Publications by authors named "Laurent Roten"

92 Publications

Validation of the 2019 Expert Consensus Algorithm for the Management of Conduction Disturbances After TAVR.

JACC Cardiovasc Interv 2021 May;14(9):981-991

Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address:

Objectives: The aim of this study was to validate the 2019 consensus algorithm in a large cohort of contemporary transcatheter aortic valve replacement (TAVR) patients.

Background: The optimal management of patients with atrioventricular conduction disturbances after TAVR is unknown. Guidance was consolidated in an expert consensus algorithm in 2019.

Methods: In a retrospective analysis of a prospective registry, patients were classified according to the 2019 consensus algorithm as eligible for early discharge (day 1 or 2 after TAVR), higher risk for high-degree atrioventricular block (HAVB) or complete heart block (CHB) or in need for a permanent pacemaker (PPM). The primary endpoint was the incidence of PPM implantation for HAVB or CHB within 30 days after TAVR. Patients with prior PPM or implantable cardioverter-defibrillator implantation, valve-in-valve procedures, or incomplete electrocardiographic data were excluded.

Results: Among 1,439 patients undergoing TAVR between January 2014 and December 2019, the 2019 consensus algorithm classified 73% as eligible for early discharge, 21% as at higher risk for HAVB or CHB, and 6% as in need of PPM. PPM implantation for HAVB or CHB occurred in 234 patients (16%) within 30 days after TAVR. The incidence of PPM implantation was 2.7% in the early discharge group, 41% in the group with higher risk for HAVB or CHB, and 100% in the PPM group.

Conclusions: The 2019 consensus algorithm safely identifies patients with no need for PPM implantation. This strategy allows more uniform management of TAVR patients and facilitates early discharge of low-risk patients without prolonged monitoring in 3 of 4 patients. However, the algorithm is less precise in the identification of high-risk patients.
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http://dx.doi.org/10.1016/j.jcin.2021.03.010DOI Listing
May 2021

Efficacy and safety of ethanol infusion into the vein of Marshall for mitral isthmus ablation.

J Cardiovasc Electrophysiol 2021 Apr 29. Epub 2021 Apr 29.

Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.

Introduction: Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM-EI) can facilitate the achievement of mitral isthmus block. This study sought to describe the efficacy and safety of this technique.

Methods And Results: Twenty-two consecutive patients (14 males, median age 71 years) with attempted VOM-EI for mitral isthmus ablation were included in the study. VOM-EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and the mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM-EI was necessary for 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM-EI and terminated or slowed by VOM-EI in 4 and 3 patients, respectively. The low-voltage area of the mitral isthmus region increased from 3.1 cm (interquartile range [IQR] 0-7.9) before to 13.2 cm (IQR: 8.2-15.0) after VOM-EI and correlated significantly with the volume of ethanol injected (p = .03). Median high-sensitive cardiac troponin-T increased significantly from 330 ng/L (IQR: 221-516) the evening of the procedure to 598 ng/L (IQR: 382-769; p = .02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%), and uneventful VOM dissection in two (11%). After a median follow-up of 3.5 months (IQR: 3.0-11.0), 10 of 18 patients (56%) with VOM-EI and available follow-up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri-mitral flutter diagnosed in three (60%).

Conclusion: VOM-EI is feasible, safe, and effective to achieve acute mitral isthmus block.
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http://dx.doi.org/10.1111/jce.15064DOI Listing
April 2021

ECG-Based Indices to Characterize Persistent Atrial Fibrillation Before and During Stepwise Catheter Ablation.

Front Physiol 2021 30;12:654053. Epub 2021 Mar 30.

Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Consistently successful patient outcomes following catheter ablation (CA) for treatment of persistent atrial fibrillation (pers-AF) remain elusive. We propose an electrocardiogram (ECG) analysis designed to (1) refine selection of patients most likely to benefit from ablation, and (2) examine the temporal evolution of AF organization indices that could act as clinical indicators of ongoing ablation effectiveness and completeness. Twelve-lead ECG was continuously recorded in 40 patients (61 ± 8 years) during stepwise CA (step-CA) procedures for treatment of pers-AF (sustained duration 19 ± 11 months). Following standard pre-processing, ECG signals were divided into 10-s epochs and labeled according to their temporal placement: pre-PVI (baseline), dur-PVI (during pulmonary vein isolation), and post-PVI (during complex-fractionated atrial electrograms and linear ablation). Instantaneous frequency (IF), adaptive organization index (AOI), sample entropy (SampEn) and f-wave amplitude (FWA) measures were calculated and analyzed during each of the three temporal steps. Temporal evolution of these measures was assessed using a statistical test for mean value transitions, as an indicator of changes in AF organization. Results were then compared between: (i) patients grouped according to step-CA outcome; (ii) patients grouped according to type of arrhythmia recurrence following the procedure, if applicable; (iii) within the same patient group during the three different temporal steps. Stepwise CA patient outcomes were as follows: (1) left-atrium (LA) terminated, not recurring (LTN, = 8), (2) LA terminated, recurring (LTR, = 20), and (3) not LA terminated, all recurring at follow-up (NLT, = 12). Among the LTR and NLT patients, recurrence occurred as AF in seven patients and atrial tachycardia or atrial flutter (AT/AFL) in the remaining 25 patients. The ECG measures indicated the lowest level of organization in the NLT group for all ablation steps. The highest organization was observed in the LTN group, while the LTR group displayed an intermediate level of organization. Regarding time evolution of ECG measures in dur-PVI and post-PVI recordings, stepwise ablation led to increases in AF organization in most patients, with no significant differences between the LTN, LTR, and NLT groups. The median decrease in IF and increase in AOI were significantly greater in AT/AFL recurring patients than in AF recurring patients; however, changes in the SampEn and FWA parameters were not significantly different between types of recurrence. Noninvasive ECG measures, though unable to predict arrhythmia recurrence following ablation, show the lowest levels of AF organization in patients that do not respond well to step-CA. Increasing AF organization in post-PVI may be associated with organized arrhythmia recurrence after a single ablation procedure.
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http://dx.doi.org/10.3389/fphys.2021.654053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042333PMC
March 2021

Pre-procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes.

