Publications by authors named "Philipp Sommer"

215 Publications

There is glory in prevention!-Atrio-esophageal fistula and atrial fibrillation ablation.

Europace 2021 Jan 13. Epub 2021 Jan 13.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.

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http://dx.doi.org/10.1093/europace/euaa417DOI Listing
January 2021

Phrenic Nerve Stimulation Improves Physical Performance and Hypoxemia in Heart Failure Patients with Central Sleep Apnea.

J Clin Med 2021 Jan 8;10(2). Epub 2021 Jan 8.

Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.

Background: Central sleep apnea (CSA) is a common comorbidity in patients with heart failure (HF) and has been linked to increased morbidity and mortality risk. In addition, CSA is associated with impaired quality of life, reduced physical performance capacity, and hypoxemia. Phrenic nerve stimulation (PNS) is a novel approach to the treatment of CSA and has been shown to be safe and effective in this indication. However, there are currently no data on the effects of PNS on physical performance and hypoxia in CSA HF patients, both of which have been shown to be linked to mortality in HF.

Methods: This prospective study enrolled patients with HF and CSA diagnosed using polysomnography. All were implanted with a PNS system (remedē system, Respicardia Inc., Minnetonka, MN, USA) for the treatment of CSA. Examinations included polysomnography (to determine hypoxemic burden), echocardiography and a standardized 6-min walk test prior to device implantation (baseline) and after 6 months of follow-up.

Results: A total of 24 patients were enrolled (mean age 67.1 ± 11.2 years, 88% male). The 6-min walk distance was 369.5 ± 163.5 m at baseline and significantly improved during follow-up (to 410 ± 169.7 m; = 0.035). Hypoxemic burden, determined based on time with oxygen saturation < 90% improved from 81 ± 55.8 min at baseline to 27.9 ± 42.8 min during PNS therapy ( < 0.01).

Conclusion: In addition to safely and effectively treating CSA, PNS is also associated with improved physical performance capacity and reduced hypoxemic burden in patients with HF.
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http://dx.doi.org/10.3390/jcm10020202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826567PMC
January 2021

Focal Impulse and Rotor Modulation Ablation vs. Pulmonary Vein isolation for the treatment of paroxysmal Atrial Fibrillation: results from the FIRMAP AF study.

Europace 2020 Dec 22. Epub 2020 Dec 22.

University Heart Center Lübeck, Medical Clinic II, Department of Electrophysiology, Lübeck, Germany.

Aims: Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. Recently, catheter ablation targeting rotors or focal sources has been developed for treatment of AF. This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM)-guided ablation as the sole ablative strategy with PVI in patients with paroxysmal AF.

Methods And Results: We conducted a multicentre, randomized trial to determine whether FIRM-guided radiofrequency ablation without PVI (FIRM group) was non-inferior to PVI (PVI group) for treatment of paroxysmal AF. The two primary efficacy end points were (i) acute success defined as elimination of AF rotors (FIRM group) or isolation of all pulmonary veins (PVI group) and (ii) long-term success defined as single-procedure freedom from AF/atrial tachycardia (AT) recurrence 12 months after ablation. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. A total of 51 patients (mean age 63 ± 10.6 years, 57% male) were enrolled. All PVs were successfully isolated in the PVI group and all rotors were successfully eliminated in the FIRM group. Single-procedure effectiveness was 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Three vascular access complications occurred in the FIRM group.

Conclusion: These partial study effectiveness results reinforce the importance of PVI in paroxysmal AF patients and indicate that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients.
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http://dx.doi.org/10.1093/europace/euaa378DOI Listing
December 2020

Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation.

Cardiol J 2020 Dec 21. Epub 2020 Dec 21.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany., Bad Oeynhausen, Germany.

Background: Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary.

Methods: Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance.

Results: Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion.

Conclusions: Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.
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http://dx.doi.org/10.5603/CJ.a2020.0180DOI Listing
December 2020

Cool enough? Lessons learned from cryoballoon-guided catheter ablation for atrial fibrillation in young adults.

J Cardiovasc Electrophysiol 2020 Nov 25;31(11):2857-2864. Epub 2020 Aug 25.

Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Introduction: Cryoballoon (CB)-guided ablation of atrial fibrillation (AF) is established in symptomatic AF patients. This study sought to determine the safety and efficacy of CB pulmonary vein isolation (PVI) in young adults.

Methods And Results: A total of 93 consecutive patients aged <45 years referred to our center for AF ablation were included in this observational study. All patients received CB-guided PVI according to a standardized institutional protocol. Follow-up was performed in our outpatient clinic using 72-h Holter monitoring and periodic telephone interview. Recurrence was defined as any AF/atrial tachycardia (AT) episode >30 s following a 3-month blanking period. A propensity matched control group consisting of patients older than 45 years were used for further evaluation. Mean age was 35 ± 7 years, 22% suffered from persistent AF, 85% were male. Mean follow-up was 2.6 ± 2 years. At the end of the observational period, 83% of patients were free of any AF/AT episodes. There was an excellent overall 12-month success rate of 92%. In comparison to a matched group the overall recurrence rate was noticeably lower in the young group (15% vs. 27%). Increasing age was associated with a hazard ratio of 1.16 for recurrence. In a multivariate analysis model, left atrial diameter remained as significant predictor of AF/AT recurrence. The complication rate was low, no permanent phrenic nerve palsy was observed.

Conclusion: CB-guided PVI in young adults is safe and effective with favorable long-term results. It may be considered as first-line therapy in this relatively healthy population.
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http://dx.doi.org/10.1111/jce.14717DOI Listing
November 2020

Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial-Authors' reply.

Europace 2020 Dec 18. Epub 2020 Dec 18.

Department of Electrophysiology, Herz- und Diabetes Zentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.

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http://dx.doi.org/10.1093/europace/euaa353DOI Listing
December 2020

Catheter ablation for atrial fibrillation in patients with end-stage heart failure and eligibility for heart transplantation.

ESC Heart Fail 2020 Dec 13. Epub 2020 Dec 13.

Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Aims: Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). The purpose of the Catheter Ablation for atrial fibrillation in patientS with end-sTage heart faiLure and Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the hypothesis that atrial fibrillation (AF) ablation has beneficial effects on mortality and morbidity during 'waiting time' for heart transplantation (HTx) or to prolong the time span until LVAD implantation.

Methods And Results: CASTLE-HTx is a randomized evaluation of ablative treatment of AF in patients with severe left ventricular dysfunction who are candidates and eligible for HTx. The primary endpoint is the composite of all-cause mortality, worsening of HF requiring a high urgent transplantation, or LVAD implantation. The secondary study endpoints are all-cause mortality, cardiovascular mortality, cerebrovascular accidents, worsening of HF requiring unplanned hospitalization, AF burden reduction, unplanned hospitalization due to cardiovascular reason, all-cause hospitalization, quality of life, number of delivered implantable cardioverter defibrillator therapies, time to first implantable cardioverter defibrillator therapy, number of device-detected ventricular tachycardia/ventricular fibrillation episodes, left ventricular function, exercise tolerance, and percentage of right ventricular pacing. Ventricular myocardial tissue will be obtained from patients who will undergo LVAD implantation or HTx to assess the effect of catheter ablation on human HF myocardium. CASTLE-HTx will randomize 194 patients over a minimum time period of 2 years.

Conclusions: CASTLE-HTx will determine if AF ablation has beneficial effects on mortality in patients with end-stage HF who are eligible for HTx.
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http://dx.doi.org/10.1002/ehf2.13150DOI Listing
December 2020

Prediction of low-voltage areas using modified APPLE score.

Europace 2020 Dec 6. Epub 2020 Dec 6.

School of Medicine-Cardiovascular Medicine, Boston University, 72 E Concord Street, Boston, MA 02118, USA.

Aims: The presence of low-voltage areas (LVAs) in patients with atrial fibrillation (AF) reflects left atrial (LA) electroanatomical substrate, which is essential for individualized AF management. However, echocardiographic anteroposterior LA diameter included into previous LVAs prediction scores does not mirror LA size accurately and impaired left ventricular ejection fraction (LV-EF) is not directly associated with atrial myopathy. Therefore, we aimed to compare a modified (m)APPLE score, which included LA volume (LAV) and LA emptying fraction (LA-EF) with the regular APPLE score for the prediction of LVAs.

