Publications by authors named "Bert Hansky"

19 Publications

  • Page 1 of 1

[Troubleshooting in Patients with Implanted Pacemaker and ICD].

Dtsch Med Wochenschr 2018 11 30;143(22):1608-1616. Epub 2018 Oct 30.

Because of the growing number of implanted cardiac pacemakers and defibrillators and the ever-increasing complexity of these devices a fundamental knowledge of device malfunctions is of utmost importance even for the non-cardiology physician. Apart from hardware problems such as device infection, lead fracture or dislocation, basic knowledge of the pacemaker sensing and pacing algorithms is also necessary in order to judge the stimulation behavior in different clinical settings. With this respect, there are specific problems for antibradycardia and resynchronizing pacemakers as well as implantable defibrillators. This article gives an overview of the most common problems with cardiac pacemakers and defibrillators as well as the differential diagnostic and therapeutic management for the physician without specific training in arrhythmology.
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http://dx.doi.org/10.1055/a-0560-3180DOI Listing
November 2018

[Transvenous neurostimulation in central sleep apnea associated with heart failure].

Herzschrittmacherther Elektrophysiol 2018 Dec 10;29(4):377-382. Epub 2018 Oct 10.

Klinik für Kardiologie und Internistische Intensivmedizin, Städtische Kliniken Bielefeld, Lehrkrankenhaus der Westfälischen Wilhelms-Universität Münster, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.

Sleep-related breathing disorders can be classified as either obstructive (OSA) or central sleep apnea (CSA). Whereas there is substantial knowledge about the pathophysiology and sound recommendations for the diagnosis and treatment of OSA, the origin of CSA is still incompletely understood, patient identification is difficult and the necessity for specific treatment is under debate. CSA often accompanies heart failure and is associated with an adverse prognosis. Optimized heart failure treatment reduces CSA and is thus the cornerstone of CSA treatment. In contrast to OSA, noninvasive ventilation does not lead to prognostic improvement in CSA and ASV ventilation may even lead to an increase in mortality. Transvenous neurostimuation of the phrenic nerve is currently under clinical investigation as a new therapeutic modality for CSA. Early results demonstrate positive effects on sleep parameters and quality of life without any evidence for a negative impact on mortality. However, these results await confirmation in larger studies before this new approach can be advocated for routine clinical use.
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http://dx.doi.org/10.1007/s00399-018-0591-xDOI Listing
December 2018

Heart on a string: a novel approach to managing difficult access to the left pericardiacophrenic vein for phrenic nerve stimulation.

Herzschrittmacherther Elektrophysiol 2018 Sep;29(3):322-324

Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld Mitte, Teutoburger Straße 50, 33604, Bielefeld, Germany.

This case highlights the difficulties in pacing lead implantation for transvenous phrenic nerve stimulation to treat central sleep apnea in heart failure. Cannulation of the left pericardiacophrenic vein (PPV) initially failed due to vessel tortuosity. On the basis of sound knowledge of collateral vessels, the inferior phrenic vein (IPV), which drains into the inferior vena cava, was intubated using a guide catheter. A guidewire could be retrogradely advanced via the IPV to the left PPV and brachiocephalic vein. The wire was captured via a snare catheter, such that the heart was held "on a string", thereby providing adequate support for lead placement.
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http://dx.doi.org/10.1007/s00399-018-0587-6DOI Listing
September 2018

[Practical aspects of pacemaker indications].

MMW Fortschr Med 2017 Jun;159(11):54-61

Klinikum Bielefeld, Bielefeld, Deutschland.

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http://dx.doi.org/10.1007/s15006-017-9043-5DOI Listing
June 2017

[Device related infections. How to identify and how to treat].

Herzschrittmacherther Elektrophysiol 2013 Sep;24(3):148-51

Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bielefeld, Teutoburger Strasse 50, 33604, Bielefeld, Germany.

