PubMed Health⌕ Search

Biomedical subjects

Jörg O Schwab

Publications and source records attributed to Jörg O Schwab.

10 recordsLinked to original sources

Connexin31 cannot functionally replace connexin43 during cardiac morphogenesis in mice.

In the gastrulating mouse embryo, the gap junction protein connexin43 is expressed exclusively in cells derived from the inner cell mass, whereas connexin31 is expressed in cells of the trophoblast lineage. Since connexin43 and connexin31 do not form heterotypic gap junction channels in exogenous expression systems, such as HeLa cells and Xenopus oocytes, previous studies have suggested that the incompatibility of these two connexins could contribute to the separation of connexin43-expressing and connexin31-expressing compartments between embryo and extraembryonic tissues at gastrulation, respectively. Thus, we have generated connexin43 knock-in connexin31 mice, in which the coding region of the connexin43 gene was replaced by that of connexin31. Interbreeding of heterozygous connexin43 knock-in connexin31 mice resulted in homozygous connexin43 knock-in connexin31 mice, but none of them survived to adulthood. As these mice were born at the expected Mendelian frequency, we conclude that the reported incompatibility of connexin43 and connexin31 to form heterotypic gap junction channels does not interfere with normal embryonic development. Neonatal homozygous connexin43 knock-in connexin31 hearts showed malformation in the subpulmonary outlet of the right ventricle, similar to general connexin43-deficient mice. Electrocardiograms of neonatal hearts in homozygous connexin43 knock-in connexin31 mice revealed significantly low voltage of the QRS complex. This is in contrast to previous results from our laboratory which showed that replacement of connexin43 by connexin40 resulted in morphologically and functionally normal hearts. We conclude that connexin31 cannot functionally replace connexin43 during cardiac morphogenesis.

Animals↗

Transient ST-segment-elevation during pulmonary vein ablation using circumferential coiled microelectrodes in a prospective multi-centre study.

AIMS: Paroxysmal atrial fibrillation (PAF) is predominantly triggered by focal ectopies located within the pulmonary veins (PV). The BITMAP Study (Breakthrough and Isolation Trial: Mapping and Ablation of Pulmonary Veins) investigated prospectively the safety and efficacy of a catheter design with circumferential mapping and ablation electrodes. We report the phenomenon of ST-segment-elevation during catheter placement in the left atrium (LA) and superior PVs in this multi-centre study. METHODS AND RESULTS: Forty-three patients (57+/-10 years) with PAF were included in this study. Radiofrequency catheter (RFC) ablation supported by the 4F REVELATION Helix microcatheter (Cardima Inc., Freemont, CA, USA) with eight distal-coiled microelectrodes for bipolar mapping and ablation. RFC was applied at the ostial region of PV (30 W, 45-50 degrees C) with a maximum of four RFC applications per electrode. In four of the 43 patients from three centres, we recorded the occurrence of ST-segment-elevation greater than 0.2 mV and accompanying left thoracic discomfort. The ECG changes and the symptoms started abruptly and lasted for 4.2+/-2.2 min. Pericardial effusion could instantaneously be excluded by echocardiography in all cases. Coronary angiograms were performed in three patients with the longest episodes; no thrombotic material or air emboli were present. The symptoms and the ECG changes resolved completely in all patients. CONCLUSION: The phenomenon of ST-segment-elevation during LA- and PV-mapping in patients with PAF may be a common occurrence. In this prospective multi-centre trial, we demonstrated the reversibility of this phenomenon; no cardiovascular or cerebral damage was reported during both the procedure and the follow-up. Although the mechanism is still unclear, vasospasm may contribute to this phenomenon because of autonomic dysregulation.

Adult↗

Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation.

INTRODUCTION: Cerebral embolism and stroke are feared complications of left atrial catheter ablation such as pulmonary vein (PV) ablation. In order to assess the thrombogenicity of left atrial catheter ablation, knowledge of both clinically evident as well as silent cerebral embolism is important. The aim of the current study was to examine the use of diffusion-weighted magnetic resonance imaging (DW-MRI) for detection of cerebral embolism, apparent as well as silent, caused by PV catheter ablation. METHODS AND RESULTS: Twenty consecutive patients without structural heart disease undergoing lasso catheter-guided ostial PV ablation using an irrigated-tip ablation catheter were studied. Cerebral MRI including DW single-shot spin echo echoplanar, turbo fluid attenuated inversion recovery, and T2-weighted turbo spin echo sequences were performed the day after the ablation procedure. Ten patients also underwent preprocedure cerebral MRI. All ablation procedures were performed without acute complications. A mean of 3.2 +/- 0.6 PVs were ablated per patient. No patient had neurological symptoms following the procedure. In 2 of 20 patients (10%), DW-MRI revealed new embolic lesions, which were located in the right periventricular white matter in one and in the left temporal lobe in the other patient. There was no statistically significant difference in age, history of hypertension, left atrial volume, and procedure duration between the 2 patients with and the 18 patients without cerebral embolism following AF ablation. CONCLUSION: This is the first study using highly sensitive DW-MRI of the brain to detect asymptomatic cerebral embolism after left atrial catheter ablation. Even small, clinically silent, embolic lesions can be demonstrated with this technique. DW-MRI can be used to monitor and compare the thrombogenicity of different AF ablation approaches.