Pacing Clin Electrophysiol 2021 Apr 15;44(4):703-710. Epub 2021 Mar 15.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Background: Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia-induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre-procedural PVC burden and outcome of idiopathic PVC catheter ablation.

Methods: Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24h-Holter at follow-up.

Results: Overall, 254 patients (median age 54 years [IQR 42-64]; 47% male) were enrolled. The median pre-ablation PVC-burden was 22% (IQR 11-31%), which was reduced to a post-ablation PVC burden of 0.3% (IQR 0-4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre-procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow-up (median 21% vs. 22%, p = .76). When assessed in pre-ablation PVC-burden groups of ≤5%, 6-15%, 16-30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC-burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52).

Conclusions: Pre-procedural Holter-determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.
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http://dx.doi.org/10.1111/pace.14211DOI Listing
April 2021

The SilenT AtRial FIBrillation (STAR-FIB) study programme - design and rationale.

Swiss Med Wkly 2021 Feb 20;151:w20421. Epub 2021 Feb 20.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.

Aims Of The Study: Anticoagulation of patients with screen-detected atrial fibrillation may prevent ischaemic strokes. The STAR-FIB study programme aims to determine the age- and sex-specific prevalence of silent atrial fibrillation and to develop a clinical prediction model to identify patients at risk of undiagnosed atrial fibrillation in a hospitalised patient population.

Methods: The STAR-FIB study programme includes a prospective cohort study and a case-control study of hospitalised patients aged 65–84 years, evenly distributed for both age and sex. We recruited 795 patients without atrial fibrillation for the cohort study (49.2% females; median age 74.8 years). All patients had three serial 7-day Holter ECGs to screen for silent atrial fibrillation. The primary endpoint will be any episode of atrial fibrillation or atrial flutter of ≥30 seconds duration. The age- and sex-specific prevalence of newly diagnosed atrial fibrillation will be estimated. For the case-control study, 120 patients with paroxysmal atrial fibrillation were recruited as cases (41.7% females; median age 74.6 years); controls will be randomly selected from the cohort study in a 2:1 ratio. All participants in the cohort study and all cases were prospectively evaluated including clinical, laboratory, echocardiographic and electrical parameters. A clinical prediction model for undiagnosed atrial fibrillation will be derived in the case-control study and externally validated in the cohort study.

Conclusions: The STAR-FIB study programme will estimate the age- and sex-specific prevalence of silent atrial fibrillation in a hospitalised patient population, and develop and validate a clinical prediction model to identify patients at risk of silent atrial fibrillation.
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http://dx.doi.org/10.4414/smw.2021.20421DOI Listing
February 2021

Sex-Related Differences in Cardiac Channelopathies: Implications for Clinical Practice.

Circulation 2021 Feb 15;143(7):739-752. Epub 2021 Feb 15.

Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (L.Y., A.D.K.).

Sex-related differences in prevalence, clinical presentation, and outcome of cardiac channelopathies are increasingly recognized, despite their autosomal transmission and hence equal genetic predisposition among sexes. In congenital long-QT syndrome, adult women carry a greater risk for Torsades de pointes and sudden cardiac death than do men. In contrast, Brugada syndrome is observed predominantly in adult men, with a considerably higher risk of arrhythmic sudden cardiac death in adult men than in women. In both conditions, the risk for arrhythmias varies with age. Sex-associated differences appear less evident in other cardiac channelopathies, likely a reflection of their rare(r) occurrence and our limited knowledge. In several cardiac channelopathies, sex-specific predictors of outcome have been identified. Together with genetic and environmental factors, sex hormones contribute to the sex-related disparities in cardiac channelopathies through modulation of the expression and function of cardiac ion channels. Despite these insights, essential knowledge gaps exist in the mechanistic understanding of these differences, warranting further investigation. Precise application of the available knowledge may improve the individualized care of patients with cardiac channelopathies. Promoting the reporting of sex-related phenotype and outcome parameters in clinical and experimental studies and advancing research on cardiac channelopathy animal models should translate into improved patient outcomes. This review provides a critical digest of the current evidence for sex-related differences in cardiac channelopathies and emphasizes their clinical implications and remaining gaps requiring further research.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.048250DOI Listing
February 2021

Association of the CHAD(S)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation.

Front Neurol 2020 12;11:609234. Epub 2021 Jan 12.

Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.

Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHADS-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear. In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHADS-VASc score and its components with ischemic brain lesions. An adapted CHAD-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used. Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHAD-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17-1.49), < 0.001 and 1.20 (1.10-1.30), < 0.001, respectively}. Age 65-74 years (OR 2.58; 95%CI 1.29-5.90; = 0.013), age ≥75 years (4.13; 2.07-9.43; < 0.001), hypertension (1.90; 1.28-2.88; = 0.002) and diabetes (1.48; 1.00-2.18; = 0.047) were associated with clinically overt brain lesions, whereas age 65-74 years (1.95; 1.26-3.10; = 0.004), age ≥75 years (3.06; 1.98-4.89; < 0.001) and vascular disease (1.39; 1.07-1.79; = 0.012) were associated with silent ischemic brain lesions. A higher CHAD-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions. www.ClinicalTrials.gov, identifier: NCT02105844.
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http://dx.doi.org/10.3389/fneur.2020.609234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835704PMC
January 2021

Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants.