Because of the enormous increase in pacemaker and implantable cardioverter-defibrillator (ICD) implants, the number of device-related infections has also increased considerably. In fact, this increase has been out of proportion due to the higher patient age at implant, the increased co-morbidity of patients and the higher complexity of the implanted devices. Apart from few exceptions the infection of a pacemaker or ICD requires complete explantation of the whole system with adjunctive antibiotic therapy. The diagnosis of device infection, the indication and different options for therapy are thoroughly discussed in this article according to the current status of knowledge.
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http://dx.doi.org/10.1007/s00399-013-0286-2DOI Listing
September 2013

[Practical aspects of pacemaker and ICD-lead extractions].

Herzschrittmacherther Elektrophysiol 2013 Sep;24(3):158-64

Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld, Bielefeld, Germany.

Special tools for lead removal enables transvenous lead extractions without cardiac exposure. The risk of fatal complications during extraction of long-term implanted leads requires detailed knowledge and trained physicians. In addition to patients’ age and gender, individual extraction risk factors are access and time since implantation, lead position, kind and number of leads. Locking stylets to anchor the lead within the lumen are necessary in all extraction procedures while the use of external sheaths is optional. Higher risk of cardiac or central vein perforation during lead mobilisation with external laser sheaths has to be respected, and these tools should be used with strong indication only. In cases of high risk, lead explantation with an open heart procedure should be considered as an alternative.
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http://dx.doi.org/10.1007/s00399-013-0282-6DOI Listing
September 2013

A silent gigantic solitary fibrous tumor of the pleura: case report.

J Cardiothorac Surg 2011 Sep 29;6:122. Epub 2011 Sep 29.

Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstr, 11, 32545 Bad Oeynhausen, Germany.

Solitary fibrous tumor of the pleura is a rare mesenchymal tumor, representing less than 5% of all neoplasms associated with the pleura. A 57-year-old man had general malaise without chest symptoms for 1 month. A chest roentgenogram and computed tomography showed a giant mass in the left thorax. Although the tumor compressed the descending aorta and other mediastinal structures strongly, thereby shifting them to the right side, the patient had no symptoms except malaise. The tumor was successfully resected via two separate thoracotomies. The tumor was measured (20 cm × 19 cm × 15 cm) and weighed (2150 g). The tumor was histologically and immunohistochemically diagnosed as benign. Although SFT is benign, a long follow-up period is essential as even patients with complete resection are at risk of recurrence many years after surgery.
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http://dx.doi.org/10.1186/1749-8090-6-122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193814PMC
September 2011

A single institution experience with pacemaker implantation in a pediatric population over 25 years.

Pacing Clin Electrophysiol 2010 Sep;33(9):1112-8

Department of Pediatric Cardiology, Ruhr University Bochum, North Rhine Westphalia, Germany.

Background: With the development of new technical devices and software more appropriate for pediatric patients, pacemaker implantations in children and young adults have increased over time. It is necessary to monitor the mid- and long-term consequences. The decision for the implantation of a cardiovertor defibrillator (ICD) in children remains challenging despite technical improvements.

Objective: To assess the safety of pacemaker implantation in children, to review old and new indications, and to point out changes of management over time.

Patients And Methods: Between 1984 and 2009, 181 patients required the implantation of a pacemaker or an ICD device at the Heart and Diabetes Centre in Bad Oeynhausen, Germany. Their charts have been reviewed pro- and retrospectively for indications, complications, longevity of the device, and the natural course.

Results: Indications have been high-degree atrioventricular block in 65% (postoperative 55%) and sinus node dysfunction in 24% (postoperative 90%), including three patients with vasovagally mediated significant bradycardia. Eleven percent required the implantation of an ICD device secondary to significant ventricular arrhythmias. The indication was class II in one-third of all patients. Complications requiring revision occurred in six patients (3.3%); one of them required removal of the device due to an infection. Ten patients died, but none related to pacemaker implantation.