Methods And Results: In patients undergoing first AF catheter ablation, LVAs were determined peri-interventionally using high-density maps and defined as signal amplitude <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before intervention. The APPLE (one point for Age ≥ 65 years, Persistent AF, imPaired eGFR ≤ 60 mL/min/1.73 m2, LA diameter ≥ 43 mm, and LVEF < 50%) and (m)APPLE (last two variables changed by LAV ≥ 39 mL/m2, and LA-EF < 31%) scores were calculated at baseline. The study population included 219 patients [median age 65 (interquartile range 57-72) years, 41% females, 59% persistent AF, 25% LVAs]. Both scores were significantly associated with LVAs [OR 1.817, 95% CI 1.376-2.399 for APPLE and 2.288, 95% CI 1.650-3.172 for (m)APPLE]. Using receiver operating characteristic curves analysis, the (m)APPLE score [area under the curve (AUC) 0.779, 95% CI 0.702-0.855] showed better LVAs prediction than the APPLE score (AUC 0.704, 95% CI 0.623-0.784), however, without statistically significant difference (P = 0.233).

Conclusion: The modified (m)APPLE score demonstrated good prognostic value for LVAs prediction and was comparable with the regular APPLE score.
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http://dx.doi.org/10.1093/europace/euaa311DOI Listing
December 2020

Awaken of the force for catheter ablation in right ventricular outflow tract?

Europace 2020 Nov 24. Epub 2020 Nov 24.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr.11, 32545 Bad Oeynhausen, Germany.

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http://dx.doi.org/10.1093/europace/euaa360DOI Listing
November 2020

Promises and pitfalls of standardized AF ablations.

Pacing Clin Electrophysiol 2020 Nov 13. Epub 2020 Nov 13.

Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany.

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http://dx.doi.org/10.1111/pace.14124DOI Listing
November 2020

First interventional exchange of a left transvenous phrenic nerve stimulation lead from the novel remedē system.

J Cardiovasc Electrophysiol 2020 Nov 1;31(11):3056-3060. Epub 2020 Sep 1.

Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr, Universität Bochum, Bad Oeynhausen, Germany.

The remedē system is a novel fully implantable transvenous phrenic nerve stimulation (TPNS) device developed to treat central sleep apnea. No information is published on how to explant or replace its leads. An eighty-one year-old had a fractured lead and we removed it over a wire. However, unbreachable resistances occurred with a new lead deployed over the enclosed wire and interventional endovascular techniques were performed to reimplant a new fully functioning system. This first report demonstrates TPNS lead exchange is possible but can be challenging. Interventional maneuvers and techniques, including balloon angioplasty, can facilitate this procedure.
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http://dx.doi.org/10.1111/jce.14725DOI Listing
November 2020

Cardiomyopathy-associated mutations in the RS domain affect nuclear localization of RBM20.

Hum Mutat 2020 Nov 9;41(11):1931-1943. Epub 2020 Sep 9.

Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Mutations in RBM20 encoding the RNA-binding motif protein 20 (RBM20) are associated with an early onset and clinically severe forms of cardiomyopathies. Transcriptome analyses revealed RBM20 as an important regulator of cardiac alternative splicing. RBM20 mutations are especially localized in exons 9 and 11 including the highly conserved arginine and serine-rich domain (RS domain). Here, we investigated in several cardiomyopathy patients, the previously described RBM20-mutation p.Pro638Leu localized within the RS domain. In addition, we identified in a patient the novel mutation p.Val914Ala localized in the (glutamate-rich) Glu-rich domain of RBM20 encoded by exon 11. Its impact on the disease was investigated with a novel TTN- and RYR2-splicing assay based on the patients' cardiac messenger RNA. Furthermore, we showed in cell culture and in human cardiac tissue that mutant RBM20-p.Pro638Leu is not localized in the nuclei but causes an abnormal cytoplasmic localization of the protein. In contrast the splicing deficient RBM20-p.Val914Ala has no influence on the intracellular localization. These results indicate that disease-associated variants in RBM20 lead to aberrant splicing through different pathomechanisms dependent on the localization of the mutation. This might have an impact on the future development of therapeutic strategies for the treatment of RBM20-induced cardiomyopathies.
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http://dx.doi.org/10.1002/humu.24096DOI Listing
November 2020

Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial.

