Background - Data about ventricular tachycardia (VT) ablation in patients with electrical storm (ES) is limited. - Objectives - This study sought to compare the prognostic outcome of patients undergoing VT ablation after ES with and without a septal substrate. - Methods - In this large single-center study, consecutive patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were included. Patients with septal substrate were compared with patients without septal substrate regarding endpoints of cardiovascular mortality, VT recurrences, recurrences of the clinical VT, and rehospitalization rates. - Results - A total of 107 patients undergoing a first VT ablation because of electrical storm (ES) were included (age 65 ± 13 years, 86% male, 45% ischemic cardiomyopathy). Major complications occurred in 11% of all patients with increased postinterventional third-degree atrioventricular blocks among patients with septal substrate (9% vs 0%; P = 0.063). Partial ablation successes were similar (95% with a septal substrate vs 100% without a septal substrate; P = 0.251). Complete ablation success was achieved in 63% with a septal substrate and in 87% without a septal substrate (P = 0.004). After a median 22 months of follow-up, patients with septal substrate died significantly more often from cardiovascular causes (26% vs 7%; log-rank P = 0.018). In univariate analysis cardiovascular mortality for ES patients with septal substrate was 4.1-fold higher (HR: 4.192; CI: 1.194-14.719; P = 0.025). Independent predictors of adverse outcome in multivariable regression analysis were presence of septal substrate (HR: 5.723; P = 0.025) and increased age (HR: 1.104; P = 0.003). Recurrences of any ventricular arrhythmia (67% vs 56%; log rank P = 0.554) and rehospitalization rates (80% vs 66%; log rank P = 0.515) were similar between groups. Recurrences of clinical VT were similar (7% vs 2%; P = 0.252). - Conclusions - Presence of a septal substrate is associated with adverse long-term cardiovascular mortality in patients admitted for VT ablation after ES. Despite decreased acute ablation successes in these patients, VT recurrence rates were similar to those without a septal substrate during follow-up.
von Julian Müller ; Karin Nentwich ; Artur Berkovitz ; Elena Ene ; Kai Sonne ; Vitaly Zhuravlev ; Ivaylo Chakarov ; Sebastian Barth ; Christian Waechter ; Michael Behnes ; Philipp Halbfaß ; Thomas Deneke
Pulmonary vein isolation using radiofrequency ablation is an effective treatment option for patients with symptomatic atrial fibrillation (AF). Application of high power over a short period of time (HPSD) is reported to create more efficient lesions and may prevent collateral thermal oesophageal injury. This study aims to compare efficacy and safety of two different HPSD ablation approaches using different ablation index settings.Consecutive patients undergoing AF ablation with HPSD (50 W; ablation index-guided) using the ThermoCool SmartTouch SF catheter were included. Patients were grouped by ablation protocol: ablation with target ablation index (AI) of 400 on the anterior left atrial wall vs. 300 at the posterior left atrial wall (AI 400/300) or AI 450/350 was performed upon the operator’s preference and compared. Peri-procedural parameters and complications were recorded, and incidences of endoscopically detected thermal oesophageal lesions (EDEL) analysed. Recurrence rates after a mean follow-up of 25 ± 7 months and reconnection patterns in patients undergoing redo procedures were investigated. A total of 795 patients (67 ± 10 years; 58% male; 48% paroxysmal AF) underwent a first AF ablation with HPSD (211 in group AI 400/300 and 584 in group 450/350). Median procedure time was 82.9 ± 24.6 min with longer ablation times in patients with target AI 400/300 due to higher intraprocedural reconnection rates, increased box lesions, and additional right atrial isthmus ablations. One hundred three patients (16%) underwent a redo procedure during follow-up documented comparable pulmonary vein (PV) reconnection among groups. Multivariate predictors of AF recurrence were age, left atrium (LA) size, persistent AF, and extra-PV ablation targets.High-power short-duration AF ablation with target AI of 400 for non-posterior wall and 300 for posterior wall lesions resulted in comparable long-term results compared to higher AI (450/350) ablations with significantly lower risk for thermal oesophageal lesions. Older age, larger LA size, persistent AF, and extra-PV ablation targets were identified in a multivariate analysis as independent risk factors for recurrences of atrial arrhythmias.
von Julian Müller ; Ivaylo Chakarov ; Philipp Halbfaß ; Karin Nentwich ; Elena Ene ; Artur Berkovitz ; Kai Sonne ; Sebastian Barth ; Christian Waechter ; Tobias Schupp ; Michael Behnes ; Ibrahim Akın ; Thomas Deneke
Background: Electrical storm (ES) represents a serious heart rhythm disorder. This study investigates the impact of ES on acute ablation success and long-term outcomes after VT ablation compared to non-ES patients. Methods: In this large single-centre study, patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were compared to patients undergoing VT ablation due to ventricular tachyarrhythmias but without ES. The primary prognostic outcome was VT recurrence, and secondary endpoints were rehospitalization rates and cardiovascular mortality, all after a median follow-up of 22 months. Results: A total of 311 patients underwent a first VT ablation due to ventricular tachyarrhythmias and were included (63 ± 14 years; 86% male). Of these, 108 presented with ES. In the ES cohort, dilated cardiomyopathy as underlying heart disease was significantly higher (p = 0.008). Major complications were equal across both groups (all p > 0.05). Ablation of the clinical VT was achieved in 94% of all patients (p > 0.05). Noninducibility of any VT was achieved in 91% without ES and in 76% with ES (p = 0.001). Patients with ES revealed increased VT recurrence rates during follow-up (65% vs. 40%; log rank p = 0.001; HR 1.841, 95% CI 1.289-2.628; p = 0.001). Furthermore, ES patients suffered from increased rehospitalization rates (73% vs. 48%; log rank p = 0.001; HR 1.948, 95% CI 1.415-2.682; p = 0.001) and cardiovascular mortality (18% vs. 9%; log rank p = 0.045; HR 1.948, 95% CI 1.004-3.780; p = 0.049). After multivariable adjustment, ES was a strong independent predictor of VT recurrence and rehospitalization rates, but not for mortality. In a propensity score-matched cohort, patients with ES still had a higher risk of VT recurrences and rehospitalizations compared to non-ES patients. Conclusions: VT ablation in patients with ES is challenging and these patients reveal the highest risk for recurrent VTs, rehospitalization and cardiovascular mortality. These patients need close follow-ups and optimal guideline-directed therapy.
