Transcoronary guidewire ablation with radiofrequency in a porcine animal model.

Objectives: Transcoronary ablation of septal hypertrophy (TASH) and surgical myectomy are the recommended treatment options for patients with hypertrophic obstructive cardiomyopathy refractory (HOCM) when conventional drug treatment is not sufficient. We describe the application of radiofrequency (RF) energy via coronary guidewires in an animal model for selective occlusion of coronary side branches that mimics the principle of TASH.

Methods: Transcoronary guidewire ablation of coronary vessels was performed in 5 adult pigs under general anaesthesia in an animal cathlab after successful bench testing of the ablation settings.

Transcoronary pacing in an animal model : Second coated guidewire versus cutaneous patch as indifferent electrodes.

Background: Transcoronary pacing is a seldom used treatment option for unheralded bradycardias in the setting of percutaneous coronary interventions (PCI). In the present study we compared a coated guidewire inserted proximally into a coronary artery with a cutaneous patch electrode as indifferent electrodes for transcoronary pacing in a porcine model.

Methods: Transcoronary pacing was investigated in 7 adult pigs in an animal catheterization laboratory.

Wire- and needle potentials facilitating transseptal puncture.

Background: Transseptal puncture for left heart interventions became a routine procedure guided by fluoroscopy and echocardiography. The use of intracardiac potentials derived from the sheath-transseptal-needle/guidewire-combination may provide helpful information to increase safety of this procedure.

Methods And Results: We recorded the intracardiac potentials from the sheath-transseptal-needle/guidewire-combination during the transseptal puncture procedure in 31 consecutive patients (mean age 67.

Transcoronary mapping of ventricular asynchrony due to left bundle branch block in a porcine model.

Background: Optimal positioning of the left ventricular (LV) lead at the latest activated part of the left ventricle is one of the major challenges in implantation of cardiac resynchronization therapy (CRT) devices with respect to ascertaining an optimal resynchronization effect resulting in a high responder rate. In the present study, we evaluated the feasibility of transcoronary measurement of LV electrical activation by a coated guidewire in a porcine model.

Methods And Results: Transcoronary measurement of ventricular activation was performed in 16 pigs under general anesthesia.

A novel approach for transcoronary pacing in a porcine model.

Background: Transcoronary pacing for the treatment of bradycardias during percutaneous coronary intervention (PCI) is a useful technique in interventional cardiology. The standard technique is unipolar pacing with the guidewire in the coronary artery against a cutaneous patch electrode. We developed a novel approach for transcoronary pacing by using intravascular electrodes in different positions in the aorta in a porcine model.

Interleukin-6, -7, -8 and -10 predict outcome in acute myocardial infarction complicated by cardiogenic shock.

Background: The IABP-SHOCK-trial was a morbidity-based randomized controlled trial in patients with infarction-related cardiogenic shock (CS), which used the change of the quantified degree of multiorgan failure as determined by APACHE II score over a 4-day period as primary outcome measure. The prospective hypothesis was that adding IABP therapy to "standard care" would improve CS-triggered multi organ dysfunction syndrome (MODS). The primary endpoint showed no difference between conventionally managed cardiogenic shock patients and those with IABP support.

Transcoronary pacing in a porcine model--impact of guidewire insulation.

Background: Bradycardia complicating percutaneous coronary intervention (PCI) can require temporary pacing. A transcoronary approach using the guidewire in the coronary artery may be a useful alternative to transvenous pacing. The purpose of the present study was to compare the efficacy of two different coronary guidewires in transcoronary pacing: a novel guidewire (VisionWire®, Biotronik, Germany) which has a coating to electrically insulate the shaft, thereby maximizing current delivery through the intracoronary section compared to a standard guidewire (without insulation) and a standard guidewire/balloon combination.

Optimizing of transcoronary pacing in a porcine model.

Background: Transcoronary pacing for the treatment of bradycardia during percutaneous coronary intervention (PCI) is not well established, but may be a useful technique in interventional cardiology. We developed a porcine model to examine the feasibility and efficacy of transcoronary pacing during PCI.

Methods And Results: Eight pigs under general anesthesia underwent unipolar transcoronary pacing with a standard floppy guidewire in a coronary artery (as the cathode) and a skin patch electrode (as the anode).

Septic cardiomyopathy - A not yet discovered cardiomyopathy?

Myocardial depression in human sepsis was only unequivocally proven in the 1980s by the group of Parrillo, who used nuclear imaging techniques to measure heart volumes and function in intensive care patients. Heart failure in sepsis is frequently masked by a seemingly normal cardiac output. However, relative to the lowered systemic vascular resistance - resulting in a reduced afterload - cardiac outputs and ventricular ejection fractions are often not adequately enhanced.

Impedance cardiography: a useful and reliable tool in optimization of cardiac resynchronization devices.

Aims: Optimizing cardiac resynchronization therapy (CRT) devices has become more complex since modification of both atrioventricular (AV) and interventricular (VV) stimulation intervals has become possible. The current paper presents data from the routine use of impedance cardiography (IC)-based cardiac output (CO) measurements to guide the optimization of AV- and VV-interval timing of CRT devices.

Methods And Results: Forty-six patients with heart failure (left ventricular ejection fraction <35%, New York Heart Association (NYHA) III-IV) and left bundle branch block (>130 ms) in sinus rhythm were evaluated 3-5 days after implantation of a CRT device by means of IC.

Temporary trans-coronary pacing by coated guidewires: a safe and reliable method during percutaneous coronary intervention.

Relevant bradycardias during percutaneous coronary intervention (PCI) are a rare event, but they require immediate therapy by temporary pacing. However, transvenous pacing is associated with frequent and severe complications. Therefore, we wanted to evaluate the safety and reliability of trans-coronary pacing by means of a PCI guidewire.