
PubMed2005

Tissue resident C reactive protein in degenerative aortic valves: correlation with serum C reactive protein concentrations and modification by statins.

OBJECTIVE: To assess aortic valve probes for valvar C reactive protein (CRP) presence, the relation between valvar and serum CRP, and a possible modification of CRP by statin medication. SETTING: Tertiary referral centre. PATIENTS AND DESIGN: End stage, degenerative valve tissue was taken from 81 patients, 57 with non-rheumatic aortic valve stenosis (AS) and 24 with degenerative aortic valve bioprosthesis (BP). Five non-stenosed valves served as controls. Tissue from four non-implanted bioprostheses was also examined. The presence and location of CRP was analysed by use of immunostaining and morphometry. Serum CRP concentrations were measured preoperatively. RESULTS: The majority of AS and BP valves exhibited CRP labelled cells, predominantly localised to the valvar fibrosa. The expression of CRP was much higher in BP than in AS (by a factor of 3.7, p = 0.03). Notably, non-stenosed aortic valves and non-implanted bioprostheses did not have CRP signalling. Serum CRP was also increased with BP (by a factor of 2.5, p = 0.02) and was significantly correlated with valvar CRP expression (r = 0.54, p < 0.001). The main finding in patients with (n = 26) and without statin treatment (n = 55) was that both valvar CRP expression (p = 0.02) and serum CRP concentrations (p = 0.04) were lower in the statin treated group. CONCLUSIONS: CRP was found in a large series of degenerative aortic valves, more often in bioprostheses than in native cusps. Serum CRP concentrations may reflect inflammatory processes within the aortic valve. The association of statin treatment with decreases in both valvar and serum CRP concentrations may explain known pleiotropic effects of statins in patients with aortic stenosis.

Aged↗
PubMed2005

Influence of obstructive sleep apnea on heart rate turbulence.

BACKGROUND: Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both heart rate turbulence (HRT) and heart rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep-disordered breathing (SDB) on HRT and HRV in patients with OSA. METHODS: Sixty-five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.-6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta-blockers or theophylline were excluded. According to the apnea-hypopnea index (AHI), the patients were assigned to group A (AHI <20, n = 31) or group B (AHI > or =20, n = 34). HRV (time domain, frequency domain) and HRT (onset, slope) were then related to the severity of SDB. RESULTS: Nighttime turbulence slope (TS) correlated inversely with the AHI (r = -0.45, p = 0.01) and was significantly lower in group B (8.9 +/- 1.6 ms/R-R interval) compared with that in group A (19.8 +/- 4.0 ms/R-R interval, P = 0.01). This relationship remained stable after adjusting TS for the number of ventricular premature contractions. No significant differences in turbulence onset or parameters of nighttime HRV were observed. CONCLUSIONS: Alterations in nighttime HRT correlate with the severity of SDB, indicating abnormalities in cardiac autonomic activity in moderate-to-severe OSA even in the absence of overt cardiac disease. These changes may be associated with the subsequent development of cardiovascular disease.

Adult↗
PubMed2005

[Atrial fibrillation -- interventional therapy with respect to age].

Actual therapy of atrial fibrillation follows either the rate or rhythm control strategy. To stabilize sinus rhythm after cardioversion or in case of paroxysmal atrial fibrillation, medical treatment is currently first line therapy. In patients who develop drug-refractory atrial fibrillation, further invasive treatment modalities like preventive pacing, hybrid therapy or catheter-based ablation techniques including pulmonary vein ablation or linear atrial lesion are available. However, interventional atrial fibrillation therapy should be reserved for the highly symptomatic patient due to its limited efficacy and risk of complication. Due to the higher relevance of the AF substrate in elderly patients, ablation therapy will be of limited use until substrate modification in addition to trigger elimination will reach an established stage as a clinical procedure. Hybrid therapy however, with ablation of the cavotricuspid isthmus is as suitable in elderly patients as in the young or middle-aged.

Aged↗
PubMed2005

[Progressive upper lobe consolidation in a 73-year old healthy woman].

A 73-year old healthy woman presented for pacemaker replacement. Chest X-ray showed an right upper lobe consolidation. CT-scan and bronchoscopy with bronchoalveolar lavage could not yield a specific diagnosis. Due to progression of the consolidation in a CT scan after 10 weeks another bronchoscopy with transbronchial biopsy was performed and yielded bronchiolo-alveolar carcinoma. The patient underwent resection of the right upper lobe and middle lobe with curative intent.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2005

[Current concepts in diagnosis and treatment of tachyarrhythmias].

