Publications by authors named "Steven D"

Left bundle branch area pacing is currently the most common form of physiological pacing prior to His bundle pacing. It is intended to prevent or correct the development of pacemaker-induced cardiomyopathy and is being used more and more frequently. In order to be able to perform this successfully, knowledge regarding the specific anatomy and radiological anatomy as well as the ECG criteria for left bundle branch pacing is required in addition to knowledge of the tools.

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A large proportion of those affected by epilepsy live in resource-poor areas. The Epilepsy surgery in low-resource settings Task Force from the ILAE undertook a survey in Africa and Latin America to identify fellowships in Epilepsy and EEG as well as in Epilepsy Surgery. The results revealed a significant shortage of training programs in these two regions of the globe.

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Objective: To investigate the effects of vagus nerve stimulation (VNS) on the seizure frequency in patients with drug-resistant epilepsy (DRE) and bilateral temporal lobe epilepsy (bi-TLE). Additionally, we aimed to determine the safety of VNS and its side effects.

Methods: Our retrospective study included 17 patients with bi-TLE who underwent VNS-device implantation at our center from 1997 to 2019.

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[Conducted energy weapons (CEW)].

Herzschrittmacherther Elektrophysiol

December 2024

Background: Conducted energy weapons (CEW, TASER) are increasingly used by law enforcement agencies in Germany. The CEWs are intended to reduce violence against police officers and to reduce moderate to severe injuries of police officers and aggressors. The delivery of repetitive electrical impulses causes neuromuscular paralysis and incapacitation; however, there are safety concerns due to deaths related to CEWs.

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Background: Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.

Methods: Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B).

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Background: The Manufacturer and User Facility Device Experience (MAUDE) database houses medical device reports of adverse events involving medical devices marketed in the United States submitted to the U.S. Food and Drug Administration (FDA) by mandatory and voluntary reporters.

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Article Synopsis
  • The study explores the effectiveness of using a smartphone app to monitor the time patients spend experiencing atrial fibrillation (AF) and related symptoms after AF ablation.
  • A total of 484 patients participated, showing high adherence and satisfaction with the app, which measured AF and symptom data three times daily.
  • Results indicated strong correlations between AF and symptom recordings, with most patients showing a paroxysmal AF pattern, suggesting successful monitoring through the app could aid in evaluating patient outcomes post-ablation.
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Article Synopsis
  • Advanced bipolar radiofrequency catheter ablation (Bi-RFA) is being studied as a new treatment for patients with ventricular tachycardia (VT) and premature ventricular contractions (PVC) that do not respond to standard unipolar radiofrequency ablation (Uni-RFA).
  • A multicenter registry conducted in Europe showed that out of 91 patients treated with Bi-RFA, 74% achieved elimination of clinical VT/PVC, and 78% experienced a significant reduction in PVC burden during follow-up.
  • The procedure was found to be generally safe and feasible, though there were some major complications reported, indicating that Bi-RFA could be a valid option for managing refractory VT/PVC
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Heart rhythm management is a continuously evolving sub-speciality of cardiology. Every year, many physicians and allied professionals (APs) start and complete their training in cardiac implantable electronic devices (CIEDs) or electrophysiology (EP) across the European Heart Rhythm Association (EHRA) member countries. While this training ideally ends with an EHRA certification, the description of the learning pathway (what, how, when, and where) through an EHRA core curriculum is also a prerequisite for a successful training.

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Background: Fibromas are rare primary benign cardiac tumours that can become symptomatic due to expansive growth, ventricular rhythm disturbances, and sudden cardiac death. Distinguishing fibromas from other (malign) cardiac masses is essential for accurate diagnosis and treatment. While there is some experience in management of cardiac fibromas in children, management of adult patients is unknown.

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As an alternative to transvenous ICD systems, two non-transvenous ICD systems have been established in recent years: The subcutaneous ICD (S-ICD), which has been established for several years, has a presternal electrode that is implanted subcutaneously and offers a shock function and, to a limited extent, post-shock pacing. In addition, the extravascular ICD (EV-ICD) has been available in Europe since 2023 which does not require transvenous electrodes and offers the option of providing patients with antibradycardic and antitachycardic stimulation in combination with a conventional ICD function. The lead of this device is implanted substernally.

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Purpose: Drug-resistant epilepsy (DRE) affects one-third of patients with focal epilepsy. A large portion of patients are not candidates for epilepsy surgery, thus alternative options, such as vagus nerve stimulation (VNS), are proposed. Our objective is to study the effect of vagus nerve stimulation on lesional versus non-lesional epilepsies.

