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Semi-invasive electromechanical target interval to guide left ventricular electrode placement
(2011)
Targeting complex fractionated atrial electrocardiograms by automated algorithms during ablation of persistent atrial fibrillation has produced conflicting outcomes in previous electrophysiological studies and catheter ablation of atrial fibrillation and ventricular tachycardia. The aim of the investigation was to evaluate atrial and ventricular high frequency fractionated electrical signals with signal averaging technique.
Methods: Signal averaging electrocardigraphy allows high resolution ECG technique to eliminate interference noise signals in the recorded ECG. The algorithm use automatic ECG trigger function for signal averaged transthoracic, transesophageal and intra-cardiac ECG signals with novel LabVIEW software.
Results: The analysis in the time domain evaluated fractionated atrial signals at the end of the signal averaged P-wave and fractionated ventricular signals at the end of the QRS complex. We evaluated atrial flutter in the time domain with two-to-one atrioventricular conduction, 212.0 ± 4.1 ms atrial cycle length, 426.0 ± 8.2 ms ventricular cycle length, 58.2 ± 1.8 ms P-wave duration, 119.6 ± 6.4 ms PQ duration, 103.0 ± 2.4 ms QRS duration and 296.4 ± 6.8 ms QT duration. The analysis in the frequency domain evaluated high frequency fractionated atrial signals during the P-wave and high frequency fractionated ventricular signals during QRS complex.
Conclusions: Spectral analysis of signal averaging electrocardiography with novel LabVIEW software can be utilized to evaluate atrial and ventricular conduction delays in patients with atrial fibrillation and ventricular tachycardia. Complex fractionated atrial and ventricular electrocardiograms may be useful parameters to evaluate electrical cardiac bradycardia and tachycardia signals in atrial fibrillation and ventricular tachycardia ablation.
Oesophageal Electrode Probe and Device for Cardiological Treatment and/or Diagnosis (US20200261024)
(2020)
An oesophageal electrode probe for bioimpedance measurement and/or for neurostimulation is provided; a device for transoesophageal cardiological treatment and/or cardiological diagnosis is also provided; a method for the open-loop or closed-loop control of a cardiological catheter ablation device and/or a cardiological, circulatory and/or respiratory support device is also provided. The oesophageal electrode probe comprises a bioimpedance measuring device for measuring the bioimpedance of at least one part of tissue surrounding the oesophageal electrode probe. The bioimpedance device comprises at least one first and one second electrode. The at least one first electrode is arranged on a side of the oesophageal electrode probe facing towards the heart. The at least one second electrode is arranged on a side of the oesophageal electrode probe facing away from the heart. The device comprises the oesophageal electrode probe and a control and/or evaluation device.
Oesophageal Electrode Probe and Device for Cardiological Treatment and/or Diagnosis (EP3706626A1)
(2020)
The invention relates to an oesophageal electrode probe (10) for bioimpedance measurement and/or for neurostimulation; a device (100) for transoesophageal cardiological treatment and/or cardiological diagnosis; and a method for the open-loop or closed-loop control of a cardiac catheter ablation device and/or a cardiac, circulatory and/or respiratory support device. The oesophageal electrode probe comprises a bioimpedance measuring device for measuring the bioimpedance of at least one part of the tissue surrounding the oesophageal electrode probe. The bioimpedance device comprises at least one first and one second electrode, wherein the at least one first electrode (12A) is arranged on a side (14) of the oesophageal electrode probe facing towards the heart and the at least one second electrode (12B) is arranged on a side (16) of the oesophageal electrode probe facing away from the heart. The device (100) comprises the oesophageal electrode probe (10) and a control and/or evaluation device (30), which is configured for receiving a first bioimpedance measurement signal from the at least one first electrode (12A) and a second bioimpedance measurement signal from the at least one second electrode (12B), and comparing same, and generating a control signal on the basis of the comparison. The control signal can be a signal for the open-loop or closed-loop control of a cardiac catheter ablation device and/or a cardiac, circulatory and/or respiratory support device.
Cardiac resynchronization therapy (CRT) is an established biventricular pacing therapy in heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically as CRT responder. Purpose of the study was to evaluate electrical left atrial conduction delay (LACD) with focused transesophageal electrocardiography in CRT responder and CRT non-responder.
Methods: Twenty heart failure patients (age 66.6±8.2 years; 2 females, 18 males) with New York Heart Association functional class 3.0±0.3 and 174.2±40.2ms QRS duration were analysed using posterior left atrial transesophageal electrocardiography with hemispherical electrodes. Electrical LACD was measured between onset and offset of transesophageal left atrial signal before implantation of CRT devices.
Results: Electrical LACD could be evaluated by bipolar transesophageal left atrial electrocardiography using TO Osypka electrode in all heart failure patients with negative correlation between 54.7±18.1ms LACD and 24.9±6.4% left ventricular ejection fraction (r=-0.65, P=0.002). There were 16 CRT responders with reduction of New York Heart Association functional class from 3.0±0.29 to 2.1±0.2 (r=0.522, P=0.038) during 9.41±10.96 month biventricular pacing and negative correlation between 49.6±14.2ms LACD and 26.0±6.2% left ventricular ejection fraction (r=-0.533, P=0.034). There were 4 CRT non-responders with no reduction of New York Heart Association functional class from 3.0±0.4 to 2.8±0.5 (r=0.816, P=0.184) during with 13.88±16.39 month biventricular pacing and no correlation between 75.25±19.17ms LACD and 20.75±6.4% left ventricular ejection fraction (r=-0.831, P=0.169).