J Thromb Haemost 2021 04 24;19(4):931-940. Epub 2021 Feb 24.

Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Objective: Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs.

Methods: We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination.

Results: We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19-0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63-0.80).

Conclusion: In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination.
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http://dx.doi.org/10.1111/jth.15251DOI Listing
April 2021

Blood Pressure and Brain Lesions in Patients With Atrial Fibrillation.

Hypertension 2021 Feb 28;77(2):662-671. Epub 2020 Dec 28.

From the Cardiology Division, Department of Medicine (S.A., S.B., P.M., M.C., C.H., T.B., C.E., C.S.Z., C.S., S.O., M.K.), University of Basel, Switzerland.

The association of blood pressure (BP) and hypertension with the presence of different types of brain lesions in patients with atrial fibrillation is unclear. BP values were obtained in a multicenter cohort of patients with atrial fibrillation. Systolic and diastolic BP was categorized in predefined groups. All patients underwent brain magnetic resonance imaging and neurocognitive testing. Brain lesions were classified as large noncortical or cortical infarcts, small noncortical infarcts, microbleeds, or white matter lesions. White matter lesions were graded according to the Fazekas scale. Overall, 1738 patients with atrial fibrillation were enrolled in this cross-sectional analysis (mean age, 73 years, 73% males). Mean BP was 135/79 mm Hg, and 67% of participants were taking BP-lowering treatment. White matter lesions Fazekas ≥2 were found in 54%, large noncortical or cortical infarcts in 22%, small noncortical infarcts in 21%, and microbleeds in 22% of patients, respectively. Compared with patients with systolic BP <120 mm Hg, the adjusted odds ratios (95% CI) for Fazekas≥2 was 1.25 (0.94-1.66), 1.41 (1.03-1.93), and 2.54 (1.65-3.95) among patients with systolic BP of 120 to 140, 140 to 160, and ≥160 mm Hg ( for linear trend<0.001). Per 5 mm Hg increase in systolic and diastolic BP, the adjusted β-coefficient (95% CI) for log-transformed white matter lesions was 0.04 (0.02-0.05), <0.001 and 0.04 (0.01-0.06), =0.004. Systolic BP was associated with small noncortical infarcts (odds ratios [95% CI] per 5 mm Hg 1.05 [1.01-1.08], =0.006), microbleeds were associated with hypertension, but large noncortical or cortical infarcts were not associated with BP or hypertension. After multivariable adjustment, BP and hypertension were not associated with neurocognitive function. Among patients with atrial fibrillation, BP is strongly associated with the presence and extent of white matter lesions, but there is no association with large noncortical or cortical infarcts. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803457PMC
February 2021

Impact of contact force sensing technology on outcome of catheter ablation of idiopathic pre-mature ventricular contractions originating from the outflow tracts.

Europace 2021 Apr;23(4):603-609

Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.

Aims: Catheter ablation of frequent idiopathic pre-mature ventricular contractions (PVC) is increasingly performed. While potential benefits of contact force (CF)-sensing technology for atrial fibrillation ablation have been assessed in several studies, the impact of CF-sensing on ventricular arrhythmia ablation remains unknown. This study aimed to compare outcomes of idiopathic outflow tract PVC ablation when using standard ablation catheters as opposed to CF-sensing catheters.

Methods And Results: In a retrospective multi-centre study, unselected patients undergoing catheter ablation of idiopathic outflow tract PVCs between 2013 and 2016 were enrolled. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a  ≥80% reduction of pre-procedural PVC burden determined by 24 h Holter ECG during follow-up. Overall, 218 patients were enrolled (median age 52 years, 51% males). Baseline and procedural data were similar in the standard ablation (24%) and the CF-sensing group (76%). Overall, the median PVC burden decreased from 21% (IQR 10-30%) before ablation to 0.2% (IQR 0-3.0%) after a median follow-up of 2.3 months (IQR 1.4-3.9 months). The rates of both acute (91% vs. 91%, P = 0.94) and sustained success (79% vs. 74%, P = 0.44) were similar in the standard ablation and the CF-sensing groups. No differences were observed in subgroups according to arrhythmia origin from the RVOT (65%) or LVOT (35%). Complications were rare (1.8%) and evenly distributed between the two groups.

Conclusion: The use of CF-sensing technology is not associated with increased success rate nor decreased complication rate in idiopathic outflow tract PVC ablation.
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http://dx.doi.org/10.1093/europace/euaa315DOI Listing
April 2021

[Telemedicine in Rhythmology - Prepared for Pandemics].

Authors:
Laurent Roten

Praxis (Bern 1994) 2020 ;109(14):1135-1140

Abteilung für Kardiologie, Inselspital, Universitätsspital Bern, Universität Bern.

Telemedicine in Rhythmology - Prepared for Pandemics The COVID-19 pandemic urged us to reorganize many of our daily clinical processes. In this regard, the protection of vulnerable patient populations is of particular importance, since any visit to the outpatient clinic implies the risk of exposure to and infection with the SARS-CoV-2 virus. Nevertheless, patients with a pacemaker, an implantable cardioverter/defibrillator (ICD) or an implantable cardiac monitor need regular follow-up to assure proper functionality of these devices. Remote monitoring is the ideal solution to meet the requirements of patient protection and device safety during pandemics. Besides, remote monitoring has already proved its value in normal times. This article summarizes the functionality of remote monitoring, describes the patient benefit and associated challenges and opportunities.
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http://dx.doi.org/10.1024/1661-8157/a003524DOI Listing
October 2020

Use of the wearable cardioverter-defibrillator - the Swiss experience.