Europace 2020 10;22(10):1487-1494

Herz- und Diabetes Zentrum NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.

Aims: The aim of the study was to determine the incidence of oesophageal lesions after radiofrequency ablation (RFA) of atrial fibrillation (AF) with or without the use of oesophageal temperature probes.

Methods And Results: Two hundred patients were prospectively randomized into two groups: the OPERA+ group underwent RFA using oesophageal probes (SensiTherm™); the OPERA- group received RFA using fixed energy levels of 25 W at the posterior wall without an oesophageal probe. All patients underwent post-interventional endoscopy and Holter-electrocardiogram after 6 months. (Clinical.Trials.gov: NCT03246594). One hundred patients were randomized in OPERA+ and 100 patients in OPERA-. The drop-out rate was 10%. In total, 18/180 (10%) patients developed endoscopically diagnosed oesophageal lesions (EDEL). There was no difference between the groups with 10/90 (11%) EDEL in OPERA+ vs. 8/90 (9%) in OPERA- (P = 0.62). Despite the higher power delivered at the posterior wall in OPERA+ [28 ± 4 vs. 25 ± 2 W (P = 0.001)], the average EDEL size was equal [5.7 ± 2.6 vs. 4.5 ± 1.7 mm (P = 0.38)]. The peak temperature did not correlate with EDEL size. During follow-up, no patient died. Only one patient in OPERA- required a specific therapy for treatment of the lesion. Cumulative AF recurrence after 6 (3-13) months was 28/87 (32%) vs. 34/88 (39%), P = 0.541.

Conclusion: This first randomized study demonstrates that intraoesophageal temperature monitoring using the SensiTherm™ probe does not affect the probability of developing EDEL. The peak temperature measured by the thermoprobe seems not to correlate with the incidence of EDEL. Empiric energy reduction at the posterior wall did not affect the efficacy of the procedure.
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http://dx.doi.org/10.1093/europace/euaa209DOI Listing
October 2020

The Shorter, the Better?: Short Duration Ablation, Catheter Stability, and Lesion Durability.

JACC Clin Electrophysiol 2020 08;6(8):986-988

Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.jacep.2020.05.001DOI Listing
August 2020

Publisher Correction: A global database of Holocene paleotemperature records.

Sci Data 2020 08 12;7(1):271. Epub 2020 Aug 12.

Institute of Archaeology and Ethnography, Russian Academy of Sciences, Siberian Branch, Novosibirsk, 630090, Russia.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41597-020-00611-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423907PMC
August 2020

Novel electroanatomical map for permanent his bundle pacing: the Mont Blanc approach - influence of the learning curve and procedural outcome.

Europace 2020 11;22(11):1697-1702

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.

Aims: Pacing the specific conduction system like the Bundle of His (HB) can lead to more physiologic activation patterns compared to traditional right ventricular apical pacing. The aim of this study was to estimate the feasibility and value of electroanatomical mapping (EAM) for HB pacing during the learning curve and its impact on procedural outcome.

Methods And Results: Fifteen consecutive patients were treated using EAM of the His bundle region before implantation. Voltage and activation maps of HB potentials were performed. The activation time from His potential to R wave (ECG-reference) was measured and correlated to the HV interval. The atrial and ventricular potentials were blended so the active window could only see the His potential. After completing the activation map, it was transformed into a peak-to-peak voltage map of the HB. With reversed black and white colour scale, the exact point of the maximal His signal amplitude was visualized. Procedural data for the implantation were analysed using this innovative approach. The average total procedural time and fluoroscopy time was 88.2 ± 19.1 min and 10.9 ± 4.5 min, respectively. The 3D mapping time was 18.4 ± 5.1 min. The 13.9 ± 5.1 His potential points were needed in average to complete the map. No periprocedural complications were seen in this cohort. In 86.7% of cases, His bundle pacing was successful. The average threshold for the His bundle stimulation and the R-wave amplitude was 1.62 ± 1 V (@1.0 ms) and 4.8 ± 3.2 mV, respectively. The pacing impedance was 513.5 ± 102.8 Ω. Average paced QRS complex width was 116.9 ± 20.3ms. On average 2.6 ± 1.6 lead positions were targeted to find the optimal pacing site.