Conclusions: Focused transesophageal left atrial electrocardiography can be utilized to analyse electrical LACD in heart failure patients. LACD correlated negative with left ventricular ejection fraction in CRT responders. LACD may be a useful parameter to evaluate electrical left atrial desynchronization in heart failure patients.
Cardiac resynchronization therapy is an established therapy for heart failure patients. The aim of the study was to evaluate electrical left cardiac atrioventricular delay and interventricular desynchronization in sinus rhythm cardiac resynchronization therapy responder and non-responder. Cardiac electrical desynchronization were measured by surface ECG and focused transesophageal bipolar left atrial and left ventricular ECG before implantation of cardiac resynchronization therapy defibrillators. Preoperative electrical cardiac desynchronization was 195.7 ± 46.7 ms left cardiac atrioventricular delay and 74.8 ± 24.5 ms interventricular delay in cardiac resynchronization therapy responder. Cardiac resynchronization therapy responder New York Heart Association class improved during long term biventricular pacing. Transesophageal left cardiac atrioventricular delay and interventricular delay may be additional useful parameters to improve patient selection for cardiac resynchronization therapy.
Background: Cardiac resynchronization therapy (CRT) is an established therapy for heart failure (HF) patients (P) with reduced left ventricular (LV) ejection fraction and electrical interventricular desynchronization, but not all P improved clinically. The aim of the study was to evaluate electrical interventricular delay (IVD) to LV delay (LVD) ratio in atrial fibrillation (AF) CRT responder (R) and non-responder (NR).
Methods: AF P (n = 18, age 60.6 ± 11.4 years, 1 female, 17 males) with HF New York Heart Association (NYHA) class 3.0 ± 0.2, 25.3 ± 5.9 % LV ejection fraction and 157.8 ± 24.4 ms QRS duration (QRSD) were measured by surface ECG and focused transesophageal bipolar LV ECG before implantation of CRT pacemaker (n = 2) or CRT defibrillator (n = 16). IVD was measured between onset of QRS in the surface ECG and onset of LV signal in the LV ECG. LVD was measured between onset and offset of LV signal in the LV ECG.
Results: Electrical ventricular desynchronization in AF CRT P were 61.9 ± 26.9ms IVD, 80.6 ± 24.3ms LVD, 0.85 ± 0.41 IVD-LVD-ratio (Figure), 3.12 ± 1.89 QRSD-IVD-ratio and 2.07 ± 0.47 QRSD-LVD-ratio. There were 72.2 % AF CRT R (n = 13) with 64.2 ± 24.6ms IVD and 77.8 ± 21.6ms LVD with Pearson correlation to 0.89 ± 0.39 IVD-LVD-ratio (r = 0.87, P < 0.01; r = -0.69, P < 0.01), 2.82 ± 1.32 QRSD-IVD-ratio (r = -0.76, P < 0.01; r = 0.67, P = 0.011) and 2.13 ± 0.46 QRSD-LVD-ratio (r = 0.57, P = 0.041; r = -0.85, P < 0.01). There were 27.8% AF CRT NR (n = 5) with 56.0 ± 34.5ms IVD and 87.8 ± 31.9ms LVD without correlation to 0.74 ± 0.48 IVD-LVD-ratio, 3.88 ± 2.98 QRSD-IVD-ratio and 1.90 ± 0.48 QRSD-LVD-ratio. During 15.3 ± 13.1 month CRT follow-up, the AF CRT R NYHA class improved from 3.0 ± 0.2 to 2.2 ± 0.3 (P < 0.001). During 18.8 ± 20.7 month CRT follow-up, the AF CRT NR NYHA class not improved from 3 to 3.3 ± 0.97.
Introduction: Cardiac resynchronization therapy (CRT) with left ventricular (LV) pacing is an established therapy for heart failure (HF) patients (P) with ventricular desynchronisation and reduced LV ejection fraction (EF). The aim of this study was to test the utilization of the transesophageal approach to measure arterial pulse pressure (PP) during LV pacing and electrical interventricular conduction delay (IVCD), to better select patients for CRT.
Methods: 32 HF patients (age 64 ± 10 years; 5 females, 27 males) with New York Heart Association (NYHA) class 2.8 ± 0.6, 27 ± 11 % LV EF and 155 ± 35 ms QRS duration were analysed with semi-invasive left cardiac pacing and electrocardiography. Esophageal TO8 Osypka catheter of 10.5 F diameter was perorally applied to the esophagus and placed in the position of maximum left atrial (LA) deflection and maximum LV deflection to measure PP with VAT or D00 pacing modes.
