Biomedical subjects

Karlheinz Seidl

Publications and source records attributed to Karlheinz Seidl.

At least 19 recordsLinked to original sources

PubMed2006

Stepped defibrillation waveform is substantially more efficient than the 50/50% tilt biphasic.

BACKGROUND: Even with biphasic waveforms, patients with high defibrillation thresholds (DFTs) still are seen; thus, improved defibrillation waveforms may be of clinical utility. The stepped waveform has three parts: the first portion is positive with two capacitors in parallel, the second is positive with the capacitors in series, and the last portion is negative, also with the capacitors in series. OBJECTIVES: The purpose of this study was to assess the clinical utility of improved defibrillation waveforms. METHODS: We measured the delivered energy DFT in 20 patients in a dual-site study using the stepped waveform and a 50/50% tilt biphasic truncated exponential as the control. All shocks were delivered using an arbitrary waveform defibrillator, which was programmed to mimic two 220-microF capacitors (110 microF in series and 440 microF in parallel). RESULTS: The peak voltage at DFT was reduced in 19 of the 20 patients. The median peak voltage was reduced by 32.0%, from 472 V to 321 V (P <.001). The median energy DFT was reduced by 33%, from 11.7 J to 7.8 J (P = .008). The mean voltage and energy were reduced by 25.3% and 20.2%, respectively. On average, the stepped waveform was able to defibrillate as well as the 50/50% tilt biphasic, with 33% more energy. The benefit was more pronounced in patients with either a lower ejection fraction or a superior vena cava coil. The benefit of the stepped waveform had an inverse quadratic correlation with the resistance (r(2) = 0.47), suggesting that the capacitance values chosen for the stepped waveform were close to optimal for a 35-Omega resistance. CONCLUSION: The stepped waveform reduced the DFT compared to the 50/50% tilt waveform in this preliminary study.

Arrhythmias, Cardiac↗

PubMed2005

Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial.

AIMS: Adjunctive therapy with glycoprotein IIb/IIIa inhibitors has been shown to reduce ischaemic complications and improve clinical outcome in patients with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction. Little is known about the use of eptifibatide in this setting. METHODS AND RESULTS: One hundred and two patients with ST elevation myocardial infarction <12 h scheduled for primary percutaneous intervention were randomly assigned to early eptifibatide given in the emergency room (early) or optional eptifibatide at the time of PCI (late or no). Primary endpoint was the patency of the infarct vessel before PCI. Patients in the early group received their first eptifibatide bolus, a mean of 45 min before angiography. TIMI 3 patency before PCI was observed in 34% in the early group and 10% in late or no group (P=0.01). The incidence of complete ST resolution 1 h after PCI was 61% in early group and 66% in the late or no group, respectively (P=n.s.). There were no significant differences in the rates of TIMI 3 flow after PCI, death, reinfarction, stroke, and major bleeding complications until day 30. CONCLUSION: In this pilot trial, double bolus eptifibatide given in the emergency room improved TIMI 3 grade flow of the infarct-related coronary artery before PCI. These results should be confirmed in a larger trial and whether this advantage translates into an improvement in clinical outcome should be tested in a trial with primary clinical endpoints.

Adult↗

PubMed2005

Do statins influence the prognostic impact of non-sustained ventricular tachycardia after ST-elevation myocardial infarction?

