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J Senges

Publications and source records attributed to J Senges.

At least 91 records · Page 5Linked to original sources
PubMed1999

Radiofrequency catheter ablation of frequent monomorphic ventricular ectopic activity.

INTRODUCTION: Frequent ventricular ectopic beats can result in severe symptoms and may even be incapacitating in some patients. Although radiofrequency catheter ablation is an effective and safe therapy for drug refractory idiopathic ventricular tachycardia, it has not been widely used in ventricular ectopy. The purpose of this study was: (1) to assess the potential role of catheter ablation in eliminating monomorphic ventricular ectopy in symptomatic patients regarding feasibility and safety and (2) to determine the usefulness of various mapping strategies. METHODS AND RESULTS: Forty-one patients with symptomatic ventricular ectopic activity (right ventricular origin in 23 patients, left ventricular origin in 18 patients) were enrolled. The mean frequency of ventricular ectopic beats was 1512+/-583/hour documented by Holter ECG monitoring. These patients had previously been unable to tolerate or had been unsuccessfully treated with a mean of 3+/-1 antiarrhythmic agents. The site of origin was mapped using earliest endocardial activation times, unipolar electrograms and pace mapping. Radiofrequency ablation was successful in 34 (83 %) of 41 patients. Multivariate logistic regression analysis revealed pace mapping as the only independent predictor for a successful ablation site (P < 0.01). After a follow-up of 3 months, the overall success rate was 71%. The mean frequency of ventricular ectopic beats after successful ablation was 12+/-10 ventricular premature beat/hour. CONCLUSION: Radiofrequency catheter ablation is an effective and safe treatment for frequent symptomatic drug refractory monomorphic ventricular ectopic activity. Pace mapping predicts best successful ablation of ventricular ectopic beats.

Adolescent↗
PubMed1999

Spectrum of reperfusion strategies and factors influencing the use of primary angioplasty in patients with acute myocardial infarction admitted to hospitals with the facilities to perform primary angioplasty. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group.

OBJECTIVE: To determine the frequency of the use of primary angioplasty in patients with acute myocardial infarction and the factors influencing its indications in hospitals with the facilities to perform this treatment. DESIGN: Data from the maximal individual therapy in acute myocardial infarction (MITRA) trial were analysed, concerning the effects of the decisions of individual hospitals, the time of admission of patients, and the effects of patient characteristics on the selection of reperfusion treatment. PATIENTS: Between June 1994 and January 1997 eight hospitals treated 1532 patients with acute myocardial infarction. 418 (27.3%) were treated conservatively, 641 (41.8%) were treated using intravenous thrombolysis, 387 (25.3%) were treated using primary angioplasty, and 86 (5.6%) received a combination of thrombolysis and angioplasty. RESULTS: The proportion of patients treated with primary angioplasty varied from 1.8% to 57.7% among the eight hospitals. The use of primary angioplasty during non-office hours also showed wide variation, ranging from 20% to 54% between centres. The use of thrombolysis was comparatively evenly distributed during the non-office hours, ranging from 50-69%. Four hospitals with a primary angioplasty use rate > 30% showed no difference in the proportion of patients with contraindications for thrombolysis, high risk patients, or a combination of both, when compared with four hospitals with a lower rate of primary angioplasty use (98/322 (30.4%) v 19/65 (29. 2%), respectively, p = 0.847). CONCLUSIONS: In hospitals with the facilities for performing primary angioplasty the most important factors influencing its use were the discretion of the individual hospital and the time of patient admission. Characteristics of patients did not influence the choice of reperfusion treatment

Angioplasty, Balloon, Coronary↗
PubMed1999

Acute myocardial infarction: selection of reperfusion strategies in the individual patient.

The selection of the reperfusion therapy (thrombolysis, PTCA, or no reperfusion) in acute myocardial infarction should depend on the risk-benefit ratio, the availability, and the costs. Thrombolysis is available everywhere and is the standard of reperfusion therapy, but carries the risk of intracranial haemorrhage. PTCA is more effective with less risk, but it is also more expensive and available only in specialised centres. In current clinical practise in Germany, the only important determinant for using PTCA as a reperfusion strategy is the availability of a catheter laboratory. Besides availability, the selection of reperfusion therapy should be made more on clinical relevance: (i) PTCA especially in patients with a large benefit, the presence of contraindications to thrombolysis, or in cardiogenic shock, and (ii) thrombolysis, if PTCA is not immediately available.

