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Ole-Alexander Breithardt

Publications and source records attributed to Ole-Alexander Breithardt.

8 recordsLinked to original sources
PubMed2005

Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration.

Patients with heart failure (HF) often suffer from sleep-related breathing disorders (SRBD) like Cheyne-Stokes respiration (CSR). Cardiac resynchronization therapy (CRT) improves myocardial function and exercise capacity in patients with HF and conduction disturbances. As CRT has been shown to reduce CSR in patients with HF, it is not clear whether CRT improves quality of life and symptomatic depression by improvement of apnea/hypopnea index (AHI) and sleep quality. Forty-two HF patients with conduction disturbance before CRT were screened for CSR and evaluated for sleep quality [Pittsburgh Sleep Quality Index (PSQI)], quality of life score [36-item short form (SF-36)], depression, and exercise capacity (VO2 peak) and ejection fraction (EF). Eighteen patients (three females, age 61+/-10, body mass index 24+/-4 kg m(-2), EF 24+/-4%, QRS complex duration 156+/-32 ms) presented CSR with an AHI of 18+/-8 (11 CSR, 7 mixed). Fourteen patients showed no SRBD (PSQI<5,AHI<5). All patients received CRT and were reevaluated after 18+/-7 weeks. CSR worsen quality of life in seven of eight terms compared to patients without SRBD. Symptomatic depressive symptoms (Beck Depression Inventory>10) were only present in patients with CSR. CRT results in improvement of peak VO2 and EF. There was no difference between patients with CSR and without SRBD on exercise capacity or EF under CRT, whereas CRT led to a significant decrease in AHI (18+/-8 to 3+/-2, p<0.0001), PSQI (18+/-4 to 6+/-3, p=0.0007), with reduction of depression score (12+/-3 to 4.8+/-3, p=0.004). In patients with HF, CSR is associated with symptomatic depressive syndromes and impaired quality of life. CRT reduced CSR with improvement of sleep quality and symptomatic depression.

Cardiac Pacing, Artificial↗
PubMed2004

Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure.

OBJECTIVES: We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA). BACKGROUND: Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown. METHODS: Twenty-four patients (7 females; 62 +/- 11 years) with HF, a reduced left ventricular ejection fraction (24 +/- 6%), and left bundle branch block (QRS duration 173 +/- 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (SaO2min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 +/- 7 weeks of CRT. RESULTS: In patients with CSA, CRT led to a significant decrease in AHI (19.2 +/- 10.3 to 4.6 +/- 4.4, p < 0.001) and PSQI (10.4 +/- 1.6 to 3.9 +/- 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in SaO2min (84 +/- 5% to 89 +/- 2%, p < 0.001). There was no significant change in AHI (1.7 +/- 0.7 to 1.5 +/- 1.6), PSQI (2.4 +/- 0.5 to 2.6 +/- 0.9), and SaO2min (90 +/- 2% to 91 +/- 1%) in patients without CSA. CONCLUSIONS: Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications in patients receiving CRT.

Aged↗
PubMed2004

Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is a new therapeutic option in patients with heart failure and ventricular conduction delay. We compared the long-term performance of left ventricular (LV) pacing via the coronary venous (CV) approach and a limited lateral thoracotomy (LLT). Data from 81 patients (age 65 +/- 12 years; 52 men, New York Heart Association class 3.0 +/- 0.4, ejection fraction 24 +/- 6%) were retrospectively analyzed for 1 year after implantation of a CRT system. Twenty-five patients received LLT leads and 56 patients received CV leads. Postoperative hospitalization was shorter after CV lead implantation (8 +/- 4 vs 12 +/- 5 days, p <0.01). No significant differences in LV pacing and sensing performance between both approaches were observed after 12 months. Reinterventions were necessary in 7 patients after CV implantation compared with only 1 reintervention (4%) in the LLT group (p = NS). Postoperative chest radiographs revealed an anterior lead position in 11 of 25 patients (44%) in the LLT group versus 3 of 56 patients (5.4%) in the CV group (p = 0.00007). Echocardiographic data demonstrated a significant increase in LV ejection fraction in the CV group (from 26.1 +/- 5.2% to 35.3 +/- 14.3% at 12 months, p <0.001, n = 42) in contrast to the LLT group (from 24.5 +/- 6.2% to 28.5 +/- 7.5% at 12 months, p = NS, n = 16) at 12-month follow-up. Cardiopulmonary exercise testing in 35 patients showed significantly more improvement in peak oxygen consumption after 12 months in the CV group (15.5 +/- 3.1 vs 13.6 +/- 2.6 ml/min/kg at implant, n = 22) compared with the LLT group (12.7 +/- 1.5 vs 11.8 ml/min/kg at implant, n = 13, p = 0.004). At 1-year follow-up the mortality rate was 24% (6 of 25) after LLT lead implantation versus 12.5% (7 of 56) after CV implantation (p = NS). Our data show that the LLT approach for LV lead placement in CRT systems has the advantage of a lower incidence of reinterventions. Hospitalization was longer, increase in functional capacity smaller, and mortality at 1-year follow-up higher, which were potentially related to a more anterior lead position. Therefore, CV leads are preferable to LLT leads.

Aged↗
PubMed2003

[Echocardiography in cardiac resynchronization therapy: identification of suitable patients, follow-up and therapy optimization].

BACKGROUND AND AIM: Cardiac resynchronization therapy (CRT) with biventricular stimulation is a new therapeutic option for patients with advanced heart failure and left ventricular asynchrony. The presence of a left bundle branch block morphology in the electrocardiogram is presently the most important selection criterion. Transthoracic echocardiography provides important additional information on the ventricular contraction sequence and the hemodynamic consequences of asynchrony. This may help to identify suitable patients, to improve the selection criteria and to optimize CRT during follow-up. This article discusses the potential techniques and limitations and provides practical guidance for the individual patient follow-up.

Aged↗
PubMed2003

[Cardiac resynchronization therapy-current status and future perspectives].

BACKGROUND AND AIM: Cardiac resynchronization therapy (CRT) by pacemakers is a new therapeutic principle in the treatment of advanced heart failure. It aims to correct the intracardiac conduction disturbances that are frequently associated with left ventricular dysfunction and thus reduce their negative hemodynamic consequences. In early studies on CRT, acute improvement in cardiac hemodynamics could be shown. Nowadays it is accepted that cardiopulmonary exercise capacity is also improved in the long term with CRT. In addition, reduction of functional mitral regurgitation and reverse left ventricular remodeling have been demonstrated in the majoriy of patients. The results of recent studies demonstrate a reduction in mortality and hospitalizations by CRT. The results of these trials have led to an accepted indication for CRT as an adjunct treatment in heart failure in the updated US guidelines. However, about 30% of patients undergoing device implantation according to currently accepted implant criteria will show no substantial improvement with CRT. Therefore, other indicators to identify therapy responders must be developed in the future, e.g. by using echocardiographic techniques. Moreover, it is yet unclear in how many patients a defibrillator backup is necessary for a CRT patient. This article summarizes the current status of CRT with regard to indications and clinical results. In addition, unresolved issues are discussed and potential developments for the future highlighted.

Adult↗