AIMS: The study evaluates the effect of statin therapy on the prognostic impact of non-sustained ventricular tachycardia (NSVT) occurring after acute ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: From the German Acute Coronary Syndrome Registry (ACOS), 3137 patients with STEMI and in-hospital Holter monitoring were analysed. Three hundred and forty-six (11.0%) patients had NSVT. When compared with patients with no documented NSVT, patients with NSVT were older, more often had myocardial infarction in their history, diabetes mellitus, and an ejection fraction <40%. Regarding frequency of drug application, medication at discharge did not (beta-blockers, ACE-inhibitors, amiodarone) or only slightly (acetylsalicylic acid, statins, and sotalol) differ between both groups. Multivariable analysis of 1 year mortality, adjusted for age, gender, diabetes, reperfusion therapy, ejection fraction <40%, and beta-blocker therapy showed the following results: In patients without statin treatment and no NSVT, 1 year mortality after STEMI was 9.2%, but increased to 25.0% [odds ratio (OR) 3.02; 95% confidence interval (CI) 1.47-6.20], if NSVT were present. In patients on statin treatment and no NSVT, 1 year mortality was only 3.2%, and in the presence of NSVT 1 year mortality was not significantly increased anymore (5.3%; OR 1.03; 95% CI 0.55-1.92). CONCLUSION: After STEMI, only in patients not on statin treatment, the occurrence of NSVT is associated with a significant and marked increase in 1 year mortality.

Aged↗

PubMed2004

The 1+1 trial: a prospective trial of a dual- versus a single-chamber implantable defibrillator in patients with slow ventricular tachycardias.

BACKGROUND: The tachycardia detection interval (TDI) in implantable cardioverter/defibrillators (ICDs) is conventionally programmed according to the slowest documented ventricular tachycardia (VT), with a safety margin of 30 to 60 ms. With this margin, VTs above the TDI may occur. However, longer TDIs are associated with an increased risk of inappropriate therapy. We hypothesized that patients with slow VTs (<200 bpm) may benefit from a long TDI and a dual-chamber detection algorithm compared with a conventionally programmed single-chamber ICD. METHODS AND RESULTS: Patients with VTs <200 bpm were implanted with a dual-chamber ICD that was randomly programmed to a dual-chamber algorithm and a TDI of > or =469 ms or to a single-chamber algorithm with a TDI 30 to 60 ms above the slowest documented VT cycle length and the enhancement criteria of cycle length variation and acceleration. The primary combined end point was the number of all inappropriate therapies, VTs above the TDI, and VTs with significant therapy delay (>2 minutes). After 6 months, a crossover analysis was performed. Total follow-up was 1 year. One hundred two patients were included in the study. The programmed TDI was 500+/-36 ms during the dual-chamber phase and 424+/-63 ms during the single-chamber phase. For the primary end point (inappropriate therapies, VTs above the TDI, or VTs with detection delay), a moderate superiority of the dual-chamber mode was found: Mann-Whitney estimator=0.6661; 95% CI, 0.5565 to 0.7758; P=0.0040. CONCLUSIONS: Dual-chamber detection with a longer TDI improves VT detection and does not increase the rate of inappropriate therapies despite a considerable increase in tachycardia burden.

Algorithms↗

PubMed2004

Immediate Risk-Stratification Improves Survival (IRIS): study protocol.

BACKGROUND: To date, the implantable cardioverter-defibrillator (ICD) has been shown to be effective for primary prevention of sudden cardiac death only in selected groups of patients in the chronic phase after myocardial infarction. METHODS AND RESULTS: The Immediate Risk-Stratification Improves Survival (IRIS) Study compares ICD therapy with no ICD therapy in selected high risk patients early after myocardial infarction. Special emphasis is placed on optimal acute and long term medical therapy in all patients including metoprolol CR/ZOK. The hypothesis is tested that use of the ICD reduces overall mortality. For that purpose, consecutive acute ST elevation or non-ST elevation myocardial infarction patients are collected in a registry. From this denominator, patients are screened, and enrolled early after myocardial infarction (day 5 to day 31) if they exhibit both a reduced left ventricular ejection fraction < or =40% and a heart rate > or =100 bpm on the first available electrocardiogram (criterion I), or non-sustained ventricular tachycardia at a rate > or =150 bpm during Holter (criterion II). CONCLUSIONS: IRIS is a large scale prospective, randomized trial to evaluate the benefit of ICD therapy for reduction of total mortality in patients considered at high risk of sudden death early after acute myocardial infarction.

Clinical Protocols↗

PubMed2004

Two-year performance of a preshaped lead for left ventricular stimulation.