Conclusion: Electroanatomical mapping-guided implantation of His-bundle leads can facilitate the identification of optimal pacing sites and allow to minimize procedure and fluoroscopy times even during the phase of the learning curve.
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http://dx.doi.org/10.1093/europace/euaa226DOI Listing
November 2020

[Smart and simple : Current role of implantables and wearables in daily practice].

Herzschrittmacherther Elektrophysiol 2020 Sep 5;31(3):265-272. Epub 2020 Aug 5.

Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.

Recent developments indeed point towards implantable and wearables, especially smartwatches, as being quite effective and a novel method for screening of arrhythmias in the general population or rhythm monitoring in our patients. The new generation of smart rhythm monitoring devices allows for continuous monitoring and simple real time access to the majority of the data. Therefore, they are well suited to be part of the growing number of so-called remote medicine concepts. Although the technology is not only restricted to smartwatches, single lead ECGs that are portable and phone applications that detect heart rate can serve as event recorders during an episode of symptoms. Furthermore, implanted rhythm monitoring may also communicate with mobile applications to allow more rapid and accurate arrhythmia diagnosis and therapy. The authors aimed to demonstrate and discuss new technical developments focusing on the latest generation of implantables and wearables and their benefit in terms of smart and simple cardiac rhythm monitoring.
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http://dx.doi.org/10.1007/s00399-020-00707-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403787PMC
September 2020

Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation: A Multicenter Study.

JACC Clin Electrophysiol 2020 07 25;6(7):773-782. Epub 2020 Mar 25.

Department of Cardiology, Medical Clinic II, University Hospital Schleswig-Holstein, Lübeck, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Lübeck, Germany.

Objectives: This study sought to assess the incidence, procedural characteristics, contributing factors, and clinical outcome of cryoballoon-based pulmonary vein isolation (CB-PVI)-related hemoptysis in a multicenter study.

Background: Hemoptysis has been described as a rare complication of CB-PVI. However, the precise mechanism and the etiology of this complication are poorly characterized.

Methods: Consecutive patients undergoing CB-PVI for paroxysmal or persistent atrial fibrillation at 4 German hospitals were included in this observational analysis.

Results: A total of 4,331 CB-PVI procedures were performed between 2006 and 2019. Fifteen patients (9 men, mean age 68.1 ± 9.8 years) developed acute hemoptysis during or within 24 h after CB-PVI, resulting in a hemoptysis frequency of 0.35%. Hemoptysis occurred in 6 of 720 procedures using the first-generation CB (0.83%) and in 9 of 3,611 procedures using the second-, third-, or fourth-generation CB (0.25%) (p = 0.015). Bronchoscopy was performed in 8 patients and showed bleeding exclusively due to mucosal injury or due to a coagulum at a bronchus adjacent to the ablation site. Hemoptysis resolved spontaneously without any long-term sequelae in all patients, except for a 92-year-old patient who died 13 days after CB-PVI due to pneumonia. No specific endobronchial treatment was necessary.

Conclusions: Acute hemoptysis after CB-PVI is a rare but potentially life-threatening complication that is usually self-limiting. Direct thermal injury of bronchi adjacent to a pulmonary vein seems to be the most likely mechanism.
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http://dx.doi.org/10.1016/j.jacep.2020.02.003DOI Listing
July 2020

Author Correction: A global database of Holocene paleotemperature records.

Sci Data 2020 07 16;7(1):246. Epub 2020 Jul 16.

Institute of Archaeology and Ethnography, Russian Academy of Sciences, Siberian Branch, Novosibirsk, 630090, Russia.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41597-020-00584-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366677PMC
July 2020

[Smart decisions in rhythmology : What should we know? What should be do? What do we still have to learn?]

Herzschrittmacherther Elektrophysiol 2020 Dec 15;31(4):328-333. Epub 2020 Jul 15.

Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.