Swiss Med Wkly 2020 Sep 30;150:w20343. Epub 2020 Sep 30.

Division of Cardiology, University Heart Centre Zurich, Switzerland.

Introduction: Sudden cardiac death caused by malignant arrhythmia can be prevented by the use of defibrillators. Although the wearable cardioverter defibrillator (WCD) can prevent such an event, its role in clinical practice is ill defined. We investigated the use of the WCD in Switzerland with emphasis on prescription rate, therapy adherence and treatment rate.

Materials And Methods: The Swiss WCD Registry is a retrospective observational registry including patients using a WCD. Patients were included from the first WCD use in Switzerland until February 2018. Baseline characteristics and data on WCD usage were examined for the total study population, and separately for each hospital.

Results: From 1 December 2011 to 18 February 2018, a total of 456 patients (67.1% of all WCDs prescribed in Switzerland and 81.1% of all prescribed in the participating hospitals) were included in the registry. Up to 2017 there was a yearly increase in the number of prescribed WCDs to a maximum of 271 prescriptions per year. The mean age of patients was 57 years (± 14), 81 (17.8%) were female and mean left ventricular ejection fraction (EF) was 32% (± 13). The most common indications for WCD use were new-onset ischaemic cardiomyopathy (ICM) with EF ≤35% (206 patients, 45.2%), new-onset nonischaemic cardiomyopathy (NICM) with EF ≤35% (115 patients, 25.2%), unknown arrhythmic risk (83 patients, 18.2%), bridging to implantable cardioverter-defibrillator implantation or heart transplant (37 patients, 8.1%) and congenital/inherited heart disease (15 patients, 3.3%). Median wear duration was 58 days (interquartile range [IQR] 31–94) with a median average daily wear time of 22.6 hours (IQR 20–23.2). Seventeen appropriate therapies from the WCD were delivered in the whole population (treatment rate: 3.7%) to a total of 12 patients (2.6% of all patients). The most common underlying heart disease in patients with a treatment was ICM (13/17, 76.5%). There were no inappropriate treatments.

Conclusion: The use of WCDs has increased in Switzerland over the years for a variety of indications. There is high therapy adherence to the WCD, and a treatment rate comparable to previously published registry data.  .
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http://dx.doi.org/10.4414/smw.2020.20343DOI Listing
September 2020

The 'double transition': a novel electrocardiogram sign to discriminate posteroseptal accessory pathways ablated from the right endocardium from those requiring a left-sided or epicardial coronary venous approach.

Europace 2020 11;22(11):1703-1711

Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France.

Aims: The precise localization of manifest posteroseptal accessory pathways (APs) often poses diagnostic challenges considering that a small area may encompass AP that may be ablated from the right or left endocardium, or epicardially within the coronary sinus (CS). We sought to explore whether the QRS transition pattern in the precordial lead may help to discriminate the necessary ablation approach.

Methods And Results: Consecutive patients who underwent a successful ablation of a single manifest AP over a 5-year period were included. Standard 12-lead electrocardiograms were reviewed. A total of 273 patients were identified. Mean age was 31 ± 15 years and 62% were male. Of the 110 identified posteroseptal AP, 64 were ablated from the right endocardium, 33 from the left endocardium, and 13 inside the CS. While a normal precordial QRS transition was most often observed, a subset of 33 patients presented an atypical 'double transition' pattern which specifically identified right endocardial AP. The combination of a q wave in V1 with a proportion of the positive QRS component in V1 < V2 > V3, predicted a right endocardial AP with a 100% specificity. In case of a positive QRS sum in V2, this 'double transition' pattern predicted a posteroseptal right endocardial AP with 99.5% specificity and 44% sensitivity. The positive predictive value was 97%. The only false positive was a midseptal AP. In the case of a negative or isoelectric QRS sum in V2, APs were located more laterally on the tricuspid annulus.

Conclusion: The combination of a q wave in V1 with a double QRS transition pattern in the precordial leads is highly specific of a right endocardial AP and rules out the need for CS or left-sided mapping.
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http://dx.doi.org/10.1093/europace/euaa200DOI Listing
November 2020

Valvular and Nonvalvular Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Replacement.

JACC Cardiovasc Interv 2020 09;13(18):2124-2133

Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address:

Objectives: The aim of this study was to investigate the impact of valvular and nonvalvular atrial fibrillation (AF) in patients undergoing transcatheter aortic valve replacement (TAVR).

Background: AF has been associated with adverse clinical outcomes after TAVR. However, the differential impact of valvular as opposed to nonvalvular AF has not been investigated.

Methods: In a retrospective analysis of a prospective registry, valvular AF was defined as AF in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis. The presence of mitral stenosis was determined by pre-procedural echocardiography. The primary endpoint was a composite of cardiovascular death or disabling stroke at 1 year after TAVR.

Results: Among 1,472 patients undergoing TAVR between August 2007 and June 2018, AF was recorded in 465 patients (31.6%) and categorized as nonvalvular in 376 (25.5%) and valvular in 89 (6.0%). AF scores including HAS-BLED, CHADS, and CHADS-VASc were comparable between patients with nonvalvular and valvular AF. The primary endpoint occurred in 9.3% of patients with no AF, in 14.5% of patients with nonvalvular AF (hazard ratio: 1.57; 95% confidence interval: 1.12 to 2.20; p = 0.009), and in 24.2% of patients with valvular AF (hazard ratio: 2.75; 95% confidence interval: 1.71 to 4.41; p < 0.001). Valvular AF conferred an increased risk for cardiovascular death or disabling stroke compared with nonvalvular AF (hazard ratio: 1.77; 95% confidence interval: 1.07 to 2.94; p = 0.027).