Important goals, when implanting a cardiac resynchronization therapy (CRT) system, are to reach a stable LV lead position in a suitable coronary sinus (CS) tributary associated with a low capture threshold and no extracardiac stimulation. The aim of this study was to assess the 2-year performance of a new preshaped lead designed for LV stimulation. The study enrolled 102 patients with heart failure and bundle branch block who underwent implantation of a CRT system, including a sheath-guided, unipolar, S-shaped LV lead placed in a CS tributary. At each follow-up the electrical parameters and CRT system related adverse events were recorded. Eight patients who underwent LV stimulation alone, versus 88 patients who received biventricular CRT systems, were analyzed separately. Access to the CS was reached in 98 patients, and the lead was permanently implanted in 96 (94%) patients. The overall procedural time was 98 +/- 28 minutes. During follow-up, three patients underwent reinterventions for phrenic nerve stimulation (n = 2) and hematoma (n = 1). The capture threshold at implantation was 1.4 +/- 0.9 V with LV versus 1.7 +/- 0.5 V with biventricular stimulation, and after a transient increase, remained between 1.6 and 1.9 V in both configurations. The device measured impedance was significantly higher with LV than with biventricular stimulation at the time of CRT system implantation (698 +/- 296 Omega vs 380 +/- 67 Omega, P < 0.05) and during follow-up. The initial R wave amplitude was 14.3 +/- 5.9 mV in LV versus 8.9 +/- 3.2 V in the biventricular configuration (NS) and 13.8 +/- 7 mV in LV versus 12.8 +/- 4.8 mV in the biventricular configuration at 24 months (NS). Implantation of the S-shaped LV lead for CRT was safe, expeditious, and associated with a high success rate and reliable long-term performance.

Aged↗

PubMed2003

Antibiotic therapy after acute myocardial infarction: a prospective randomized study.

BACKGROUND: Infection with Chlamydia pneumoniae is suspected to contribute to the pathogenesis of human atherosclerosis. We investigated whether treatment with the macrolide antibiotic roxithromycin would reduce mortality or morbidity in patients with an acute myocardial infarction. METHODS AND RESULTS: Eight hundred seventy-two patients with an acute myocardial infarction (AMI) were randomly assigned to receive double-blind treatment with either 300 mg roxithromycin or placebo daily for 6 weeks. Primary end point was total mortality during 12-month follow-up. Four hundred thirty-three patients were treated with roxithromycin and 439 with placebo. With the exception of a higher proportion of patients suffering an anterior wall AMI (48.1% in the roxithromycin group versus 40.2% in the placebo group; P=0.027) and a lower prevalence of chronic obstructive pulmonary disease in the roxithromycin group (3.5% versus 6.9%, P=0.028), baseline characteristics, reperfusion therapy, and medical treatment were well balanced between the two groups. More patients in the roxithromycin group interrupted their study medication before completion of at least 4 weeks of treatment (78 of 433 [18%] versus 48 of 439 [11%]; P=0.003; odds ratio, 1.8; 95% CI, 1.2 to 2.6). Follow-up at 12 months was achieved in 868 of 872 (99.5%) patients. Total mortality at 12 months was 6.5% (28 of 431) in the roxithromycin group compared with 6.0% (26 of 437) in the placebo group (odds ratio, 1.1; 95% CI, 0.6 to 1.9; P=0.739). There were also no differences in the secondary combined end points at 12 months. CONCLUSIONS: Treatment of AMI patients with roxithromycin did not reduce event rates during 12 months of follow-up. Therefore, our findings do not support the routine use of antibiotic treatment with a macrolide in patients with AMI.

Aged↗

PubMed2003

Sodium channel gene (SCN5A) mutations in 44 index patients with Brugada syndrome: different incidences in familial and sporadic disease.