Acute Disease↗
PubMed1999

Primary angioplasty in acute myocardial infarction: differences between referred patients and those treated in hospitals with on-site facilities?

BACKGROUND: Primary angioplasty for acute myocardial infarction (AMI) can only be performed in a limited number of centers. Therefore, some patients will be referred for this procedure. DESIGN: We analyzed the data of the prospective observational MITRA trial, which took place at 54 hospitals in southwest Germany, to describe current practices and outcomes in referred patients compared to patients treated on-site. RESULTS: Out of 491 patients treated with primary angioplasty, 63 (12.8%) were referred. Out of 46 hospitals without facilities to perform primary angioplasty, 29 (63%) never referred patients. Referred patients were less often male (60.3% versus 75.9%; p = 0.013), suffered more often from anterior wall infarction (62.9% versus 45.8%; p = 0.014), and more often had absolute contraindications against thrombolysis (11.1% versus 2.8%; p = 0.006). In-hospital time to treatment was 80 minutes in patients treated on-site compared to 190 minutes in referred patients (p = 0.001). There was a non-significant difference of in-hospital mortality between the two groups (11.1% for referred versus 7.5% on-site; p = 0.319). Referred patients had a higher hospital morbidity as expressed by a higher proportion of post-infarction angina (28.6% versus 4.2%; p = 0.001), a more frequent need for urgent revascularization (43.8% versus 16.4%; p = 0.001) and a higher proportion of advanced heart failure (11.1% versus 4.4%; p = 0.062). CONCLUSIONS: Referral of patients with AMI for primary angioplasty is used only in a minority of hospitals. The referred patients represent a selected, more ill subgroup, resulting in a higher hospital morbidity compared to patients treated on-site. Continuous efforts should be undertaken to decrease the time delay from admission at the initial hospital to the beginning of revascularization.

Acute Disease↗
PubMed1998

Comparison of metoprolol and sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/defibrillator.

The purpose of this prospective study was to evaluate, on an intention-to-treat basis, the efficacy of d,l-sotalol and metoprolol with regards to the recurrence of arrhythmic events after implantable cardioverter defibrillator (ICD) implantation. After ICD implantation, 70 patients were randomly assigned to treatment with either metoprolol (mean dosage 104+/-37 mg/day in 35 patients) or d,l-sotalol (mean dosage 242+/-109 mg/day in 35 patients). During follow up ventricular tachycardia (VT), fast VT, and ventricular fibrillation (VF) episodes were calculated. Metoprolol treatment led to a marked reduction in the recurrence of arrhythmic events. Actuarial rates for absence of VT recurrence at 1 and 2 years were significantly higher in the metoprolol group compared with the d,l-sotalol group (83% and 80% vs 57% and 51%, respectively, p=0.016). The actuarial rates for absence of fast VT or VF were 80% in the metoprolol group compared with 46% in the d,l-sotalol group (p=0.002). During a follow up of 26+/-16 months, there were 3 deaths in the metoprolol group compared with 6 deaths in the d,l-sotalol group. Actuarial rates of overall survival were not significantly different in the 2 groups (91% vs 83%, p=0.287). In this prospective, randomized, controlled study the recurrence rate of ventricular tachyarrhythmias in patients treated with metoprolol was lower than in patients treated by d,l-sotolol.

Adolescent↗
PubMed1998

Risk of thromboembolic events in patients with atrial flutter.

Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter. A history of embolic events was noted in 11 patients. Acute embolism (<48 hours) occurred in 4 patients (3 after direct current cardioversion, 1 after catheter ablation). During follow-up of 26+/-18 months, 9 patients experienced thromboembolic events. During the follow-up, the overall embolic event rate (including acute embolism and thromboembolic events during follow-up) was 7 % in this patient population. Risk indicators for an embolic event in an univariate analysis were organic heart disease (p = 0.037), depressed left ventricular function (p = 0.02), history of systemic hypertension (p = 0.004), and diabetes mellitus (p = 0.0038). Using multivariate analysis, a history of hypertension was the only independent predictor for elevated embolic risk in this patient population (odds ratio = 6.5; 95% confidence intervals 1.5 to 45). Thus, the thromboembolic risk is higher than previously recognized for patients with atrial flutter. Anticoagulation therapy may decrease this risk.