A diagnostic and therapeutic approach of supraventricular and ventricular tachyarrhythmia is always challenging. Several criteria serve to discriminate correctly between these two types of tachycardia. Cardiac arrhythmias are terminated reliably by intravenous (IV) application of antiarrhythmic drugs: adenosine for supraventricular arrhythmia, amiodarone or ajmaline for ventricular tachycardia. Furthermore, AV-nodal tachycardia, atrioventricular reciprocating tachycardia, and typical atrial flutter is treated curatively by radiofrequency ablation during an electrophysiological study. This interventional therapy is well established in patients suffering from ventricular premature contractions or tachycardia originating in the right or left ventricular outflow tract. Aside treatment with an implantable defibrillator, patients with coronary artery disease highly benefit from adjusted pharmaceutical treatment.

Anti-Arrhythmia Agents↗
PubMed2005

Atrial fibrillation: profit from cardiac pacing?

The impact of cardiac pacing on the prevention of atrial fibrillation is under scientific investigation. Several prospective randomised clinical trials have reported that atrial-based "physiologic" AAI(R)- or DDD(R)-pacing is associated with a lower incidence of paroxysmal and permanent atrial fibrillation than single-chamber ventricular pacing in patients with a conventional pacemaker indication. However, it is still uncertain whether atrial pacing itself has independent antiarrhythmic properties. In contrast, right ventricular pacing is considered to promote atrial fibrillation, even in preserved AV synchrony during dual-chamber pacing. The electrical secondary prevention of atrial fibrillation is mainly based on variations of the atrial pacing site and sophisticated preventive pacing algorithms incorporated in the pacemaker software. Dual-site right atrial and biatrial pacing were reported to exhibit modest to no benefit for the prevention of atrial fibrillation, whereas septal pacing and specific preventive pacing algorithms have been demonstrated to reduce the incidence of atrial fibrillation in a number of clinical trials. However, the role of septal pacing and preventive pacing algorithms still has to be clarified since, overall, study results have been inconsistent so far. One of the main goals of future investigations should be the identification of responder groups of preventive pacing concepts. In clinical practice, the efficacy of pacing algorithms and septal pacing has to be determined in the individual case. These options should be taken into account in patients with symptomatic bradycardia as the indication for cardiac pacing and, in addition, symptomatic atrial fibrillation.

Atrial Fibrillation↗
PubMed2005

Pharmacological and ablative hybrid therapy of atrial fibrillation. Long-term effect on quality of life and arrhythmia-related symptoms.

UNLABELLED: The pharmacological and ablative hybrid therapy of atrial fibrillation (AF) consists of radiofrequency catheter ablation of antiarrhythmic drug-induced typical atrial flutter (AFl) and continuation of drug therapy. The purpose of this study was to determine the effect of this therapy on AF symptoms and quality of life (QoL). Forty-six patients were monitored after isthmus-ablation of drug-induced typical AFl and continuation of their antiarrhythmic drug treatment over a mean follow-up of 22.4+/-11.6 months. AF characteristics, symptoms and QoL before and after ablation were evaluated by the SF-36 question- naire, the Symptoms Checklist-Frequency and Severity Scale and the analysis of ECG recordings. 63% of patients demonstrated recurrences of AF. However, the frequency and duration of symptomatic episodes significantly decreased in 82.6 and 76% of patients. All categories of the SF-36 improved significantly and the AF symptomatology showed a relevant attenuation in 65.8% of the study population. CONCLUSION: The pharmacological and ablative hybrid therapy significantly reduced the mean number and the duration of symptomatic AF episodes as well as AF-correlated symptoms and was associated with significant QoL improvement.

Anti-Arrhythmia Agents↗
PubMed2005

[Atrial fibrillation: rate or rhythm control--individual patient management].

The treatment of atrial fibrillation still remains challenging in everyday practice. Even after the introduction of catheter ablation, the decision-making process about the type of therapy became more complex. The recently published guidelines of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology clearly show therapeutic approaches for different types of atrial fibrillation. The fear of thromboembolism still forces the physician to restore sinus rhythm and achieve optimized anticoagulation. Based on large studies, we are able to decide for each patient individually whether oral anticoagulation or ASA is required. Future studies in a large cohort of patients are still necessary to clarify the value of interventional therapy in conjunction with antiarrhythmic drug therapy. These will provide patients with safe therapy and high quality of life despite presenting paroxysmal or persistent atrial fibrillation.

Anti-Arrhythmia Agents↗
PubMed2004

[Interventional catheter closure of persistent foramen ovale (PFO) in a patient with paradoxical embolism and Brugada's syndrome].

HISTORY AND ADMISSION FINDINGS: A 41-year-man was admitted because of acute bluish-grey skin discoloration in cold sensation in the right hand. His brother had suffered sudden cardiac death, aged 42 years. INVESTIGATIONS: Angiography demonstrated embolic occlusion of the digital artery of the right thumb. Transesophageal echocardiography showed a persistent foramen ovale (PFO) with an aneurysm of the atrial septum (ASA) with marked right-to-left shunt of contrast medium during a Valsalva maneuvre as well as two smaller septal fenestrations. There was no evidence of any other source of embolism. The resting electrocardiogram showed an incomplete right bundle branch block with ST elevations in V (1)-V (3), changes like those described in Brugada's syndrome. TREATMENT AND COURSE: Paradoxical embolism having been demonstrated, the PFO with ASA were closed with a percutaneously introduced Helex septum occluder. Later an implantable cardioverter-defibrillator (ICD) was introduced. CONCLUSIONS: A PFO, particularly if associated with an atrial aneurysm, is an important site of paradoxical embolism. In symptomatic patients percutaneous transcatheter septal occlusion should be considered preceding any ICD insertion thought necessary for concurrent Brugada's syndrome.