The Brugada syndrome (BS) is a distinct form of idiopathic ventricular fibrillation and may cause sudden cardiac death in healthy young individuals. In the surface ECG, BS can be recognized by an atypical right bundle branch block and ST-segment elevation in the right precordial leads. Mutations in the cardiac sodium channel gene SCN5A are only known to cause BS. In a multi-center effort, we have collected clinical data on 44 unrelated index patients and family members and performed a complete genetic analysis of SCN5A. In 37% the disease was familial, whereas in the majority it was sporadic (63%). Five novel SCN5A mutations (2602delC, resulting in: E867X; 2581_2582del TT: F861fs951X; 2673G>A: E1225K; 4435_4437delAAG: K1479del; and 5425C>A: S1812X) were found and were randomly located in SCN5A. Mutation frequencies (SCN5A+) differed significantly between familial (38%) and sporadic disease (0%) (p=0.001). Disease penetrance was complete in the SCN5A+ adult patients, but incomplete in SCN5A+ children (17%). Genetic testing of SCN5A is especially useful in familial disease to identify individuals at cardiac risk. In sporadic cases, however, a genetic basis and the value of mutation screening has to be further determined. These results are in line with a possibly genetic and clinical heterogeneity of BS.

Adolescent↗

PubMed2003

Laboratory monitoring of heparin and the combination of heparin and the platelet glycoprotein IIb/IIIa receptor antibody fragment abciximab (c7E3) in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND: Previous studies in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) have restricted laboratory monitoring to the activated clotting time (ACT). It remains unknown whether the ACT-prolonging effect of abciximab is clinically equivalent to a comparable degree of anti-coagulation by heparin. PATIENTS AND METHODS: 30 patients undergoing PTCA received 100 IU of heparin/kg body weight. Another 30 patients received an initial bolus of 70 IU of heparin/kg + abciximab. We determined ACT, laboratory and onsite activated partial thromboplastin time (APTT) and plasma heparin levels. RESULTS: Despite markedly different preintervention heparin dosing, the ACTs were not significantly different between groups. After termination of PTCA, the median ACTs of both study groups were nearly equivalent (267 vs. 272 s; p = 0.79). The median ACT-prolonging effect of abciximab could be equated with 0.68 IU/ml heparin. Both APTT assays were not suitable for monitoring the anticoagulant effects during PTCA due to their high sensitivity. By contrast, the plasma heparin levels clearly reflected the different heparin doses. The weak correlation (r = 0.23) between ACTs and heparin levels in patients receiving heparin + abciximab was due to excessively prolonged ACTs in six patients (540-1,245 s). These data could be attributed to an unusually high response to abciximab. By contrast, the ACT was a reliable measure of the anticoagulant effect of heparin in patients receiving exclusively heparin. CONCLUSIONS: ACT reflects both heparin and abciximab therapy, whereas heparin levels reflect only heparin dose. The APTT assays were not suitable for monitoring the anticoagulant effects during PTCA.

Abciximab↗

PubMed2003

[Non-contact mapping of the left atrium using a multi electrode mapping array].

In contrast to the sequential mapping systems such as the conventional and the electroanatomic mapping, the non-contact mapping provides simultaneous mapping. The non-contact-mapping system detects far-field endocardial potentials from a multielectrode-array catheter and reconstructs over 3,000 unipolar virtual electrograms. Based on the virtual electrograms, the system produces an instantaneous three-dimensional (3-D) isopotential map. High-density mapping of the endocardial activation sequence allows immediate and simultaneous identification of a propagation vector along the line and the identification of an arrhythmogenic focus on a single beat. The methods and results of different ablation strategies for atrial fibrillation using the non-contact-mapping system are reported.

Atrial Fibrillation↗

PubMed2003

Cardioversion related thromboembolism: value of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.