Conclusion: Pacemaker implantation even in young pediatric patients is generally safe. No complication led to the death of a patient. The number of class II indications has been increasing. The future aim is to improve pediatric algorithms and to prevent unnecessary pacing.
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http://dx.doi.org/10.1111/j.1540-8159.2010.02781.xDOI Listing
September 2010

Cardiac resynchronization therapy: long-term alternative to cardiac transplantation?

Ann Thorac Surg 2009 Feb;87(2):432-8

Department of Cardio-Thoracic Surgery, Heart- and Diabetes Center North-Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.

Background: Cardiac transplantation remains the gold standard for treating end-stage heart failure. However, because of donor shortage and posttransplant complications alternative options are needed.

Methods: We investigated the impact of cardiac resynchronization therapy on clinical outcome in 545 patients with left bundle-branch block and interventricular asynchrony, who fulfilled the cardiac criteria for cardiac transplantation listing. Primary end point was heart failure death. Secondary end points were New York Heart Association class, functional (cardiopulmonary exercise tolerance, 6-minute hall walk distance), and morphologic (left ventricular end-diastolic diameter) factors.

Results: The average follow-up period was 39.6 months (standard deviation, 26.1 months). In total, 1,784 years of observation were accrued. The percentage of nonresponders (no functional and morphologic improvement during follow-up) was 21.2%. One-year and 3-year freedom from heart failure death was 92.3% and 77.3%, respectively. Functional variables improved, but the left ventricular end-diastolic diameter decreased during the first 6 months of cardiac resynchronization therapy only in patients who survived during follow-up. Under cardiac resynchronization therapy, 42.5% (n = 34) of the cardiac transplantation candidates with atrial fibrillation at baseline returned to sinus rhythm.

Conclusions: Our data suggest that cardiac resynchronization therapy is a reliable long-term therapeutic option for the treatment of end-stage heart failure and intraventricular asynchrony.
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http://dx.doi.org/10.1016/j.athoracsur.2008.09.071DOI Listing
February 2009

Stenting of coronary veins: a critical comment.

Authors:
Bert Hansky

Europace 2008 Dec;10(12):1363

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http://dx.doi.org/10.1093/europace/eun305DOI Listing
December 2008

Lethal atrioesophageal fistula after pulmonary vein isolation using high-intensity focused ultrasound (HIFU).

Heart Rhythm 2008 Jan 24;5(1):145-8. Epub 2007 Aug 24.

Bielefeld Mitte Hospital, Department for Cardiology and Internal Intensive Care Medicine, Bielefeld, Germany.

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http://dx.doi.org/10.1016/j.hrthm.2007.08.023DOI Listing
January 2008

Coronary sinus dissection during left ventricular pacing electrode implantation.

Ann Thorac Cardiovasc Surg 2007 Aug;13(4):275-7

Department of Cardiovascular Surgery, Nihon University Hospital, Tokyo, Japan.

Coronary sinus (CS) dissection during biventricular pacing electrode implantation is a complication that rarely develops. A 71-year-old female with recurrent ventricular tachycardia, heart decompensation, and poor left ventricular function because of dilated cardiomyopathy was admitted for the implantation of a cardioverter-defibrillator for biventricular pacing. During the operation, we experienced a CS dissection with hematoma in the left ventricle wall while introducing the guidance catheter into the CS. However, the pacing lead was successfully implanted into the posterolateral vein using the "over-the-wire" technique. The postoperative electrocardiogram showed a decreased QRS; meanwhile, the echocardiography revealed dimensional reduction and functional improvement of the left ventricle.
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August 2007

Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases.

Pacing Clin Electrophysiol 2007 Jan;30(1):44-9

Heart Center NRW, University of Bochum, Bad Oeynhausen, Germany.

Background: Securing transvenous left ventricular (LV) pacing leads without an active fixation mechanism in proximal coronary vein (CV) segments is usually challenging and frequently impossible. We investigated how active fixation leads can be safely implanted in this location, how to avoid perforating the free wall of the CV, and how to recognize and respond to perforations.