Results: Temporary transesophageal LV pacing was possible with VAT mode (n=16) and D00 mode (n=16) in all patients. In 15 Δ-PP-responders, PP was higher during LV pacing on than LV pacing off (78.3 ± 26.6 versus 65.9 ± 23.7 mmHg, P < 0.001) and NYHA class improved from 3.1 ± 0.35 to 2.1 ± 0.35 (P < 0.001) during 29 ± 26 month biventricular (BV) pacing follow-up (6 Medtronic and 9 Boston BV pacing devices). In 17 Δ-PP-non-responders, PP was not higher during LV pacing on than LV pacing off (61.5 ± 23.9 versus 60.9 ± 23.5 mmHg, P = 0.066). IVCD was significant longer in Δ-PP-responders than in Δ-PP-non-responders (87 ± 33 ms versus 37± 29 ms, P < 0.001).
Conclusion: Semi-invasive transesophageale LA and LV pacing with D00 and VAT mode and LV electrogram recording may be useful techniques to predict CRT improvement.
Introduction: Cardiac resynchronisation therapy (CRT) with atrioventricular (AV) and interventricular (VV) optimized biventricular pacing (BV) is an established therapy for heart failure (HF) patients. The aim of the study was to compare AV and VV delay optimization with cardiac output (CO), cardiac index (CI), contractility index (IC) and acceleration index (ACI) impedance cardiographic (ICG) methods in CRT.
Methods: 15 HF patients (age 66 ± 10 years; 2 females, 13 males) in New York Heart Association (NYHA) class 3.1 ± 0.4, left ventricular (LV) ejection fraction 21.3 ± 7.8 % and QRS duration 176.1 ± 31.7 ms underwent AV and VV delay optimization with CO, CI, IC and ACI (Cardioscreen ®, Medis GmbH, Ilmenau, Germany) at different AV and VV delay BV pacing settings versus right ventricular (RV) pacing one day after implantation of a CRT device.
Results: Optimal AV delay after atrial sensing was 108.6 ± 20.3 ms (n=14) and optimal AV delay after atrial pacing 190 ± 14.1 ms (n=2) with AV delay range from 80 ms to 200 ms. Optimal VV delay was -12.3 ± 25.9 ms left ventricular before RV pacing. RV versus BV pacing mode resulted in improvement of CO from 3.4 ± 1.2 l/min to 4.4 ± 1.4 l/min (p<0.001), CI from 1.8 ± 0.64 l/min/m² to 2.4 ± 0.78 l/min/m² (p<0.001), IC from 0.028 ± 0.011 1/s to 0.036 ± 0.013 1/s (p<0.001) and ACI from 0.667 ± 0.227 1/s² to 0.834 ± 0.282 1/s² (p<0.002). During 34 ± 26 month BV pacing, the NYHA class improved from 3.1 ± 0.4 to 2.1 ± 0.4 (p<0.001).
Conclusion: AV and VV delay optimized BV pacing acutely improve hemodynamic parameters of transthoracic ICG and their NYHA class during long-term follow-up. ICG may be a simple and useful technique to optimize AV and VV delay in CRT.
Introduction: Cardiac resynchronisation therapy (CRT) with atrioventricular (AV) and interventricular (VV) optimized biventricular pacing (BV) is an established therapy for heart failure (HF) patients with electrical interventricular conduction delay (IVCD). The aim of the study was to compare AV and VV delay optimization with cardiac output (CO) and acceleration index (ACI) impedance cardiographic (ICG) methods.
Methods: HF patients with IVCD 86.8 ± 33 ms (n=15, age 66 ± 10 years; 2 females, 13 males), New York Heart Association (NYHA) functional class 3.1 ± 0.4, left ventricular (LV) ejection fraction 21.3 ± 7.8 % and QRS duration 176.1 ± 31.7 ms underwent AV and VV delay optimization with CO and ACI methods (Cardioscreen, Medis GmbH, Ilmenau, Germany). After evaluation of optimal AV delay, we evaluated optimal VV delay during simultaneous LV and right ventricular (RV) pacing (LV=RV), LV before RV pacing (LV-RV) and RV before LV pacing (RV-LV).
Results: Optimal VV delay was -12.3 ± 25.9 ms LV-RV pacing with VV delay range from -80 ms LV-RV pacing to +20 ms RV-LV pacing and RV=LV pacing. Optimal AV delay after atrial sensing was 108.6 ± 20.3 ms (n=14) and optimal AV delay after atrial pacing 190 ± 14.1 ms (n=2) with AV delay range from 80 ms to 200 ms. RV versus BV pacing mode resulted in improvement of CO from 3.4 ± 1.2 l/min to 4.4 ± 1.4 l/min (p<0.001) and ACI from 0.667 ± 0.227 1/s² to 0.834 ± 0.282 1/s² (p<0.002). During 34 ± 26 month BV pacing, the NYHA class improved from 3.1 ± 0.4 to 2.1 ± 0.4 (p<0.001).
Conclusion: AV and VV delay optimized BV pacing acutely improve ICG CO and ACI and their NYHA class during long-term follow-up. ICG may be a simple and useful technique to optimize AV and VV delay in CRT.