The aim of this article is to review two recent investigations of the value of transesophageal echocardiography to guide direct current cardioversion in different patient populations. In the Ludwigshafener Observational Cardioversion Study (LOCS) a TEE was performed prior to electrical cardioversion in patients with atrial fibrillation who had been receiving oral anticoagulation adjusted to an international normalized ratio of 2 to 3 for at least three weeks. In contrast, the ACUTE study investigated the value of transesophageal echocardiography in patients with atrial fibrillation in whom long-term oral anticoagulants had not been initiated in comparison to standard anticoagulation therapy. Furthermore, the following questions in respect to anticoagulation therapy are addressed: (1) how should patients be approached for pharmacological or spontaneous conversion; (2) how to treat emergency situations, (3) what is the importance of the postcardioversion period and long-term anticoagulation therapy; and (4) what is the role of low molecular weight heparin in the pericardioversion period.

Anticoagulants↗

PubMed2003

Catheter ablation of chronic atrial fibrillation with noncontact mapping: are continuous linear lesions associated with ablation success?

Catheter-based, right and left atrial compartmentalization procedure was evaluated using a noncontact mapping (NCM) system. Its usefulness to identify and close discontinuities in linear lesions in both atria was evaluated. The impact of linear lesion continuity on ablation success of chronic AF was also investigated. Nineteen patients with symptomatic, drug refractory chronic AF were studied. Right atrial ablation with three predefined lines was attempted in all patients. In 18 patients, left atrial ablation was performed with four linear lesions. During a follow-up of 12 +/- 3 months, 6 of 19 patients remained in sinus rhythm (SR) without antiarrhythmic agents (AAs). In addition, four patients were maintained in SR with AA. Thirteen of 14 patients with gaps identified during off-line analysis had recurrence of AF. Only one patient with a gap was free of recurrence without AAs. In the remaining five patients without recurrence of AF, no gap was observed during off-line analysis. In all four patients who were free of AF with additional treatment of AAs, two gaps had been identified. In the remaining nine patients with chronic AF recurrence, a mean of 4.9 gaps were identified. Excluding the initial learning period (first five patients) the success rate increased to 43% (6/14 patients) without and to 71% (10/14 patients) with AA. NCM identifies discontinuities in lines of ablation. Successful ablation of chronic AF is associated with continuity of linear lesions and good clinical technique demands a vigilant search for and closure of every gap.

Atrial Fibrillation↗

PubMed2003

Noncontact mapping of ectopic atrial tachycardias: different characteristics of isopotential maps and unipolar electrogram.

The success rate for catheter ablation of ectopic atrial tachycardia (AT) has been limited by the inherent difficulty in localizing the site of origin within the complex three-dimensional structures of the atria. The objective of the study was to determine the usefulness of a noncontact mapping system for catheter ablation of AT. Radiofrequency ablation of 25 ATs was performed using a noncontact mapping system. Three different characteristics of isopotential maps and unipolar electrogram morphologies were observed: Group 1: Isopotential maps displayed a narrow, sharp ring of colors around a white, center spot. Unipolar electrograms revealed a Q-S morphology with a rapid dV/dt. Group 2: Isopotential maps displayed a broad ring of colors with little or no white spot in the center. Unipolar electrograms revealed a low amplitude, broad and smooth Q-S morphology in front of a second component with a rapid dV/dt. Group 3: Isopotential maps displayed a broad ring of colors. Unipolar electrogams revealed a low amplitude and fractionated waveform followed by endocardial breakthrough with a gradual dV/dt. Radiofrequency catheter ablation was successful in all ATs of groups 1 and 2, and failed in two of three ATs in group 3. The overall success rate was 92%. No severe complications were observed. Noncontact isopotential mapping is helpful to identify and characterize the origin of ectopic AT. Ablation success is associated with the characteristics of isopotential maps and unipolar electrogram morphologies. The overall success rate was 92%.

Body Surface Potential Mapping↗

PubMed2003

Mortality, morbidity, and complications in 3344 patients with implantable cardioverter defibrillators: results fron the German ICD Registry EURID.