Aged↗
PubMed1998

[Pseudoaneurysm in the vicinity of the ascending aorta caused by contained disruption at the insertion site of a coronary artery bypass graft. A case report].

In this case report a 65-year-old patient came into the emergency ward with acute chest pain after coronary artery bypass graft operation in 1985. On routine chest X-ray in 1995 a mediastinal widening was diagnosed. The chest X-ray in 1997 (Figure 1) showed an increase of the diameter of the known mediastinal widening. Therefore a CT-scan was performed (Figures 2a and 2b). This showed an enhancement of contrast material in a contained structure, without identifying its origin. Therefore a coronary angiography was done. Here, we diagnosed a contained disruption of the aorta at the insertion site of the bypass graft at the right coronary artery. Figure 3a shows leakage of contrast material out of the aorta into the pseudoaneurysm and in Figure 3b this is demonstrated in a schematic drawing. Figure 4a shows supraselective imaging of the pseudoaneurysm, demonstrated in a schematic drawing in Figure 4b. As the chest pain could only be handled by i.v.-medication, betablocker and bed rest we decided to operate. Intra-operatively the diagnosis was confirmed (Figure 5a and 5b). Postoperatively the patient died due to cerebral ischemia. Despite the lethal outcome an operative revision appears even retrospectively justified because of the increasing size of the pseudoaneurysm in addition to new symptoms that were difficult to treat. On the other hand there are no data available in order to estimate the risk of a spontaneous course.

Aged↗
PubMed1998

[Incidence of atrial fibrillation in relation to atrial catheter site in two-chamber pacemakers].

INTRODUCTION: This study evaluated the impact of the atrial lead implantation site on the subsequent development of atrial arrhythmias. METHOD: Dual chamber pacemakers were implanted in 109 consecutive patients. The indication was AV-block in 51 patients, sick sinus syndrome in 58 patients. No patient had chronic atrial fibrillation, but 12 patients (11%) had paroxysmal atrial fibrillation before implantation. Patients were classified according to the atrial lead implantation site: right atrial appendage and right atrial free wall. RESULTS: Preimplant episodes of atrial fibrillation were similar in patients with lead implantation at the free wall and with implantation in the right atrial appendix (13% vs 7.5%, P=0.53). During a mean follow-up of 24+/-13 months, new paroxysmal atrial fibrillation occurred in 5% after lead implantation in the appendix vs 28% of patients after implantation at the right atrial free wall (P = 0.004). CONCLUSION: The development of atrial arrhythmias in dual chamber pacing is influenced by the implantation site of the atrial lead. The frequency of atrial arrhythmias during follow-up is higher after atrial lead implantation at the right lateral wall than in the appendix.

Adult↗
PubMed1998

The 60 Minutes Myocardial Infarction Project. Characteristics on admission and clinical outcome in patients with reinfarction compared to patients with a first infarction.

PURPOSE: The purpose of the study was to evaluate parameters that characterize patients with myocardial reinfarction as compared to patients with a first infarction in clinical practice, and possibly to determine their clinical outcome. METHODS: The 60 minutes Myocardial Project is a German multicentre prospective observational study in which 136 hospitals are participating. Fourteen thousand, nine hundred and eighty consecutive patients with acute Q wave myocardial infarction were included from July 1992 to September 1994. RESULTS: Out of these 14,980 patients, there were 2854 (19%) with reinfarction and 12,126 (81%) with a first infarction. Patients with a reinfarction arrived at the hospital 24 min earlier than patients with a first infarction (pre-hospital delay 156 vs 180 min; P < 0.001); the door-to-needle time with reinfarction was longer (38 vs 30 min; P < 0.001); however, patients with reinfarction were older (69 vs 66 years; P < 0.001), had a lower rate of a diagnostic first ECG (54 vs 71%; P < 0.001) and received thrombolytic therapy less frequently than patients with a first infarction (46 vs 52%; P < 0.001). A low number of patients received primary PTCA ( n = 205) since only a few hospitals offered a primary PTCA service at the time the study was performed. In patients with reinfarction, there were more reasons as to why thrombolytic therapy was not given (24 vs 21%; P < 0.001). Left bundle branch block occurred more frequently in patients with reinfarction (15 vs 8%; P < 0.001). The intra-hospital course in patients with reinfarction was associated with an increase of complications and intra-hospital death (23 vs 15%; P < 0.001. CONCLUSIONS: Although reinfarction patients arrived earlier at hospital than patients with a first infarction, the former received thrombolytic therapy less frequently than the latter. Patients with reinfarction were older, more frequently had a non-diagnostic ECG on admission and had a higher rate of contraindications against thrombolytic therapy.