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Aims: Atrial fibrillation (AF) is common in heart failure (HF) and negatively impacts outcomes. The role of ablation-based rhythm control in patients with AF and HF with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF) is not known. The CABA-HFPEF-DZHK27 (CAtheter-Based Ablation of atrial fibrillation compared to conventional treatment in patients with Heart Failure with Preserved Ejection Fraction) trial will determine whether early catheter ablation for AF can prevent adverse cardiovascular outcomes in patients with HFpEF or HFmrEF.

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Article Synopsis
  • Pulsed field ablation (PFA) is a new method for treating atrial fibrillation (AF) that focuses on ablating heart tissue while minimizing harm to nearby structures.
  • In the MANIFEST-17K study, data from 106 centers involved 17,642 patients and showed no serious complications like esophageal damage, with only a 1% major complication rate.
  • The results suggest that PFA has a strong safety profile and may change how AF is treated, compared to traditional thermal ablation methods.
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Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have become established in preventing sudden cardiac death, with some advantages over transvenous defibrillator systems, including a lower incidence of lead failures. Despite technological advancements, S-ICD carriers may suffer from significant complications, such as premature battery depletion (PBD), that led to an advisory for nearly 40 000 patients. This multicentre study evaluated the incidence of PBD in a large set of S-ICD patients.

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Background: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

Objective: To assess the outcomes of pulsed-field ablation (PFA) in HF.

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Background: Atrial fibrillation (AF) and heart failure (HF) coexist, increasing morbidity and mortality. Studies have demonstrated improved outcomes following AF ablation in HF patients with reduced ejection fraction (EF).

Objective: This study sought to assess the outcomes of pulsed field ablation (PFA) in HF.

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Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer potentially distinct advantages over transvenous defibrillator systems. Recent randomized trials showed significantly lower lead failure rates than transvenous ICD. Still, S-ICDs remain associated with the risk of inappropriate shocks (IAS).

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Article Synopsis
  • The implantation of electrodes for cardiac devices demands a high level of technical skill and precision, particularly in the right ventricle and atrium, impacting patient safety and therapy effectiveness.
  • Focus is placed on the differences between apical and septal stimulation when positioning electrodes in the ventricle.
  • The article serves as a practical guide for implanters, detailing the steps for proper electrode placement, but does not cover techniques for physiological stimulation like cardiac resynchronization therapy (CRT) or conduction system pacing (CSP).
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Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is a treatment option for focal drug-resistant epilepsy. In previous studies, this technique has shown seizure reduction by ≥50% in 50% of patients at 1 year. However, the relationship between the location of the ablation within the epileptogenic network and clinical outcomes remains poorly understood.

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Aims: Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA).

Methods And Results: Eighty-three international experts met in Münster for 2 days in September 2023.

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Article Synopsis
  • Atrial fibrillation (AF) ablation has become a well-established treatment method in the last 30 years, supported by evidence showing it is safe and effective.
  • In response to advancements in research and technology, new guidelines have been released over the years, the latest being necessary to provide updated recommendations for patient care.
  • This revised consensus involves collaboration among major cardiac electrophysiology societies from Europe, Asia-Pacific, and Latin America to ensure comprehensive guidelines for AF treatment.
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Objective: Despite the general safety and efficacy of epilepsy surgery, there is evidence that epilepsy surgery remains underutilized. Although there are an increasing number of studies reporting epilepsy surgery in older adults, there is no consensus on whether epilepsy surgery is efficacious or safe for this population. Our objective was to systematically assess the efficacy as well as safety of resective surgery in people aged 50 years or older with drug-resistant epilepsy.

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Background: The cryoballoon (CB) has become a standard tool for pulmonary vein isolation (PVI), but the technology is limited in certain ways. A novel RF-balloon (Heliostar™, Biosense Webster, CA, USA) promises the advantages of a balloon technology in combination with 3D mapping.

Methods: To assess procedural data and outcome, all patients undergoing RF-balloon PVI were included and compared with data from consecutive patients undergoing CB PVI for paroxysmal AF.

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Article Synopsis
  • Pulmonary vein isolation (PVI) alone is often inadequate for treating persistent atrial fibrillation, and adding left atrial posterior wall (LAPW) ablation has had mixed results due to concerns about safety and effectiveness.
  • This study compares the safety and effectiveness of PVI combined with LAPW ablation versus PVI alone using pulsed-field ablation (PFA) in patients with persistent atrial fibrillation.
  • Results show no significant difference in freedom from arrhythmias or major adverse events between the two groups, indicating that adding LAPW ablation may not improve outcomes in this patient population.
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