Heart rhythm disorders are one of the most common cardiac problems in Germany. Every year, about 95,000 ablation procedures, 42,000 implantable cardioverter-defibrillators (ICD) and 102,000 pacemaker implantations are performed with the annual numbers continuing to increase. Besides technological innovations in the field of therapeutic devices (e.g., ablation tools), there are fundamental changes in the diagnostic workup for arrhythmias since smartwatches and wearable devices are increasingly available on the market. In this article, an overview on the latest developments in the field of invasive electrophysiology and rhythmology is provided. The following are explained: why electrocardiograms (ECGs) from smartwatches/wearables are usually of good quality and can be used for screening or confirmation of a diagnosis; why we should consider re-establishment of sinus rhythm in patients with atrial fibrillation or limited left ventricular function; to what extent investigator and center experience influence patient safety; how we can induce a physiological contraction pattern in about 70% of AV block patients by direct stimulation of the specific conduction system, why the benefit of an implantable ICD is questionable in nonischemic cardiomyopathy and ejection fraction (EF) <35 %; and finally, why cardiomyopathies induced by ventricular extrasystoles (VES) are so difficult to predict.
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http://dx.doi.org/10.1007/s00399-020-00696-6DOI Listing
December 2020

The hidden skills of the cryoballoon: occlusion of cardiac perforation in a patient with persistent left superior vena cava-a case report.

Eur Heart J Case Rep 2020 Jun 26;4(3):1-5. Epub 2020 Mar 26.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.

Background: Cardiac tamponade is one of the most serious complications when performing cardiac interventions. Although most of the patients can be treated effectively using pericardiocentesis, urgent surgery can be necessary in case of continuous bleeding and patients' haemodynamic impairment.

Case Summary: With this unique clinical case report we describe an acute endovascular occlusion of a cardiac perforation utilizing the inflated 28 mm cryoballon at the transseptal puncture site close to the superior part of the coronary sinus ostium in a patient with persistent left superior vena cava (PLSVC) and severe post-procedural tamponade. Prior to this maneuver, 1200 mL of haemorrhagic effusion has been aspirated. Forty-five minutes after cryoballoon-guided occlusion we deflated the balloon and no additional blood could be aspirated over the following 20 minutes.

Discussion: Cryoballon-guided occlusion of the perforation site saved the patient from immediate cardiac surgery and resulted in stable haemodynamic conditions. This bailout approach was transferred from coronary interventions where occlusion of a perforated vessel using balloon devices is a common technique to achieve acute hemostasis.
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http://dx.doi.org/10.1093/ehjcr/ytaa056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319836PMC
June 2020

Holocene global mean surface temperature, a multi-method reconstruction approach.

Sci Data 2020 06 30;7(1):201. Epub 2020 Jun 30.

University of Lausanne, Institute of Earth Surface Dynamics, Lausanne, 1015, Switzerland.

An extensive new multi-proxy database of paleo-temperature time series (Temperature 12k) enables a more robust analysis of global mean surface temperature (GMST) and associated uncertainties than was previously available. We applied five different statistical methods to reconstruct the GMST of the past 12,000 years (Holocene). Each method used different approaches to averaging the globally distributed time series and to characterizing various sources of uncertainty, including proxy temperature, chronology and methodological choices. The results were aggregated to generate a multi-method ensemble of plausible GMST and latitudinal-zone temperature reconstructions with a realistic range of uncertainties. The warmest 200-year-long interval took place around 6500 years ago when GMST was 0.7 °C (0.3, 1.8) warmer than the 19 Century (median, 5, 95 percentiles). Following the Holocene global thermal maximum, GMST cooled at an average rate -0.08 °C per 1000 years (-0.24, -0.05). The multi-method ensembles and the code used to generate them highlight the utility of the Temperature 12k database, and they are now available for future use by studies aimed at understanding Holocene evolution of the Earth system.
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http://dx.doi.org/10.1038/s41597-020-0530-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327079PMC
June 2020

Publisher Correction: A global database of Holocene paleotemperature records.

Sci Data 2020 06 15;7(1):183. Epub 2020 Jun 15.

Institute of Archaeology and Ethnography, Russian Academy of Sciences, Siberian Branch, Novosibirsk, 630090, Russia.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41597-020-0515-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295788PMC
June 2020

Unusual Midventricular LV Obstruction With Flow Aimed to the Apex Due to Apical RV Pacing: Elimination by Sequential Septo-Apical RV Pacing.