Materials And Methods: In five patients with no alternative to LV pacing from proximal CV segments, 4 Fr SelectSecure (Medtronic, Minneapolis, MN, USA) leads, which have a fixed helix, were implanted through a modified 6 Fr guide catheter with a pre-shaped tip (Launcher, Medtronic).

Results: Active fixation leads were successfully implanted in proximal CVs in five patients. There were no complications. Acute and chronic pacing thresholds were comparable to those of conventional CV leads. The pre-shaped guide catheter tip remains in close proximity to the myocardial aspect of the CV, directing the lead helix toward a safe implantation site.

Conclusions: If only proximal CV pacing sites are available, 4 Fr SelectSecure leads can be safely implanted through a modified Launcher guide catheter, avoiding more invasive implantation techniques. Other than venous stenting or implantation of leads with retractable tines, SelectSecure leads are expected to remain extractable.
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http://dx.doi.org/10.1111/j.1540-8159.2007.00578.xDOI Listing
January 2007

Left ventricular pacing through the anterior interventricular vein in a patient with mechanical tricuspid, aortic and mitral valves.

Ann Thorac Surg 2005 Jul;80(1):328-30

Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany.

Transvenous endocardial pacemaker implantation is contraindicated in patients after mechanical tricuspid valve replacement. A 76-year-old woman who suffered from bradyarrhythmia was implanted with a left ventricular pacing lead through a transvenous coronary vein after aortic, mitral, and tricuspid valve replacements. There were no complications and the stimulation thresholds were stable. The use of coronary vein leads provides a minimally invasive approach, safety, and effective stimulation for patients with a mechanical tricuspid valve.
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http://dx.doi.org/10.1016/j.athoracsur.2004.01.041DOI Listing
July 2005

Endocardial pacing after Fontan-type procedures.

Pacing Clin Electrophysiol 2005 Feb;28(2):140-8

Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany.

Background: Sinus node dysfunction is a frequent complication of Fontan-type procedure. Epicardial pacing is considered as the standard treatment for these patients.

Methods And Results: We evaluated an endocardial approach in seven patients using a 4.1 French bipolar lumenless lead (SelectSecure) that is positioned through a steerable guiding catheter. Either a purely transvenous or an open transatrial approach can be used for lead placement. The smallest child weighed 12 kg. Individual anatomy was assessed preimplantation using magnetic resonance imaging and injection of radiographic contrast agent through the guiding catheter. A pullback pressure recording was used to confirm unimpaired blood flow into the pulmonary artery. Five of our seven patients underwent de novo transvenous atrial lead implantation for AAIR pacing. In the remaining two patients, both atrial and ventricular leads were inserted. One patient with an intraatrial tunnel underwent transvenous-lead placement. The remaining patient with an extracardiac conduit received atrial and ventricular leads implanted through a guiding catheter inserted through an atriotomy. The postoperative management included short- or long-term oral anticoagulation.

Conclusions: Transvenous endocardial lead implantation avoids the problem of increasing capture thresholds typically observed with epicardial leads. Due to its high tensile strength and lumenless design, the isodiametric lead is expected to remain extractable for an extended period of time.
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http://dx.doi.org/10.1111/j.1540-8159.2005.04006.xDOI Listing
February 2005

Effect of cardiac resynchronization therapy on global and regional oxygen consumption and myocardial blood flow in patients with non-ischaemic and ischaemic cardiomyopathy.

Eur Heart J 2005 Jan 30;26(1):70-6. Epub 2004 Nov 30.

Institute of Molecular Biophysics, Radiopharmacy, and Nuclear Medicine, Heart and Diabetes Center North Rhine-Westphalia, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.

