Publications by authors named "Alicia Jeanette Fischer"

7 Publications

  • Page 1 of 1

Impact of specialized electrophysiological care on the outcome of catheter ablation for supraventricular tachycardias in adults with congenital heart disease: Independent risk factors and gender aspects.

Heart Rhythm 2021 11 13;18(11):1852-1859. Epub 2021 Jul 13.

Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany.

Background: Limited data exist on the impact of gender and specialized care on the requirement of repeat treatment of supraventricular tachycardia (SVT) in adult patients with congenital heart disease (ACHDs).

Objective: The study aimed to assess independent predictors of a combined end point of re-catheter ablation (CA) or cardioversion at 3 years of follow-up, including the impact of gender and specialized ACHD care.

Methods: All ACHDs registered in a database of one of the largest German health insurers (≈9.2 million members) who underwent CA for SVT were analyzed.

Results: Of 38,892 ACHDs 16 years or older, 485 (49.5% women; median age 58.4 years; interquartile range 42.1-70.8 years) underwent CA for SVT. Over 3-year follow-up, the number of yearly CA procedures increased significantly, particularly for atrial fibrillation (+195%) and atrial flutter (+108%). Moderate to severe complexity heart disease (odds ratio [OR] 1.66; P = .01), advanced age (OR 1.85 per year; P = .02), chronic kidney disease (OR 1.70; P = .01), and atrial fibrillation (OR 2.02; P = .002) emerged as independent predictors of retreatment. Retreatment was significantly less often performed if primary CA was carried out at a specialized CHD center (P = .009) in patients with moderate to severe complexity heart disease. Women treated in specialist centers had a 1.6-fold reduced risk of undergoing retreatment (P = .01).

Conclusion: CA for SVT is increasingly performed in ACHDs, especially for atrial flutter and atrial fibrillation. Patients with moderate and severe complexity congenital heart defects and female ACHDs benefit from upfront referral to specialized CHD centers for CA. Centralization of care for ACHD arrhythmias should thus be advocated.
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http://dx.doi.org/10.1016/j.hrthm.2021.07.009DOI Listing
November 2021

Antiarrhythmic drugs-safety and efficacy during pregnancy.

Herzschrittmacherther Elektrophysiol 2021 Jun 29;32(2):145-151. Epub 2021 Mar 29.

Electrophysiology Bremen, Heart Center Bremen, Bremen, Germany.

When deciding on antiarrhythmic drug (AAD) treatment, a thorough knowledge of the physiological adaptation processes that occur during pregnancy and their effect on metabolism and the efficacy of AAD is mandatory. Beyond the desired effects of AAD therapy, side effects can occur in pregnant women. Furthermore, potential harm to fetal development-depending on gestational age-needs to be considered. A thorough evaluation of potential risks opposed to expected benefits for mother and fetus should be carried out before initiation of AAD treatment. Regular maternal echocardiography and fetal sonographic examination during pregnancy under AAD treatment are advisable. If possible, serum concentrations of AAD should be measured on a regular basis. Due to electrolyte and volume imbalances after delivery, maternal monitoring is recommended for approximately 48 h under AAD therapy. Current guidelines are based on almost historic analyses, where AAD were often prescribed for other indications than rhythm disorders. In clinical practice, AAD predominantly used during pregnancy are intravenous adenosine for acute treatment of atrioventricular nodal dependent tachycardias, whereas betablockers, sotalol, and flecainide can be orally administered for long-term therapy.
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http://dx.doi.org/10.1007/s00399-021-00759-2DOI Listing
June 2021

When a multipolar catheter misses an "arm": A known complication experienced anew.

HeartRhythm Case Rep 2020 Oct 22;6(10):745-748. Epub 2020 Jul 22.

Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

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http://dx.doi.org/10.1016/j.hrcr.2020.07.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573382PMC
October 2020

Utility of deep learning networks for the generation of artificial cardiac magnetic resonance images in congenital heart disease.

BMC Med Imaging 2020 10 8;20(1):113. Epub 2020 Oct 8.

Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany.

Background: Deep learning algorithms are increasingly used for automatic medical imaging analysis and cardiac chamber segmentation. Especially in congenital heart disease, obtaining a sufficient number of training images and data anonymity issues remain of concern.

Methods: Progressive generative adversarial networks (PG-GAN) were trained on cardiac magnetic resonance imaging (MRI) frames from a nationwide prospective study to generate synthetic MRI frames. These synthetic frames were subsequently used to train segmentation networks (U-Net) and the quality of the synthetic training images, as well as the performance of the segmentation network was compared to U-Net-based solutions trained entirely on patient data.

Results: Cardiac MRI data from 303 patients with Tetralogy of Fallot were used for PG-GAN training. Using this model, we generated 100,000 synthetic images with a resolution of 256 × 256 pixels in 4-chamber and 2-chamber views. All synthetic samples were classified as anatomically plausible by human observers. The segmentation performance of the U-Net trained on data from 42 separate patients was statistically significantly better compared to the PG-GAN based training in an external dataset of 50 patients, however, the actual difference in segmentation quality was negligible (< 1% in absolute terms for all models).

Conclusion: We demonstrate the utility of PG-GANs for generating large amounts of realistically looking cardiac MRI images even in rare cardiac conditions. The generated images are not subject to data anonymity and privacy concerns and can be shared freely between institutions. Training supervised deep learning segmentation networks on this synthetic data yielded similar results compared to direct training on original patient data.
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http://dx.doi.org/10.1186/s12880-020-00511-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542728PMC
October 2020

[Anatomic pitfalls and challenges of His bundle pacing].

Herzschrittmacherther Elektrophysiol 2020 Jun 6;31(2):104-110. Epub 2020 May 6.

Department of Cardiology, National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, London, Großbritannien.

Long-term right ventricular apical pacing is known to be deleterious for left ventricular function leading to the clinical picture of heart failure with all the possibly associated complications, ranging up to death of the affected patient. This led to the ambition to find alternative pacing sites such as pacing at the right ventricular outflow tract or septal pacing. An attractive alternative is selective His bundle pacing with the goal to use the physiologic His-Purkinje system in order to enable intrinsic conduction and physiologic myocardial contraction. To find and identify the His bundle poses a challenge for operators. For exact endocardial mapping, knowledge of the anatomic landmarks is as important as the ability to evaluate local electrocardiograms. The goal of this review is to characterize the anatomic landmarks to help physicians to identify these precise targets for His bundle pacing.
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http://dx.doi.org/10.1007/s00399-020-00680-0DOI Listing
June 2020

Management of obese patients with respiratory failure - A practical approach to a health care issue of increasing significance.

Respir Med 2016 08 7;117:174-8. Epub 2016 Jun 7.

Division of Cardiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.

In the general population, prevalence of obesity is increasing continuously. Concomitantly, a growing number of obese patients with severe illnesses presents at intensive care units (ICU). Particularly respiratory management of this patient group poses a challenge to intensive care physicians because of differences in respiratory anatomy and physiology in obese compared to non-obese individuals. Aim of this review is to present treatment options for critically ill obese patients requiring mechanical ventilation based on current studies concerning patient positioning, ventilatory regimen as well as extended therapy with veno-venous extracorporeal membrane oxygenation (ECMO). The ideal concept for respiratory management depends on multiple aspects and has to be determined individually. Knowledge of altered respiratory anatomy and physiology in obese patients and possible treatment options may facilitate respiratory management in this patient group.
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http://dx.doi.org/10.1016/j.rmed.2016.06.002DOI Listing
August 2016
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