Conclusions: The presence of valvular AF in patients undergoing TAVR increased the risk for cardiovascular death or disabling stroke compared with both no AF and nonvalvular AF. (SWISS TAVI Registry; NCT01368250).
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http://dx.doi.org/10.1016/j.jcin.2020.05.049DOI Listing
September 2020

Unexpected high failure rate of a specific MicroPort/LivaNova/Sorin pacing lead.

Heart Rhythm 2021 Jan 13;18(1):41-49. Epub 2020 Aug 13.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Background: Pacing leads are the Achilles heel of pacemakers. Most manufacturers report a 3-year survival rate of >99% of their leads. We observed several failures of the Beflex/Vega leads (MicroPort, Shanghai, China; formerly Sorin/LivaNova).

Objective: The purpose of this study was to investigate failure rates of Beflex/Vega leads.

Methods: We analyzed the performance of Beflex/Vega leads implanted at our tertiary referral center. All-cause lead failures (any issues requiring reinterventions such as lead dislocations, cardiac perforations, and electrical abnormalities) were identified during follow-up. The Beflex/Vega lead was compared with a reference lead (CapSureFix Novus 5076, Medtronic, Minneapolis, MN) implanted within the same period and by the same operators.

Results: A total of 585 leads were analyzed (382 Beflex/Vega and 203 CapSureFix Novus 5076 leads). Cumulative failure rate estimates were 5.2%, 6.3%, and 12.4% after 1, 2, and 3 years for the Beflex/Vega lead. This was worse compared to the reference lead (1.5%, 1.5%, 3.7% after 1, 2, and 3 years; P = .001). Early failure manifestations up to 3 months occurred at a similar rate (Beflex/Vega vs CapSureFix Novus 5076 lead: 1.3% vs 0.5% for dislocations; 1.3% vs 1.0% for perforations). During follow-up, electrical abnormalities such as noise oversensing (P = .013) and increased pacing thresholds (P = .003) became more frequent in the Beflex/Vega group. Electrical abnormalities were the most common failure manifestation 3 years after implantation in this group (9.4% vs 2.2% for the CapSureFix Novus 5076).

Conclusion: The failure rate of the Beflex/Vega lead of >10% after 3 years was higher than that of a competitor lead. This gives rise to concern since >135,000 such leads are active worldwide.
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http://dx.doi.org/10.1016/j.hrthm.2020.08.010DOI Listing
January 2021

Stereotactic Radiotherapy for the Management of Refractory Ventricular Tachycardia: Promise and Future Directions.

Front Cardiovasc Med 2020 25;7:108. Epub 2020 Jun 25.

Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Ventricular tachycardia (VT) caused by myocardial scaring bears a significant risk of mortality and morbidity. Antiarrhythmic drug therapy (AAD) and catheter ablation remain the cornerstone of VT management, but both treatments have limited efficacy and potential adverse effects. Stereotactic body radiotherapy (SBRT) is routinely used in oncology to treat non-invasively solid tumors with high precision and efficacy. Recently, this technology has been evaluated for the treatment of VT. This review presents the basic underlying principles, proof of concept, and main results of trials and case series that used SBRT for the treatment of VT refractory to AAD and catheter ablation.
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http://dx.doi.org/10.3389/fcvm.2020.00108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329991PMC
June 2020

Covert Brain Infarction: Towards Precision Medicine in Research, Diagnosis, and Therapy for a Silent Pandemic.

Stroke 2020 08 10;51(8):2597-2606. Epub 2020 Jul 10.

Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital, University of Bern, Switzerland.

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http://dx.doi.org/10.1161/STROKEAHA.120.030686DOI Listing
August 2020

Identifying coronary artery disease patients at risk for sudden and/or arrhythmic death: remaining limitations of the electrocardiogram.

Eur Heart J 2020 08;41(30):2911-2912

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.

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http://dx.doi.org/10.1093/eurheartj/ehaa470DOI Listing
August 2020

Leadless pacemaker implantation quality: importance of the operator's experience.

Europace 2020 06;22(6):939-946

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.

Aims: Leadless cardiac pacemaker (PM) implantation differs from conventional PM implantation. While the procedure has been considered safe, recent real-world data raised concerns about the learning curve of new operators and their implantation quality. The goal of this study was to investigate the influence of the first operator's experience on leadless PM implantation quality and procedural efficiency.

Methods And Results: We performed a bicentric analysis of all Micra TPS™ implantations in two large tertiary referral hospitals. We assessed both leadless PM implantation quality based on the absence of complications (requiring intervention or prolonged hospitalization), good electrical performance (pacing threshold ≤ 1.5 V/0.24 ms, R-wave amplitude > 5 mV), and acceptable fluoroscopy duration (<10 min) as well as procedural efficiency in relation to the operator's experience. Univariate and multivariate logistic regression analyses were performed to identify predictors for implantation quality and procedural efficiency. Leadless PM implantation was successful in 106/111 cases (95.5%). Three patients (2.7%) experienced acute complications (one cardiac tamponade, one femoral bleeding, one posture-related PM exit block). Multivariate analysis showed that implantation quality of more experienced first operators was higher [odds ratio 1.09 (95% confidence interval 1.00-1.19), P = 0.05]. Procedural efficiency increased with operator experience as evidenced by an inverse correlation of procedure time, time to the first deployment, fluoroscopy time, and the number of procedures performed (all P < 0.05).

Conclusion: The operator's learning curve is a critical factor for leadless PM implantation quality and procedural efficiency.
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http://dx.doi.org/10.1093/europace/euaa097DOI Listing
June 2020

Effect of acute myocardial ischemia on inferolateral early repolarization.