Journal of Clinical Medicine Basel : MDPI, 2012 12(2023), 7 vom: Apr., Seite 1-15 Online-Ressource
Heiko Hausendorf; Joachim Scharloth; Kyoko Sugisaki; Noah BubenhoferNoah Bubenhofer; Heiko Hausendorf; Joachim Scharloth; Kyoko Sugisaki
Michael Bender; Noah Bubenhofer; Selena Calleri; Hajo Diekmannshenke; Christina Gansel; Heiko Hausendorf; Maaike Kellenberger; David Koch; Jan Langenhorst; Marie-Luis Merten; Marcus Müller; Marcel Naef; Joachim Scharloth; Kyoko Sugisaki; Nicolas Wiedmer; Stephan Wolff
Postcards -- History; Postcards -- Social aspects; LITERARY CRITICISM / European / German; Cultural History; Culture; German Literature; Greeting; Holidays; Image; Language; Linguistics; Literary Studies; Literature; Media; Text; Tourism; Aufsatzsammlung; Deutsch; Ansichtspostkarte; Sprache; Literaturwissenschaft; Postkarte; Linguistik; Kulturanalyse; Open Access
Frontmatter
Inhalt
Vorwort
Ansichtskarten als Gegenstand: Methodologische Aspekte
Ansonsten radeln wir viel
Rituelle Wechselnichtigkeiten
[anko] - Ansichtskartenkorpus
Strukturwandel der Urlaubswelt(en)
Grüße aus Trujillo
Was auf Ansichtskarten geschrieben steht
Codeswitching auf Ansichtskarten
Wie kurz ist eine Ansichtskarte?
Feriengrüße positionierungstheoretisch
Sport im Urlaub?
»s'Bild isch kein bschiss!«
»Man gewöhnt sich an alles«
Reisen und die Zeit
Die dunkle Seite der Ansichtskarte
Anhang
Dokumentation des Ansichtskartenkorpus
Autor*innenverzeichnis
Die Ansichtskarte ist ein Erfolgsmedium des 20. Jahrhunderts. Mit ihrer Beidseitigkeit von Text und Bild ist sie seit der Nachkriegszeit zur Ikone des modernen Massentourismus geworden. Den Gruß aus der Ferne mit Mitteilungen über das Erlebte zu verbinden, gehört seither zu den Alltagsritualen des Urlaubs. Aber was genau schreiben Menschen auf Ansichtskarten? Welche sprachlich-kommunikativen Muster des Urlaubsgrußes haben sich bewährt und wie haben sie sich im Laufe der Jahrzehnte verändert? Und droht die Ansichtskarte angesichts der Konkurrenz elektronischer Nachfolger auszusterben? Die Beiträger*innen des Bandes gehen diese Fragen unter korpus-, text- und kulturlinguistischen Gesichtspunkten empirisch nach
von Dominik Sturm ; David Capper ; Felipe Andreiuolo ; Marco Gessi ; Christian Kölsche ; Annekathrin Reinhardt ; Philipp Sievers ; Annika K. Wefers ; Azadeh Ebrahimi ; Abigail Kora Suwala ; Gerrit H. Gielen ; Martin Sill ; Daniel Schrimpf ; Damian Stichel ; Volker Hovestadt ; Bjarne Daenekas ; Agata Rode ; Stefan Hamelmann ; A. Christopher Previti ; Natalie Jäger ; Ivo Buchhalter ; Mirjam Blattner-Johnson ; Barbara Christine Jones ; Monika Warmuth-Metz ; Brigitte Bison ; Kerstin Grund ; Christian Sutter ; Steffen Hirsch ; Nicola Dikow ; Olaf Witt ; Andreas von Deimling ; Hermann L. Müller ; Torsten Pietsch ; Felix Sahm ; Stefan Pfister ; David T. W. Jones
Cancer epidemiology; Cancer epigenetics; CNS cancer; Diagnostic markers; Paediatric cancer
The large diversity of central nervous system (CNS) tumor types in children and adolescents results in disparate patient outcomes and renders accurate diagnosis challenging. In this study, we prospectively integrated DNA methylation profiling and targeted gene panel sequencing with blinded neuropathological reference diagnostics for a population-based cohort of more than 1,200 newly diagnosed pediatric patients with CNS tumors, to assess their utility in routine neuropathology. We show that the multi-omic integration increased diagnostic accuracy in a substantial proportion of patients through annotation to a refining DNA methylation class (50%), detection of diagnostic or therapeutically relevant genetic alterations (47%) or identification of cancer predisposition syndromes (10%). Discrepant results by neuropathological WHO-based and DNA methylation-based classification (30%) were enriched in histological high-grade gliomas, implicating relevance for current clinical patient management in 5% of all patients. Follow-up (median 2.5 years) suggests improved survival for patients with histological high-grade gliomas displaying lower-grade molecular profiles. These results provide preliminary evidence of the utility of integrating multi-omics in neuropathology for pediatric neuro-oncology.
Nature medicine [New York, NY] : Springer Nature, 1995 29(2023), 4, Seite 917-926 Online-Ressource
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