Publications by authors named "Thorsten Lewalter"
Expert opinion on design and endpoints for studies on catheter ablation of atrial fibrillation.
J Cardiovasc Electrophysiol
November 2024
Article Synopsis
- Catheter ablation for atrial fibrillation (AF) is widely researched, and this expert opinion aims to enhance future studies by applying lessons from past research and promoting consistency in methodologies.
- The effectiveness of these studies can improve with clearly defined endpoints and a thorough understanding of emerging technologies, as well as a need to revisit some current research methods.
- A panel of clinical experts has produced recommendations highlighting essential elements such as documenting clinical details, managing medications during trials, and assessing outcomes to aid in the standardization and quality of AF catheter ablation studies.
Outcomes of surgical ablation for atrial fibrillation in on- versus off-pump coronary artery bypass grafting.
Interdiscip Cardiovasc Thorac Surg
September 2024
Objectives: A considerable number of patients undergoing coronary artery bypass grafting surgery suffer from atrial fibrillation and should be treated concomitantly. This manuscript evaluates the impact of on-pump versus off-pump bypass grafting on the applied lesion set and rhythm outcome.
Methods: Between January 2017 and April 2020, patients who underwent combined bypass grafting and surgical ablation for atrial fibrillation were consecutively enrolled in the German CArdioSurgEry Atrial Fibrillation registry (CASE-AF, 17 centres).
(1) Background: Meteorological factors seem to exert various effects on human health, influencing the occurrence of diseases such as thromboembolic events and strokes. Low atmospheric pressure in summer may be associated with an increased likelihood of ischemic stroke. The aim of this study was to investigate the potential impact of meteorological conditions on left atrial appendage (LAA) thrombus formation.
View Article and Find Full Text PDFAims: 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.
View Article and Find Full Text PDFBackground: Understanding the dynamics of conduction velocity (CV) and voltage amplitude (VA) is crucial in cardiac electrophysiology, particularly for substrate-based catheter ablations targeting slow conduction zones and low voltage areas. This study utilizes ultra-high-density mapping to investigate the impact of heart rate and pacing location on changes in the wavefront direction, CV, and VA of healthy pig hearts.
Methods: We conducted in vivo electrophysiological studies on four healthy juvenile pigs, involving various pacing locations and heart rates.
Article Synopsis
- The study analyzed catheter ablation success rates and complications in 591 patients with cardiac pacemakers compared to 7,393 patients without them, finding that patients with pacemakers were generally older and had more health issues.
- One-year mortality rates were higher in the pacemaker group (2.4%) versus the non-pacemaker group (1.3%), along with increased risks of re-hospitalization and combined cardiovascular events.
- Despite these increased risks, the rate of procedural success was high (98.8%) for those with pacemakers, and serious device-related complications were very low (0.4%).
Article Synopsis
- Interventional left atrial appendage occlusion (LAAO) is effective for patients with nonvalvular atrial fibrillation (AF) who can't use long-term blood thinners, especially those with a history of stroke.
- A study from the LAARGE registry found that LAAO was similarly effective and safe for stroke patients compared to those without a stroke history, with high success rates and low complication rates in both groups.
- The results suggest that LAAO could be a viable option for secondary prevention in high-risk AF patients, showing no significant differences in risk of death or stroke between those with and without prior strokes.
Objectives: The CArdioSurgEry Atrial Fibrillation (CASE-AF) registry is a prospective, multicentre study for collecting and analysing real-world data of surgical atrial fibrillation (AF) treatment. This study aimed to evaluate outcomes of surgery for long-standing persistent AF at 1 year.
Methods: In total, 17 centres consecutively include all eligible patients with continuous AF lasting for ≥1 year.
[Longterm results of interventional antiarrhythmic therapy].
Herzschrittmacherther Elektrophysiol
December 2023
Background And Objectives: Long-term oral anticoagulation (OAC) following successful catheter ablation of atrial fibrillation (AF) remains controversial. Prospective data are missing. The ODIn-AF study aimed to evaluate the effect of OAC on the incidence of silent cerebral embolic events and clinically relevant cardioembolic events in patients at intermediate to high risk for embolic events, free from AF after pulmonary vein isolation (PVI).
View Article and Find Full Text PDF[Isthmus-dependent right atrial flutter : Clinical course after isthmus ablation].
Herzschrittmacherther Elektrophysiol
December 2023
Ablation of the cavotricuspid isthmus (CTI) to create bidirectional isthmus blockade is the most effective way to achieve rhythm control in typical atrial flutter. Compared with drug therapy, ablation reduces cardiovascular mortality, all-cause mortality, stroke risk, and the risk of cardiac decompensation. Concomitant arrhythmia of atrial flutter is atrial fibrillation (AF); therefore the duration of oral anticoagulation should be adapted according to the risk of stroke and bleeding.
View Article and Find Full Text PDFBackground: Ultra-high-density mapping systems allow more precise measurement of the heart chambers at corresponding conduction velocities (CVs) and voltage amplitudes (VAs). Our aim for this study was to define and compare a basic value set for unipolar CV and VA in all four heart chambers and their separate walls in healthy, juvenile porcine hearts using ultra-high-density mapping.