Heart Rhythm 2020 06 23;17(6):922-930. Epub 2020 Jan 23.

Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address:

Background: Inferolateral early repolarization (ER) is associated with an increase in arrhythmic risk, particularly in the presence of myocardial ischemia.

Objective: The purpose of this study was to determine the effect of myocardial ischemia on ER.

Methods: We retrospectively analyzed procedural electrocardiograms (ECGs) of patients with ER undergoing a controlled, 1-minute coronary balloon occlusion for collateral function testing. ECG leads with ER were analyzed immediately before coronary balloon occlusion (PRE), at 60 seconds of coronary balloon occlusion (OCCL), and >30 seconds after balloon deflation.

Results: Seventy-seven patients with ER in the preprocedural ECG (86% inferior, 20% lateral) underwent 135 coronary balloon occlusions during which a J wave was recorded in 224 leads (ER leads). From PRE to OCCL, ST-segment amplitude (ST) in the ER lead increased in 94 cases (44%) from 0.00 ± 0.03 to 0.05 ± 0.06 mV (P < .0001). In this group, J-wave amplitude (JWA) increased from 0.10 ± 0.07 to 0.13 ± 0.09 mV (P < .0001). ST in the ER lead decreased or was unchanged in 121 cases (56%) from PRE to OCCL (from 0.01 ± 0.05 to -0.02 ± 0.04 mV; P < .0001). In this group, JWA decreased from 0.10 ± 0.05 to 0.08 ± 0.07 mV (P < .0001). The change in JWA was related to the change in ST (linear regression analysis; R = 0.34; P < .0001), while there was no relation between the change in R-wave amplitude and the change in ST (R = 0.0003; P = .83).

Conclusion: During acute ischemia, JWA mirrors ST-segment changes. This may explain increased arrhythmic vulnerability of patients with ER during myocardial ischemia. It also adds weight to the hypothesis of ER being a phenomenon of repolarization.
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http://dx.doi.org/10.1016/j.hrthm.2020.01.019DOI Listing
June 2020

Sex-related electrocardiographic differences in patients with different types of atrial fibrillation: Results from the SWISS-AF study.

Int J Cardiol 2020 05 3;307:63-70. Epub 2020 Jan 3.

Center for Computational Modeling in Cardiology, Switzerland; Cardiocentro Ticino, Switzerland. Electronic address:

Background: Sex-related electrocardiographic differences are a well-known phenomenon, but not their expression in patients with atrial fibrillation (AF). In this study we aim to assess the presence of significant sex-related differences in ECG features, with particular attention to P-wave parameters, of a large cohort of patients affected by different types of AF.

Methods: A 5-min resting 16-lead ECG was evaluated for 1119 AF patients in sinus rhythm. The durations of the main ECG waves and intervals were measured for both atrial and ventricular activity. Moreover, the beat-to-beat P-wave variability was computed for lead II and for the first principal component (PC1) computed across the 16 leads. The percentage of variance explained by PC1 was computed.

Results: Males compared to females showed significantly longer RR interval (1.02 ± 0.16 s vs 0.97 ± 0.15 s, p < .001), PQ interval (191 ± 34 ms vs 183 ± 35 ms, p = .008), QRS duration (105 ± 17 ms vs 98 ± 13 ms, p = .021), significantly lower percentage of variance explained by PC1 and P-wave variability. Males with paroxysmal AF compared to females with paroxysmal AF had significantly longer RR interval (1.01 ± 0.17 s vs 0.96 ± 0.14 s, p < .001), shorter QTc (388 ± 27 ms vs 402 ± 27 ms, p < .001), lower P-wave variability in PC1. Males with persistent AF compared to females with persistent AF had significantly shorter QTc interval (396 ± 30 ms vs 407 ± 26 ms, p = .019), longer PQ interval (194 ± 35 ms vs 182 ± 30 ms, p = .037), higher V1 terminal force (2.1 ± 1.2 mV*ms vs 1.8 ± 1 mV*ms, p = .007), lower percentage of variance explained by PC1.

Conclusions: AF patients present with several sex-related ECG differences. Consequently, sex should be taken into account when developing ECG algorithms identifying patients at risk for AF progression.
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http://dx.doi.org/10.1016/j.ijcard.2019.12.053DOI Listing
May 2020

High incidence of diaphragmatic myopotential oversensing by a specific implantable cardioverter defibrillator.

Pacing Clin Electrophysiol 2020 02 30;43(2):234-239. Epub 2019 Dec 30.

Department of Cardiology, Inselspital, Bern University Hospital and the University of Bern, Bern, Switzerland.

Introduction: Diaphragmatic myopotential oversensing (dMPO) by implantable cardioverter defibrillators (ICDs) is thought to be a rare condition that can be misdiagnosed as lead failure and lead to unnecessary lead replacement. We observed several cases of dMPO in patients with Sorin/LivaNova ICDs (MicroPort Sci.). We sought to systematically assess the incidence of dMPO in patients with Sorin/LivaNova ICDs.

Methods And Results: A predefined number of 100 consecutive patients with Sorin/LivaNova ICDs were prospectively included in the device clinic of our center. Stored arrhythmia episodes were checked for spontaneous dMPO. In addition, we performed provocation maneuvers by Valsalva. At least one episode of spontaneous or provoked dMPO was seen in 12 (12%) of the 100 patients included in the study (86% males, median age: 66 years). Nine of 89 patients (10%) with true bipolar and 3 of 11 patients (27%) with integrated bipolar sensing configuration were affected. Spontaneous dMPO was observed in 7 of 58 patients (12%) with sensitivity programmed to 0.4 mV and in 2 of 42 patients (5%) with sensitivity programmed to 0.6 mV (not significant). In three patients, dMPO could be provoked with no spontaneous episodes recorded. In two nonpacemaker-dependent patients with a CRT-D, ventricular pacing was temporarily inhibited. No antitachycardia therapy was triggered by dMPO in any patient.