Adult↗
PubMed1998

Is the atrial high rate episode diagnostic feature reliable in detecting paroxysmal episodes of atrial tachyarrhythmias?

The atrial high rate episode diagnostic in the Thera pacemaker reports frequency, duration, and date/time of atrial tachyarrhythmias according to programmed criteria. The aim of the study was to validate the atrial high rate episode diagnostic feature. Episodes of atrial fibrillation recorded by Holter monitoring were compared to episodes detected by the pacemaker. Forty five ambulatory (Holter) recordings were used for evaluation. Thirty of 45 ambulatory (Holter) recordings showed sinus rhythm. On 4 of these 30 ambulatory (Holter) recordings, the Thera detected 12 episodes of atrial tachyarrhythmias as false-positives (sinus rhythm was detected as atrial tachyarrhythmia). The main reason was far-field R and T was oversensing. On 15 of 45 ambulatory (Holter) recordings, 125 episodes of atrial tachyarrhythmias were recorded. Ninety-three of these events also were detected by the pacemaker, while for 32 events the Thera reported sinus rhythm. The main reason was that the episodes were of too short duration. Therefore, the Thera (programmed with detection rate 160 beats/min, detection beats 40, termination beats 10) was unable to detect atrial tachycardias. Software simulation of the diagnostic algorithm under several programming settings using the digitized Holter files demonstrated highly reliable detection of atrial tachyarrhythmias (sensitivity 98%, specificity 100%) when programmed as follows: detection rate 220 beats/min, detection beats 10, termination beats 20. It can be concluded that Thera's high rate episode monitor is a reliable tool for detection of atrial tachyarrhythmias, if programmed as recommended.

Aged↗
PubMed1998

Unexpected complete AV block following transcatheter ablation of a left posteroseptal accessory pathway.

Radiofrequency catheter ablation is the procedure of choice for the nonpharmacological treatment of AV connections that are responsible for debilitating tachycardia. This article describes a patient with a manifest left posteroseptal accessory pathway and recurrent syncopes in whom a transient complete AV block occurred after transcatheter radiofrequency ablation of the left posteroseptal pathway. Three electrical abnormalities were present in this patient: AV infra-Hisian block, a left posteroseptal accessory pathway, and an AV nodal reentry tachycardia. This case report reminds you that one should be prepared for all fall backs during catheter ablation.

Atrioventricular Node↗
PubMed1998

Impact of early risk stratification on the length of hospitalization in patients with acute Q-wave myocardial infarction. 'The 60-minutes myocardial infarction project'.

UNLABELLED: An assessment of individual risk factors may identify a subgroup of postinfarction patients at low risk, i.e. patients appropriate for early discharge. Using a large unselected population of the national registry, 'The 60-Minutes Myocardial Infarction Project', we (1) attempted to provide a retrospective analysis of clinical factors and in-hospital mortality in a population living on the 6th hospital day following admission to define a low-risk patient group with a residual in-hospital mortality of less than 1% eligible for early discharge, and (2) to analyze the current impact of risk stratification based on these clinical factors on the length of hospitalization. The study group consisted of 12,045 survivors on the 6th day after admission out of 14,980 patients of the registry with proven Q-wave myocardial infarction. Risk modeling was performed with multiple logistic regression. RESULTS: A total of 873 patients (7.3%) died after day 6 in hospital. The most important prognostic factors were cardiopulmonary resuscitation prior to admission (odds ratio, OR: 7.2, confidence interval, CI: 5.11-10.22), thrombolysis complicated by severe bleedings (OR: 6.2, CI: 1.2-31. 2) and age >70 years (OR 4.7, CI 3.51-6.39). The other more significant independent predictors of increased mortality were end-stage renal disease, age between 56 and 70 years, systolic blood pressure <95 mm Hg on admission, history of trauma </=2 months, cancer and left-bundle-branch block. Summarizing these nine groups of patients with the strongest association to in-hospital mortality, we defined a high-risk group comprising 79% of the AMI patients with a residual in-hospital mortality of 8.8%. On the other hand, by excluding these nine high-risk patient groups, a low-risk group of 21% of all AMI patients seems to be appropriate for early discharge (residual in-hospital mortality = 1.07%). However, in the current practice, there was no difference regarding the median length of hospital stay between the two risk groups. The low-risk patients were hospitalized 20 days compared to 22 days in the high-risk patients. CONCLUSION: Using a simple logistic regression model, which considers clinical factors of the early hospital phase, one fifth of the infarction patients can be stratified to be at low risk, and might be eligible for early hospital discharge. Currently, an individual risk stratification has no impact on the length of hospital stay in Germany.