Methods: We used the Rhythmia Mapping System to create electroanatomical maps of four pig hearts in sinus rhythm.
Article Synopsis
- Interventional left atrial appendage occlusion (LAAO) is a treatment option that replaces long-term oral anticoagulation for patients with nonvalvular atrial fibrillation, particularly those with a high risk of bleeding.
- A study examined the impact of spontaneous echo contrast (SEC) on the risk of device-related thrombus (DRT) and thromboembolic events (TEs) in two groups of patients: those with SEC and those without it.
- The results showed that while procedural success was high in both SEC groups, DRT was only noted in the SEC- group and TEs were rare in both, suggesting that SEC presence might not significantly affect post-LAAO outcomes.
Aims: Prevalent atrial fibrillation (AF) is associated with excess cardiovascular (CV) death (D) and hospitalizations (H) in heart failure (HF) with preserved ejection fraction (pEF). We evaluated if it had an independent role in excess CVD in HFpEF and studied its impact on cause-specific mortality and HF morbidity.
Methods And Results: We used propensity score-matched (PSM) cohorts from the TOPCAT Americas trial to account for confounding by other co-morbidities.
Objectives: This study of German Cardiosurgery Atrial Fibrillation (CASE-AF) registry aims to describe the 1-year outcomes of patients undergoing ablative procedures for atrial fibrillation (AF) in a cardiosurgical setting.
Methods: Between January 2017 and April 2020, 17 German cardiosurgical units enrolled 1,000 consecutive patients undergoing concomitant or stand-alone ablation for AF. In-hospital and 1-year follow-up data were collected on web-based electronic case report forms.
Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021.
View Article and Find Full Text PDFArticle Synopsis
- Interventional left atrial appendage occlusion (LAAO) is a procedure used for patients with nonvalvular atrial fibrillation who cannot take standard blood thinners, and this study looks at its effects on patients with low versus high stroke risk.
- The study included 638 patients divided into low-risk (CHA DS -VASc score ≤2) and high-risk (score >2) groups, finding that while implantation success was high, low-risk patients experienced more moderate complications despite having no major strokes or bleeds within a year.
- The authors suggest that the need for LAAO in low-risk patients should be carefully evaluated to weigh potential benefits against risks.
Article Synopsis
- Patients undergoing left atrial appendage closure (LAAC) often have severe anemia, affecting 22.3% of a study group, but this does not impact the success rate of the procedure or lead to more in-hospital complications.
- Anemic patients were generally older and had more health issues, reflected in higher risk scores, yet had significantly lower rates of severe complications during their hospital stay compared to non-anemic patients.
- Despite the lower in-hospital complication rates, anemic patients experienced higher one-year mortality mainly due to existing co-morbidities, suggesting the need for careful monitoring in this population.
Purpose: Data regarding post-procedural antithrombotic therapy following percutaneous left atrial appendage (LAA) in real-world populations using various occluder systems is limited. In the present analysis, anticoagulation (AC) was compared against antiplatelet therapy (APT) using data from the real-world multi-center LAARGE study.
Methods: Patients following LAA closure enrolled in the LAARGE study were assigned to two groups depending on initial post-implantation antithrombotic regime consisting of either AC or APT.
The German CArdioSurgEry Atrial Fibrillation Registry: In-Hospital Outcomes.
Thorac Cardiovasc Surg
June 2023
Background: The aim of this study was to describe outcomes of patients undergoing surgical ablation for atrial fibrillation (AF) as either stand-alone or concomitant cardiosurgical procedures in Germany.
Methods: Patients with AF undergoing concomitant or stand-alone surgical ablation were included in the registry. Cardiac surgery centers across Germany were invited to participate and sought to enroll 1,000 consecutive patients.
Potential of remote monitoring to prevent sensing and detection failures in implantable cardioverter defibrillators.
Herzschrittmacherther Elektrophysiol
March 2022
Background: Sensing malfunction and misinterpretation of intracardiac electrograms (IEGMs) in patients with implantable cardioverter defibrillators (ICDs) may lead to inadequate device activity such as inappropriate shock delivery or unnecessary mode-switching. Remote monitoring has the potential for early detection of sensing malfunction or misclassification and may thus prevent adverse device activity. Therefore, the authors analyzed the amount, nature, and distribution of misclassification in current ICD and cardiac resynchronization therapy defibrillator technology using the device transmissions of the IN-TIME study population.
View Article and Find Full Text PDFAim: Percutaneous left atrial appendage (LAA) closure has been established as alternative stroke prophylaxis in patients with non-valvular atrial fibrillation (AF) and high bleeding risk. However, little is known regarding the outcome after LAA closure depending on the HAS-BLED score.
Methods: A sub-analysis of the prospective, multicenter, Left-Atrium-Appendage Occluder Register-GErmany (LAARGE) registry was performed assessing three different groups with respect to the HAS-BLED score (0-2 [group 1] vs.