Aims: We studied the effects of cardiac resynchronization therapy (CRT) on global and regional myocardial oxygen consumption (MVO2) and myocardial blood flow (MBF) in non-ischaemic (NICM) and ischaemic dilated cardiomyopathy (ICM).

Methods And Results: Thirty-one NICM and 11 ICM patients, all of them acute responders, were investigated. MVO2 and MBF were obtained by 11C-acetate PET before and after 4 months of CRT. In NICM global MVO2 and MBF did not change during CRT, while the rate pressure product (RPP) normalized MVO2 increased (P=0.03). Before CRT regional MVO2 and MBF were highest in the lateral wall and lowest in the septum. Under therapy, MVO2 and MBF decreased in the lateral wall (P=0.045) and increased in the septum (P=0.045) resulting in a more uniform distribution. In ICM, global MVO2, MBF, and RPP did not change under CRT. Regional MVO2 and MBF showed no significant changes but a similar tendency in the lateral and septal wall to that in NICM.

Conclusion: CRT induces changes of MVO2 and MBF on a regional level with a more uniform distribution between the myocardial walls and improved ventricular efficiency in NICM. Based on the investigated parameters, CRT appears to be more effective in NICM than in ICM.
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http://dx.doi.org/10.1093/eurheartj/ehi046DOI Listing
January 2005

Successful heart-lung transplantation in a patient with kyphoscoliosis.

J Heart Lung Transplant 2003 Apr;22(4):468-73

Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany.

The association is well established between congenital heart disease and spinal deformities such as scoliosis or kyphosis, but data are not available for risks and the outcome of heart surgery in patients with spinal deformities. We report a case of successful orthotopic heart lung transplantation in a patient with complex congenital heart disease and severe chest deformity who had undergone previous spinal fusion surgery for progressive right convex thoracic kyphoscoliosis.
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http://dx.doi.org/10.1016/s1053-2498(02)00489-8DOI Listing
April 2003

Coronary vein balloon angioplasty for left ventricular pacemaker lead implantation.

J Am Coll Cardiol 2002 Dec;40(12):2144-9

Department of Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany.

Objectives: Retrospective analysis of five cases of coronary vein balloon angioplasty performed to allow insertion of left ventricular pacing leads.

Background: Coronary vein stenoses or an insufficient vessel caliber can preclude transvenous placement of coronary vein leads.

Methods: We compared our total patient population (n = 218), in whom we implanted coronary vein leads, to those five patients who required coronary vein angioplasty to allow lead placement. Standard over-the-wire coronary artery balloon angioplasty catheters were used to dilate the vessel to 2.5 mm (n = 3) or 3.5 mm (n = 2).

Results: Transvenous lead placement succeeds in >99% of patients. Four cases of target vein stenoses and one case of a vein of insufficient caliber were successfully treated by balloon angioplasty. There were no complications.

Conclusions: Coronary vein angioplasty is an effective and safe technique to permit transvenous left ventricular pacing lead insertion in cases of target vein stenoses or insufficient target vein caliber.
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http://dx.doi.org/10.1016/s0735-1097(02)02601-3DOI Listing
December 2002

Left heart pacing--experience with several types of coronary vein leads.

J Interv Card Electrophysiol 2002 Feb;6(1):71-5

Heart Center NRW, Ruhr-University of Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.

Our experience with 121 coronary vein (CV) leads in 116 patients shows that CV leads are the leads of choice for pacing the left ventricle (LV). The information gained from pre-operative venous angiography permits individual selection of the most appropriate lead model for each case. The use of steerable electrophysiology catheters facilitates guide catheter cannulation of the coronary sinus (CS) when the anatomy is difficult and reduces the risk of complications. By selecting the CV lead model most suitable for each individual patient, we achieved successful implantation in 99.1% of patients. In this day and age, epicardial electrodes should be restricted to cases with CS anomalies which make CS cannulation impossible, and to LV lead implantation during heart surgery.
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http://dx.doi.org/10.1023/a:1014140716802DOI Listing
February 2002
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