Conclusions: DMPO is frequent in patients with Sorin/LivaNova ICDs, especially with sensitivity programmed to 0.4 mV. It also frequently occurs with true bipolar sensing configuration. DMPO should not be misinterpreted as lead failure to avoid unnecessary lead replacement.
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http://dx.doi.org/10.1111/pace.13864DOI Listing
February 2020

Severe and uniform bi-atrial remodeling measured by dominant frequency analysis in persistent atrial fibrillation unresponsive to ablation.

J Interv Card Electrophysiol 2020 Nov 13;59(2):431-440. Epub 2019 Dec 13.

Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Background: High values of ECG and intracardiac dominant frequency (DF) are indicative of significant atrial remodeling in persistent atrial fibrillation (peAF). We hypothesized that patients with peAF unresponsive to ablation display higher ECG and intracardiac DFs than those remaining in sinus rhythm (SR) on the long term.

Methods: Forty consecutive patients underwent stepwise ablation for peAF (sustained duration 19 ± 11 months). Electrograms were recorded before ablation at 13 left atrium (LA) sites and at the right atrial appendage (RAA) and coronary sinus (CS) synchronously to the ECG. DF was defined as the highest peak within the power spectrum.

Results: peAF was terminated within the LA in 28 patients (left-terminated [LT]), whereas 12 patients remaining in AF after ablation (not left-terminated [NLT]) were cardioverted. Over a mean follow-up of 34 ± 14 months, all 12 NLT patients had a recurrence. Of the LT patients, 71% had a recurrence (20/28, LT_Rec), while 29% remained in SR throughout the follow-up (8/28, LT_SR). DF values and correlations between pairs of LA appendage (LAA), RAA, and CS DFs showed distinctive patterns among the subgroups. The NLT subgroup displayed the highest ECG and intracardiac DFs, with strong intragroup homogeneity between pairs of CS and LAA DFs, and to a lesser extent between pairs of CS and RAA DFs. Conversely, the LT_SR subgroup showed the lowest DFs, with significant intragroup heterogeneity between pairs of CS and both LAA and RAA DFs.

Conclusions: Patients with peAF unresponsive to ablation show high surface and intracardiac DFs indicative of severe and uniform bi-atrial remodeling.
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http://dx.doi.org/10.1007/s10840-019-00681-1DOI Listing
November 2020

Outcome of video-assisted thoracoscopic implantation of epicardial left ventricular leads with visual targeting for cardiac resynchronization therapy.

Interact Cardiovasc Thorac Surg 2020 03;30(3):373-379

Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.

Objectives: Our goal was to analyse the implantation and outcome of thoracoscopic epicardial leads after a failed endovascular approach or follow-up (FU) complications after endovascular implantation.

Methods: We reviewed the records of patients with failed endovascular left ventricular (LV) lead placement or complications during FU, who were subsequently referred to cardiac surgeons for treatment with thoracoscopic LV lead implantation. We analysed the reasons for endovascular failure; the indications for the surgical procedures; and the clinical, echocardiographic and device FU results.

Results: Between 2010 and 2013, a total of 23 patients were included. Among them, 17 of the patients had no previous cardiothoracic surgery, 13 (76%) had successful video-assisted thoracoscopy (VAT) LV lead implantation, 3 (18%) had a conversion to thoracotomy and 1 (6%) failed. Of the 6 patients with prior cardiothoracic surgery, 2 (33%) had VAT only, 3 (50%) had primary thoracotomies and 1 (17%) had a conversion. Two major complications occurred. The reasons for LV endovascular lead failure were subclavian vein occlusion (n = 2), implant failure (n = 13) and complications during the FU period (n = 8). FU information was available for 20 patients: 17 (85%) had improved symptoms. The median FU period was 33 months. A total of 78% of patients were in New York Heart Association (NYHA) functional class III-IV before the operation; 30% were in NYHA functional class III-IV at the last FU examination. The left ventricular ejection fraction increased from 25% before surgery to 31% at the last FU examination. Overall, sensing and pacing threshold values remained stable over time. In 1 patient, lead revision was necessary due to an increase in the pacing threshold.

Conclusions: VAT implantation of LV leads had an excellent response rate with an improvement in NYHA functional class and left ventricular ejection fraction. The lead measurements were mainly stable over time.
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http://dx.doi.org/10.1093/icvts/ivz276DOI Listing
March 2020

Optical coherence tomography allows 3D reconstruction of ablation lesions.

Eur Heart J Cardiovasc Imaging 2020 04;21(4):468

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.

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http://dx.doi.org/10.1093/ehjci/jez285DOI Listing
April 2020

Incidence and Predictors of Atrial Fibrillation Progression.

J Am Heart Assoc 2019 10 8;8(20):e012554. Epub 2019 Oct 8.

Division of Cardiology Department of Medicine University Hospital Basel University of Basel Basel Switzerland.