Adult↗

Atrial fibrillation.

The treatment of atrial fibrillation still remains challenging in everyday practice. Even after the introduction of catheter ablation, the decision making about the type of therapy became more complex. The recently published guidelines of the American Heart Association, the American College of Cardiology and the European Society of Cardiology clearly show therapeutic approaches for different types of atrial fibrillation. The fear of thromboembolism still forces the physician to restore sinus rhythm and perform a perfect anticoagulation. Based on large studies, we are able to decide for each patient individually whether oral anticoagulation or aspirin is required. Future studies in a large cohort of patients are still necessary to clarify the value of interventional therapy in conjunction with antiarrhythmic drug therapy. These will provide patients with safe therapy and a high quality of life despite presenting paroxysmal or persistent atrial fibrillation.

American Heart Association↗

Gold-tip electrodes--a new "deep lesion" technology for catheter ablation? In vitro comparison of a gold alloy versus platinum-iridium tip electrode ablation catheter.

Gold-tip electrodes. Radiofrequency (RF) catheter ablation is widely used to induce focal myocardial necrosis using the effect of resistive heating through high-frequency current delivery. It is current standard to limit the target tissue-electrode interface temperature to a maximum of 60-70 degrees C to avoid char formation. Gold (Au) exhibits a thermal conductivity of nearly four times greater than platinum (Pt-Ir) (3.17 W/cm Kelvin vs 0.716 W/cm Kelvin), it was therefore hypothesized that RF ablation using a gold electrode would create broader and deeper lesions as a result of a better heat conduction from the tissue-electrode interface and additional cooling of the gold electrode by "heat loss" to the intracardiac blood. Both mechanisms would allow applying more RF power to the tissue before the electrode-tissue interface temperature limit is reached. To test this hypothesis, we performed in vitro isolated liver and pig heart investigations comparing lesion depths of a new Au-alloy-tip electrode to standard Pt-Ir electrode material. Mean lesion depth in liver tissue for Pt-Ir was 4.33+/-0.45 mm (n=60) whereas Au electrode was able to achieve significantly deeper lesions (5.86+/-0.37 mm [n=60; P<0.001]). The mean power delivered using Pt-Ir was 6.95+/-2.41 W whereas Au tip electrode delivered 9.64+/-3.78 W indicating a statistically significant difference (P<0.05). In vitro pig heart tissue Au ablation (n=20) increased significantly the lesion depth (Au: 4.85+/-1.01 mm, Pt-Ir: 2.96+/-0.81 mm, n=20; P<0.001). Au tip electrode again applied significantly more power (P<0.001). Gold-tip electrode catheters were able to induce deeper lesions using RF ablation in vitro as compared to Pt-Ir tip electrode material. In liver and in pig heart tissue, the increase in lesion depth was associated with a significant increase in the average power applied with the gold electrode at the same level of electrode-tissue temperature as compared to platinum material.

Animals↗

Influence of basic heart rate and sex on heart rate turbulence in healthy subjects.

Acceleration and deceleration of the heart rate after the occurrence of a ventricular premature complex is characterized as heart rate turbulence (HRT). Two parameters quantify heart rate turbulence: onset and slope. The physiological properties have not been clarified in a large cohort of persons yet. This study evaluated properties of HRT, and focused on the influence of basic heart rate and sex on HRT. Using a special protocol, 95 persons were studied prospectively. HRT and its physiological properties were determined in 95 persons using Holter ECGs. The authors found 24% with a turbulence onset 0% and 5% with a turbulence slope <2.5 ms/RRI. Mean heart rate during Holter differed significantly between women and men (745 vs 817 ms, P < 0.0001). A linear, weighted regression model revealed that an increased heart rate before a ventricular premature complex is associated with a decreased turbulence onset (P < 0.0001). Turbulence slope was attenuated by basic heart rate only in men (P = 0.0022). On the contrary, the study detected no influence of the basic heart rate on turbulence slope in women (P = 0.0015 for the comparison between women and men). Basic heart rate and sex show an influence on HRT and should be considered when using HRT for noninvasive risk stratification.

Adult↗

Influence of the point of origin on heart rate turbulence after stimulated ventricular and atrial premature beats.