ICDs are the therapy of choice in patients with life-threatening ventricular arrhythmias. Mortality, morbidity, and complication rates including appropriate and inappropriate therapies are unknown when ICDs are used in routine medical care and not in well-defined patients included in multicenter trials. Therefore, the data of 3,344 patients (61.1 +/- 12.1 years; 80.2% men; CAD 64.6%, dilated cardiomyopathy 18.9%; NYHA Class I-III: 19.1%, 54.3%, 20.1%, respectively; LVEF > 0.50: 0.234, LVEF 0.30-0.50: 0.472, LVEF < 0.30: 0.293, respectively) implanted in 62 German hospitals between January 1998 and October 2000 were prospectively collected and analyzed as a part of the European Registry of Implantable Defibrillators (EURID Germany). The 1-year survival rate was 93.5%. Patients in NYHA Class III and aLVEF < 0.30 had a lower survival rate than patients in NYHA Class I and a preserved LVEF (0.852 vs 0.975,P = 0.0001). Including the 1-year follow-up, 49.5% of patients had an intervention by the ICD, 39.8% had appropriate ICD therapies, 16.2% had inappropriate therapies. Overall, 1,691 hospital readmissions were recorded. The main causes for hospital readmissions were ventricular arrhythmias (61.3%) and congestive heart failure symptoms (12.9%). Thus, demographic data and mortality of patients treated with an ICD in conditions of standard medical care seems to be comparable and based on, or congruent with, the large secondary preventions trials. When ICDs are used in standard medical care, the 1-year survival rate is high, especially in patients with NYHA Class I and preserved LVEF. However, nearly half of all patients suffer from ICD intervention.

Defibrillators, Implantable↗

PubMed2003

Safety and efficacy of a dual chamber implantable cardioverter defibrillator capable of slow ventricular tachycardia discrimination: a randomized study.

New developments in dual chamber implantable cardioverter defibrillators (ICD) have increased the specificity of therapy delivery. This study was performed to examine the performance of an algorithm, focusing on its ability to distinguish slow ventricular tachycardia (VT) from sinus rhythm or supraventricular tachyarrhythmias. The patient population included 77 men and 13 women, 63 +/- 11 years old, treated with ICDs after episodes of spontaneous or inducible ventricular tachyarrhythmias. They were randomized to programming of the ICD to a lower limit of VT detection at 128 beats/min (group I, n = 44), versus 153 beats/min II (group II, n = 46). The primary endpoint of the study consisted of comparing the specificity and sensitivity of the algorithm between the two groups of patients. Over a 10.1 +/- 3.5 months follow-up, 325 episodes were detected in the Tachy zone in group I, versus 106 in group II. The sensitivity and specificity of the algorithm in group I were 98.8% and 94.4%, respectively, versus 100% and 89% in group II (NS). A single episode of VT at a rate of 132 beats/min was diagnosed as SVT in group I. The sensitivity and specificity of the algorithm for tachycardias <153 beats/min were 97.4% and 94.5%, respectively. Overall VT therapy efficacy was 100% in both groups. The performance of this algorithm in the slow VT zone supports the programming of a long Tachy detection interval to document slow events, and allows to treat slow VT, if necessary, without significant risk of inappropriate interventions for sinus tachycardia.

Algorithms↗

PubMed2002

Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients?

OBJECTIVES: This study was designed to analyze the incidence of "dual tachycardia"-ventricular tachycardia (VT) or ventricular fibrillation (VF) preceded by paroxysmal atrial tachycardia (AT) or atrial fibrillation (AF)-in patients receiving dual-chamber implantable cardioverter defibrillators (ICDs). BACKGROUND: Paroxysmal AT/AF occurs commonly in patients who receive ICDs for the treatment of life-threatening VT/VF. Although AF is associated with an adverse prognosis in the setting of structural heart disease, the relationship between AT/AF and VT/VF is unclear. METHODS: We followed 537 patients undergoing implantation of the Jewel AF ICD (Model 7250, Medtronic, Minneapolis, Minnesota) for 11.4 +/- 8.2 months. These included 398 patients with a history of at least two episodes of AT or AF during the preceding year as well as 139 patients enrolled because of VT/VF alone. RESULTS: There were 233 dual tachycardia episodes in 45 patients during follow-up. Overall, 8.9% of episodes detected as VT/VF were dual tachycardias, and 20.3% of patients with VT/VF had at least one dual tachycardia episode. The median duration of AT/AF preceding the first VT/VF detection was 1.09 h (25% to 75% quartile 0.24 to 33.4 h). When AT/AF continued between two consecutive VT/VF detections, the median interdetection interval was 11 min. When AT/AF terminated either because of a ventricular therapy or spontaneously, the median interdetection interval was prolonged to 71 h (p < 0.001). CONCLUSIONS: Dual tachycardia is common in ICD recipients with a history of AT/AF. The duration of AT/AF preceding the first VT/VF detection is < or =1 h about 50% of the time. Termination of the AT/AF significantly delays the time to the next VT/VF detection.

