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Thomas Rostock

Publications and source records attributed to Thomas Rostock.

42 records · Page 3Linked to original sources
PubMed2004

Radiofrequency catheter ablation of a macroreentrant ventricular tachycardia late after surgical repair of tetralogy of Fallot using the electroanatomic mapping (CARTO).

This case report describes a patient with a sustained monomorphic VT after surgical repair of a tetralogy of Fallot (TOF). In combination with the three-dimensional electroanatomic mapping system, CARTO, and conventional mapping techniques the VT was identified as a macro-reentrant tachycardia circling around the border between pulmonary graft and right ventricular outflow tract (RVOT). A y-shaped ablation line crossing this zone was created. The VT terminated during RF application and was not inducible again. This case underlines the use of a combined conventional and three-dimensional electroanatomic mapping technique can be helpful for catheter ablation of ventricular arrhythmias in TOF patients.

Adult↗
PubMed2003

[Pharmacologic management of atrial fibrillation by specialists in internal medicine, cardiologists, and general practitioners (GPs) in Berlin].

BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is the most frequent form of arrhythmia with a prevalence of 9%. During the last 15 years, there have been considerable changes of antiarrhythmic treatment. Aim of the present study was to investigate in which way general practitioners (GPs) as well as specialists in internal medicine and cardiologists in private practice are managing treatment of AF in the German capital. METHODS: A random sample of physicians practicing in all parts of Berlin were interviewed in written or oral form about their common attitudes to cardioversion, maintenance treatment, and anticoagulation in patients with AF. RESULTS: A very conservative, restrictive attitude in using internationally recommended antiarrhythmic drugs and anticoagulation was observed. Cardioversion is performed over too long time periods. CONCLUSIONS: The findings indicate uncertainty and lack of quality assurance in the management of AF and underline the necessity to follow the existing international guidelines more carefully.

Anti-Arrhythmia Agents↗
PubMed2003

Large tip electrodes for successful elimination of atrial flutter resistant to conventional catheter ablation.

The most widely accepted criterion for successful radiofrequency catheter (RFC) ablation of typical atrial flutter is the development of bi-directional isthmus block. In a subset of patients, conventional RFC ablation fails to achieve this endpoint because deeper and wider lesions are required. We investigated the efficacy of a long 8-mm tip catheter in these cases. One hundred and seventy-four consecutive patients (137 male; 61 +/- 9 years) with recurrent typical atrial flutter underwent conventional RFC ablation first with a standard 4 mm tip catheter. In resistant cases (n = 52), ablation was continued using a large tip 8-mm catheter when the 4-mm tip catheter failed. Resistant atrial flutter was identified when 21 RFC pulses failed to reach the selected endpoint of bi-directional isthmus block or in cases of transient bi- directional block (at least 3 episodes). In 122 of the 174 patients (70%) conventional atrial flutter ablation was successfully performed with 13 +/- 5 RFC applications. In the remaining 52 subjects (30%), the ablation procedure was completed using the large tip electrode catheter. In 30 of these 52 patients (58%), the catheter was changed because of persistent intra-atrial conduction after 21 RFC pulses and in 22 (42%) because of intermittent conduction block after 11 +/- 5 applications. Using the large tip electrode catheter, the selected endpoint was achieved in all patients of both groups with 3 +/- 2 RFC pulses (power output of 50-60 W, pulse duration of 60 sec). No post-procedure complications were observed. After 15 +/- 5 months of follow-up, 16 patients (9%) had recurrence of atrial flutter. Five of the patients had been in the resistant group. In patients with atrial flutter resistant to conventional ablation therapy, the long tip (8-mm) catheter appears to be a safe and effective alternative to use of the conventional 4-mm tip catheter.

Atrial Flutter↗
PubMed2003

Dissociated activity and pulmonary vein fibrillation following functional disconnection: impact for the arrhythmogenesis of focal atrial fibrillation.

The present study sought to investigate the electrophysiological properties of isolated pulmonary veins following successful radiofrequency (RF) catheter ablation in patients with paroxysmal atrial fibrillation (PAF). Overall, 71 pulmonary veins in 37 consecutive patients (age: 56 +/- 9 years) with recurrent PAF were targeted for RF ablation at the ostial region in order to achieve a complete functional block. Following disconnection, the incidence of dissociated pulmonary vein (PV) activity and its response to orciprenalin were studied. RF ablation abolished conduction in 67 (94%) of 71 potentially arrhythmogenic PVs after a mean of 10.7 +/- 6.4 RF applications for each PV. After ablation, spontaneous dissociated automatic activity (9 to 52 beats/min, median 27) was found in 6 out of 67 isolated PVs (left superior: n = 1, left inferior: n = 1, right superior: n = 2, common left PV: n = 2). Slight acceleration (13 to 68 beats/min, median 29) of dissociated PV activity was observed during infusion of orciprenalin. Following isolation, initiation of sustained or nonsustained local fibrillation was recorded in only two cases of the common left sided PV with preceding automatic activity. In one patient PV fibrillation occurred during orciprenalin infusion following a repetitive response to a dissociated automatic rhythm with increasing duration as well as destabilization. In the other patient, PV fibrillation occurred immediately after the occurrence of PV automaticity. Slow dissociated automatic rhythms are detectable within 9% of disconnected PVs. The unique anatomic substrate of common left PVs seem to favor the occurrence of local fibrillation following isolation. The initiation pattern of fibrillation within the isolated PV has pathophysiological implications and underlines the contribution of multiple factors to the onset and sustenance of PAF.

Aged↗
PubMed2003

Electrical disconnection of an arrhythmogenic superior vena cava with discrete radiofrequency current lesions guided by noncontact mapping.

This case describes a 54-year-old patient with paroxysmal atrial fibrillation and atrial flutter. Conventionally recorded local electrogram demonstrated a cycle length of 245 ms in the SVC which was conducted to the right atrium in a 2:1 fashion. The analysis of the virtual unipolar local electrogram from the noncontact mapping system demonstrated slow conduction between SVC and right atrium orthogonal to the atrial breakthrough in the upper part of the crista terminalis. RF ablation at the atrial breakthrough induced the electrical disconnection between the CVC and the right atrium.

Atrial Fibrillation↗