Aged↗
PubMed1998

Importance of preimplantation procedures in candidates for an implantable atrial defibrillator.

INTRODUCTION: Due to the limited efficacy of antiarrhythmic drugs for the treatment of atrial fibrillation, several nonpharmacologic therapeutic options have been developed. One of these options is an implantable atrial defibrillator for patients with severe symptoms and infrequent drug-refractory episodes of atrial fibrillation. The purposes of this study were: (1) to evaluate how many patients with atrial fibrillation are possible candidates for an implantable atrial defibrillator; and (2) to report the results and findings of preimplantation testing in a single center. METHODS AND RESULTS: From our atrial fibrillation outpatient clinic, we evaluated the number of possible candidates for an atrial defibrillator using the following criteria: (1) recurrent persistent atrial fibrillation; (2) long-lasting but infrequent episodes; (3) refractory to antiarrhythmic drugs; (4) capability of maintaining normal sinus rhythm; and (5) no factors increasing proarrhythmic risk. In those patients eligible for an atrial defibrillator, a separate preimplantation test was performed to evaluate atrial defibrillation limits and patient acceptance. Thirty-one of 196 patients were possible candidates for an atrial defibrillator. Fourteen of these 31 patients agreed to participate in the METRIX clinical study phase I on atrial defibrillators. Six of these patients met implantation criteria; two patients refused permanent implantation because of intolerable pain. Implantation was performed in four patients; however, one patient could not be cardioverted intraoperatively despite a successful preimplantation test. CONCLUSION: About 16% of selected patients with atrial fibrillation are possible candidates for an atrial defibrillator. However, successful preimplantation testing does not exclude implantation failure.

Aged↗
PubMed1997

[Catheter ablation in cardiac arrhythmia. Interventional therapy of symptomatic and threatening arrhythmias of the heart].

Catheter ablation is a curative intervention for the treatment of supraventricular, but also ventricular, tachycardias that has proved both safe and effective. In patients with supraventricular tachycardias in underlying WPW syndrome or nodal tachycardia and appreciable symptoms, catheter ablation can be considered the treatment of choice. But many patients with monomorphic ventricular extrasystole that is difficult to control medically experience considerable subjective impairment in their daily life. It is possible that in such patients, too, catheter ablation may, sometime in the future, be used to cure their condition. However, long-term results must first be awaited.

Aged↗
PubMed1997

Influence of the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO-1) trial on the use of thrombolytics in Germany. ALKK Study Group. Arbeitsgemeinschaft der Leitenden Kardiologischen Krankenhausärtze.

Our results show significant and independent influence of the GUSTO-1 trial on the use of recombinant tissue plasminogen activator in acute myocardial infarction in Germany. This influence started soon after the publication of the trial and was not restricted to subgroups who benefitted most from recombinant tissue plasminogen activator.

Aged↗
PubMed1997

[Tricuspid valve endocarditis. Demonstration of a rare disease exemplified with 3 case reports].

BACKGROUND: Endocarditis of the tricuspid valve is a rare form of valvular endocarditis and occurs mainly in patients with special risk factors. CASE REPORTS: The three case reports demonstrate 3 young patients (age 30 to 37 years, 2 female and 1 male) with a typical history of those risk factors. The two women were intravenous drug addicts and one of them had suffered already an episode of tricuspid valve endocarditis several years ago. The man developed his infection after implantation of a pacemaker. In all of the three patients the endocarditis was due to infection with staphylococci twice staphylococcus epidermidis and once staphylococcus aureus. In two of the three patients the endocarditis could not be cured by intravenous antibiotics alone and these patients had to undergo cardiac valvular surgery. All patients left the hospital after several weeks without signs of infection. CONCLUSION: In clinical praxis the introduction of a special endocarditis service, a small team which has to be consulted in every suspected case of endocarditis, seems to be beneficial as well as the use of the Duke criteria for diagnosis in those cases.

AIDS-Related Opportunistic Infections↗