Aged↗

PubMed2002

Embolic events in patients with atrial fibrillation and effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study.

OBJECTIVES: The primary objective was to evaluate the usefulness of transesophageal echocardiography (TEE)-guided cardioversion to prevent thromboembolic complications in patients with atrial fibrillation (AF) and effective anticoagulation (International Normalized Ratio of 2 or 3) at least three weeks before cardioversion. BACKGROUND: Transesophageal echocardiography has been proposed as a method of screening patients for left atrial thrombi before direct-current cardioversion of AF. The usefulness of TEE as a screening tool has always been evaluated in patients without long-term anticoagulation before cardioversion. METHODS: This prospective, single-center, observational study, performed on an intention-to-cardiovert basis, comprised 1,076 consecutive, unselected patients with AF. The initial two years were designed to be the control phase, during which the conventional approach was used. After that, cardioversion guided by TEE was performed in consecutive patients. RESULTS: The prevalence of left atrial thrombi was 7.7% in patients with persistent AF and effective anticoagulation. During the first four weeks after electrical cardioversion, six thromboembolic complications were observed in patients in whom the TEE-guided approach was employed (6 [0.8%] of 719 patients), compared with three thromboembolic complications in patients in whom the conventional approach was used (3 [0.8%] of 357 patients). None of the patients in whom electrical cardioversion was not performed experienced an embolic event. CONCLUSIONS: There were no differences in the rate of embolic events between the two treatment groups. In patients with AF and effective anticoagulation, TEE-guided electrical cardioversion does not reduce the embolic risk. However, TEE revealed left atrial thrombi in 7.7% of patients with AF and effective anticoagulation, before direct-current cardioversion.

Aged↗

PubMed2002

Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT).

BACKGROUND: Patients with idiopathic dilated cardiomyopathy (DCM) and impaired left ventricular ejection fraction have an increased risk of dying suddenly. METHODS AND RESULTS: Patients with recent onset of DCM (< or =9 months) and an ejection fraction < or =30% were randomly assigned to the implantation of an implantable cardioverter-defibrillator (ICD) or control. The primary end point of the trial was all-cause mortality at 1 year of follow-up. The trial was terminated after the inclusion of 104 patients because the all-cause mortality rate at 1 year did not reach the expected 30% in the control group. In August 2000, the vital status of all patients was updated by contacting patients, relatives, or local registration offices. One hundred four patients were enrolled in the trial: Fifty were assigned to ICD therapy and 54 to the control group. Mean follow-up was 22.8+/-4.3 months, on the basis of investigators' follow-up. After 1 year, 6 patients were dead (4 in the ICD group and 2 in the control group). No sudden death occurred during the first and second years of follow-up. In August 2000, after a mean follow-up of 5.5+/-2.2 years, 30 deaths had occurred (13 in the ICD group and 17 in the control group). Cumulative survival was not significantly different between the two groups (93% and 80% in the control group versus 92% and 86% in the ICD group after 2 and 4 years, respectively). CONCLUSIONS: This trial did not provide evidence in favor of prophylactic ICD implantation in patients with DCM of recent onset and impaired left ventricular ejection fraction.

Cardiac Surgical Procedures↗