BACKGROUND: Heart rate turbulence (HRT) is a new and auspicious parameter for risk stratification in patients suffering from structural heart disease. The HRT parameters onset (TO) and slope (TS) are derived from Holter ECGs. Only a few studies have evaluated physiologic properties like age or prematurity of the ventricular beat on HRT. Until now, to our knowledge, little is known about the influence of the point of origin of the premature beat on HRT. Therefore, we conducted a study consisting of 25 patients (pts) with premature beats generating from 2 different sites in the atrium and ventricle. METHODS: During an electrophysiologic study, premature extra beats were induced. The high right atrium (HRA) and the lateral part of the coronary sinus (CS) represented the atrial pacing sites, while the right ventricular apex (RVAP) and right ventricular out flow tract (RVOT) represented the ventricular pacing sites. Prematurity started at 450 ms and was decreased to the refractoriness of each site. TO and TS were computed and correlated to the site of origin and the coupling interval (CI). RESULTS: Atrial TO was positive in 9 pts (HRA) and 7 (CS) as well as ventricular TO in 2 pts, respectively. TO induced in CS correlated with the CI (r = -0.50, p < 0.05). TS was negative, independent of the site of origin. Atrial TS showed no correlation with the CI. TO generated from both ventricular sites was positive in 2 pts. TO from RVAP correlated with the CI (r = -0.81, p < 0.005), but not with RVOT. TS from both ventricular sites exhibited no correlation with the pacing site, but correlated with themselves (r = -0.69, p < 0.03). CONCLUSION: The site of origin of the premature beat exhibits no influence on heart rate turbulence slope. The prematurity of the extra beat correlates with turbulence onset, but not with slope. Finally, the site of origin revealed no influence on HRT slope. Therefore, the calculation of heart rate turbulence derived from extra beats extracted from Holter ECG is reliable.

Atrial Premature Complexes↗

Decremental pulmonary venous pulse propagation: impact for catheter ablation in focal atrial fibrillation.

BACKGROUND: Electrical isolation of pulmonary veins (PV's) is crucial to achieve success in catheter ablation for trigger elimination in focal atrial fibrillation (AF). To guide ostial PV radiofrequency (RF) delivery, it is necessary to identify the electrical breakthrough (EBT) between PV and left atrium. For this purpose, coronary sinus (CS) fixed rate pacing is commonly used. This study evaluated, whether CS extrastimulus pacing is superior in identifying the EBT area as compared to fixed rate pacing. METHODS: In 9 patients (51 +/- 10 years) undergoing a left sided electrophysiological study for AF ablation, 25 PV's (10 right and 15 left-sided PV's) were mapped using a 4 French fixed-wire catheter with eight 6 mm coiled Platinum electrodes in a distal looped configuration (Revelation Helix, Cardima Inc.). For mapping and ablation the electrode loop was positioned in the PV ostium rectangular to the longitudinal PV axis. EBT area was identified as those electrodes indicating the earliest PV signals during CS pacing. We measured number of EBT electrodes and time between EBT and the latest activated bipoles at the electrode loop during fixed rate and extrastimulus pacing. The reduction of two or more EBT electrodes was defined as a significant benefit in EBT identification. RESULTS: In 22 of 25 PV's mapped PV potentials could be observed. Performing fixed rate pacing the EBT area was identified in a mean of 4.2 +/- 1 electrodes, whereas using extrastimulus pacing, EBT area could be significantly reduced to 2.3 +/- 0.8 electrodes. The time between EBT and latest electrode activated increased from 14 +/- 7 ms to 22 +/- 10 ms indicating an intrapulmonary conduction delay during extrastimulus pacing. In 13 of 22 PV's mapped (59%), extrastimulus pacing was beneficial in the identification of the EBT, as the primary target for RF delivery. CONCLUSIONS: CS extrastimulus pacing induces intra-PV decremental conduction properties allowing one to identify a more localised and smaller EBT area as the primary target for RF delivery. Performing PV ablation to treat focal AF, extrastimulus maneuvers allow to unmask the "true" EBT and thus may help to limit intrapulmonary RF delivery.

Adult↗

Circumferential pulmonary vein mapping and ablation in focal atrial fibrillation: single catheter technique.

BACKGROUND: Atrial fibrillation (AF) can be cured in a subgroup of patients performing catheter ablation and eliminate trigger arrhythmias mainly originating in the pulmonary veins (PV's). CASE REPORT: This case report describes the use of a novel catheter design combining both, circumferential mapping and radiofrequency delivery capabilities to perform pulmonary vein ablation in patients with focal AF. It could be demonstrated that this catheter was able to eliminate pulmonary vein potentials in a single left atrial catheter technique without acute evidence for PV stenosis. In two PV's of a second patient, where the Helix catheter was placed in a very ostial position, it was not possible to completely eliminate the PV signal component of the ostial electrogram. Long-term follow-up with AF recurrence documentation will clarify whether ostial PV signal amplitude reduction may serve as an acceptable procedural endpoint. CONCLUSION: PV potential elimination is feasible using this novel catheter design; safety and long-term efficacy of this single catheter approach will be evaluated in a multicenter study (BITMAP study: Breakthrough and Isolation Trial: Mapping and Ablation of Pulmonary Veins).

Adult↗