Can J Cardiol 2020 Nov 15;36(11):1831.e11-1831.e13. Epub 2020 May 15.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

We report the case of an 88-year-old man who developed a mid-left-ventricular (LV) obstruction caused by apical pacing to manage third-degree atrioventricular block. The flow generated by the obstruction was directed toward the LV apex and appeared from late systole to early diastole. The obstruction appeared to result from earlier contraction at the apex compared with the midventricular portion of the LV, which was followed by an also earlier apical relaxation. The obstruction was eliminated by using a second right-ventricular mid-septally attached electrode combined with a sequential septo-apical pacing (septal stimulation 40 ms before apical pacing).
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http://dx.doi.org/10.1016/j.cjca.2020.04.046DOI Listing
November 2020

A global database of Holocene paleotemperature records.

Sci Data 2020 04 14;7(1):115. Epub 2020 Apr 14.

Institute of Archaeology and Ethnography, Russian Academy of Sciences, Siberian Branch, Novosibirsk, 630090, Russia.

A comprehensive database of paleoclimate records is needed to place recent warming into the longer-term context of natural climate variability. We present a global compilation of quality-controlled, published, temperature-sensitive proxy records extending back 12,000 years through the Holocene. Data were compiled from 679 sites where time series cover at least 4000 years, are resolved at sub-millennial scale (median spacing of 400 years or finer) and have at least one age control point every 3000 years, with cut-off values slackened in data-sparse regions. The data derive from lake sediment (51%), marine sediment (31%), peat (11%), glacier ice (3%), and other natural archives. The database contains 1319 records, including 157 from the Southern Hemisphere. The multi-proxy database comprises paleotemperature time series based on ecological assemblages, as well as biophysical and geochemical indicators that reflect mean annual or seasonal temperatures, as encoded in the database. This database can be used to reconstruct the spatiotemporal evolution of Holocene temperature at global to regional scales, and is publicly available in Linked Paleo Data (LiPD) format.
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http://dx.doi.org/10.1038/s41597-020-0445-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156486PMC
April 2020

Impact of single versus double transseptal puncture on outcome and complications in pulmonary vein isolation procedures.

Cardiol J 2020 Mar 24. Epub 2020 Mar 24.

Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation.

Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP.

Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA₂DS₂-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788).

Conclusion: There was no clear benefit of single or double TSP in AF ablation.
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http://dx.doi.org/10.5603/CJ.a2020.0037DOI Listing
March 2020

Does the origin of ablated premature ventricular contractions determine the level of left ventricular function improvement?

Kardiol Pol 2020 05 23;78(5):438-446. Epub 2020 Mar 23.

Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland

Background: Premature ventricular contractions (PVCs) are associated with tachycardiomyopathy and high mortality rate. The treatment depends on the engaged ventricle. For PVCs originating from the right outflow tract (OT), radiofrequency catheter ablation (RFCA) is recommended (class IB‑R recommendation) in preference to pharmacotherapy. In those originating from the left ventricle, ablation is a class IIa B‑NR recommendation.

Aims: The aim of the study was to assess the success of RFCA of PVCs based on arrhythmia origin.

Methods: A total of 110 consecutive patients with monomorphic PVCs referred for ablation were enrolled and divided according to the site of ablation to the OT group and the ventricles (VENT) group. Holter electrocardiography and echocardiography were performed before the procedure and at 6‑month follow‑up.

Results: Long‑term RFCA success was achieved in 93 (85%) patients (89% in the OT group and 82% in the VENT group; P = 0.39). The PVC reduction was similar in both groups (median [interquartile range] 99.55% [14] and 99.88% [6], respectively; P = 0.56). The OT group presented greater left ventricle (LV) recovery than the VENT group (odds ratio, 2.01; 95% CI, 1.15-10.75; P = 0.015). The procedure in the VENT group was longer, required additional access, the complication rate was similar, and 1 serious adverse event (aortic dissection) was observed in a patient with arrhytmia originating in the LV outflow tract.

Conclusions: The origin of PVCs does not determine the success of arrhythmia elimination. The OT origin may predict LV improvement. The duration of RFCA in the VENT group was longer. The outflow tract origin may predict reversal of LV deterioration.
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http://dx.doi.org/10.33963/KP.15246DOI Listing
May 2020