Background The incidence and predictors of atrial fibrillation (AF) progression are currently not well defined, and clinical AF progression partly overlaps with rhythm control interventions (RCIs). Methods and Results We assessed AF type and intercurrent RCIs during yearly follow-ups in 2869 prospectively followed patients with paroxysmal or persistent AF. Clinical AF progression was defined as progression from paroxysmal to nonparoxysmal or from persistent to permanent AF. An RCI was defined as pulmonary vein isolation, electrical cardioversion, or new treatment with amiodarone. During a median follow-up of 3 years, the incidence of clinical AF progression was 5.2 per 100 patient-years, and 10.9 per 100 patient-years for any RCI. Significant predictors for AF progression were body mass index (hazard ratio [HR], 1.03; 95% CI, 1.01-1.05), heart rate (HR per 5 beats/min increase, 1.05; 95% CI, 1.02-1.08), age (HR per 5-year increase 1.19; 95% CI, 1.13-1.27), systolic blood pressure (HR per 5 mm Hg increase, 1.03; 95% CI, 1.00-1.05), history of hyperthyroidism (HR, 1.71; 95% CI, 1.16-2.52), stroke (HR, 1.50; 95% CI, 1.19-1.88), and heart failure (HR, 1.69; 95% CI, 1.34-2.13). Regular physical activity (HR, 0.80; 95% CI, 0.66-0.98) and previous pulmonary vein isolation (HR, 0.69; 95% CI, 0.53-0.90) showed an inverse association. Significant predictive factors for RCIs were physical activity (HR, 1.42; 95% CI, 1.20-1.68), AF-related symptoms (HR, 1.84; 95% CI, 1.47-2.30), age (HR per 5-year increase, 0.88; 95% CI, 0.85-0.92), and paroxysmal AF (HR, 0.61; 95% CI, 0.51-0.73). Conclusions Cardiovascular risk factors and comorbidities were key predictors of clinical AF progression. A healthy lifestyle may therefore reduce the risk of AF progression.
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http://dx.doi.org/10.1161/JAHA.119.012554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818023PMC
October 2019

Usefulness of Genetic Testing in Sudden Cardiac Arrest Survivors With or Without Previous Clinical Evidence of Heart Disease.

Am J Cardiol 2019 06 18;123(12):2031-2038. Epub 2019 Mar 18.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address:

Genetic testing in survivors of sudden cardiac arrest (SCA) with a suspicious cardiac phenotype is considered clinically useful, whereas its value in the absence of phenotype is disputed. We aimed to evaluate the clinical utility of genetic testing in survivors of SCA with or without cardiac phenotype. Sixty unrelated SCA survivors (median age: 34 [interquartile range 20 to 43] years, 82% male) without coronary artery disease were included: 24 (40%) with detectable cardiac phenotype (Ph(+)SCA) after the SCA event and 36 (60%) with no clear cardiac phenotype (Ph(-)SCA). The targeted exome sequencing was performed using the TruSight-One Sequencing Panel (Illumina). Variants in 185 clinically relevant cardiac genes with minor allele frequency <1% were analyzed. A total of 32 pathogenic or likely pathogenic variants were found in 27 (45%) patients: 17 (71%) in the Ph(+)SCA group and 10 (28%) in the Ph(-)SCA group. Sixteen (67%) Ph(+)SCA patients hosted mutations congruent with the suspected phenotype, in which 12 (50%) were cardiomyopathies and 4 (17%) channelopathies. In Ph(-)SCA cases, 6 (17%) carried a mutation in cardiac ion channel genes that could explain the event. The additional 4 (11%) mutations in this group, could not explain the phenotype and require additional studies. In conclusion, cardiac genetic testing was positive in nearly 2/3 patients of the Ph(+)SCA group and in 1/6 of the Ph(-)SCA group. The test was useful in both groups to identify or confirm an inherited heart disease, with an important impact on the patient care and first-degree relatives at risk.
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http://dx.doi.org/10.1016/j.amjcard.2019.02.061DOI Listing
June 2019

How to Reach the Left Atrium in Atrial Fibrillation Ablation?: Patent Foramen Ovale Versus Transseptal Puncture.

Circ Arrhythm Electrophysiol 2019 04;12(4):e006744

Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (R.S., A.H., J.S., H.S., F.N., A.L., S.B., E.G., A.M.-D., J.F., T.R., L.R., H.T.).

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http://dx.doi.org/10.1161/CIRCEP.118.006744DOI Listing
April 2019

Radiofrequency ablation lesion assessment using optical coherence tomography - a proof-of-concept study.

J Cardiovasc Electrophysiol 2019 06 29;30(6):934-940. Epub 2019 Mar 29.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Background: Radiofrequency catheter ablation (RFA) is an effective treatment for atrial fibrillation. However, ablation lesions are usually only assessed functionally. The immediate effect of RFA on the tissue is not directly visualized. Optical coherence tomography (OCT) is an imaging technique that uses light to capture high-resolution images with histology-like quality. Therefore, it might be used for high-precision imaging of ablation lesions.

Methods And Results: Radiofrequency ablation lesions (n = 25) were produced on the freshly excised left and right ventricular porcine endocardium. A Thermocool ST SF NAV ablation catheter (Biosense Webster Inc) and an EP-Shuttle ablation generator (Stockert GmbH) were used to produce ablation lesions with powers from 10 to 40 W (energies ranging from 100 Ws to 900 Ws). After ablation, the tissue was imaged with a swept source OCT system (at a wavelength of 1300 nm). Subsequently, the ablation lesions underwent the histological analysis. The ablation lesions could be visualized by OCT in all 17 samples with ablation powers ≥20 W, meanwhile, no lesion could be observed in the other eight samples with lower power (10 W). Lesion depths and lesion radiuses, as assessed by OCT, correlated well with those observed on the subsequent histological analysis (Spearman's r = 0.94, P < 0.001 and r = 0.84, P < 0.001). In addition, successful three-dimensional reconstructions of ablation lesions were performed.

Conclusion: OCT can provide a visual high-resolution assessment of ablation lesions.
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http://dx.doi.org/10.1111/jce.13917DOI Listing
June 2019