Adult↗
PubMed2004

Mayer-von Rokitansky-Küster-Hauser syndrome in association with a hitherto undescribed variant of the Holt-Oram syndrome with an aorto-pulmonary window.

We report on the association of Mayer-von Rokitansky-Küster-Hauser syndrome (MRKHS) with a unique form of Holt-Oram syndrome (HOS) with an aorto-pulmonary window. A 24-year-old Turkish woman was referred to our hospital because of primary amenorrhoea. Both her vagina and uterus were absent, and the diagnosis of MRKHS was established. Laparoscopic creation of a neovagina by the modified Vecchietti technique was performed. A rare congenital malformation of the heart, namely an aorto-pulmonary window, had required cardiac surgery when the patient was a 6-month-old infant. This cardiac malformation plus associated upper limb anomalies led to the clinical diagnosis of HOS. To the best of our knowledge, this is only the second report in the scientific literature on the concurrence of MRKHS and HOS, and the first published case of HOS with an aorto-pulmonary window as the cardiac malformation.

Abnormalities, Multiple↗
PubMed2004

Heart rate variability in patients suffering from structural heart disease and decreased AV-nodal conduction capacity. Insights into the formation of heart rate variability.

METHODS: Time and frequency domain analysis were conducted during a period of 600 s each. We performed a special protocol consisting of five different "pacing" periods: 1) recording of normal sinus rhythm (SR1); 2) atrial pacing with a rate 15% higher than the intrinsic heart rate; 3) ventricular pacing triggered by atrial activation (VAT, with a short AV-delay of 80 ms); 4) AV-sequential pacing with an atrial rate 15% higher than the intrinsic heart rate and a very short AV delay of 80 ms (DDD); 5) normal sinus rhythm (SR2). Only patients with normal AV-nodal conduction or with AV-block I degrees were included. The influence of a structural heart disease as well as a non-sustained VT on Holter ECG and a depressed EF on HRV parameters were analyzed using a multivariate analysis. All patients were lying in a supine position. Blood pressure was measured continuously and the frequency of breathing was controlled. RESULTS: No differences in HRV between the two sinus rhythm periods SR1 versus SR2 could be detected. Neither SR1 vs VAT showed a significant difference for SDNN and r-MSSD. In contrast, HRV during SR1 compared to AAI, and HRV during VAT compared to AAI were significantly different (p < 0.001). When comparing HRV during DDD, which should be zero, and AAI, we found a significantly lower SDNN and r-MSSD (1.2 ms vs 4 ms, p < 0.04). The presence of structural heart disease, a non-sustained ventricular tachycardia, a depressed ejection fraction of less than 0.50 did not reveal a significant influence on the HRV parameters (multivariate analysis). The mean Wenckebach in patients with structural heart disease tended to be greater (437 ms vs 350 ms, p = 0.05); an increase in the Wenckebach was not correlated to a change in HRV parameters (p = ns). CONCLUSION: Heart rate variability derived from consecutive RR-intervals is predominantly caused by periodicity in sinus-node impulse formation. A conduction variability of the AV-node exists, but is very low. The presence of a structural heart disease, a non-sustained ventricular tachycardia on Holter ECG, as well as a depressed ejection fraction of less than 0.50 showed no significant influence on the HRV parameters. Therefore, one can apply the calculation of heart rate variability for risk stratification in patients suffering from structural heart disease and moderate AV-nodal conduction disturbances. Attenuation of the oscillation of the heart rate, i. e. heart rate variability (HRV), is associated with an increased risk for mortality in patients with structural heart disease. Many of these patients also suffer from conduction disturbances, e. g. AV-nodal conduction delays. Whether the calculation of HRV in those patients is recommendable has not been investigated yet. Therefore, we conducted a study consisting of 20 consecutive patients in order to determine the formation of HRV, the influence of structural heart disease, the presence of a nonsustained ventricular tachycardia (VT), and a reduced ejection fraction (EF) on the HRV parameters during an elective electrophysiologic study.

Adult↗
PubMed2004

Transcatheter PFO closure with a prominent Eustachian valve.

We report the successful PFO closure in a 57-year old woman with complex atrial anatomy. To avoid the risk of interfering with the occluder device due to a prominent Eustachian valve, a Helex Septal Occluder was implanted. Differential therapeutic considerations and specific device characteristics are outlined.

Cardiac Catheterization↗