Geh.-Rat Prof. Dr. Hugo Wilhelm von Ziemssen (1829–1902) war Direktor des ehemaligen Städtischen Kran-kenhauses links der Isar in München. Er war Initiator des Lehrstuhls für Hydro-, Mechano-Elektrotherapie und Physikalische Medizin an der Universität Mün-chen 1898. Durch Zufall gelang es ihm 1882, an einer Patientin namens Catharina Serafin, einer 46-jährigen Tagelöhnerin aus Oberschlesien, spezielle elektrophy-siologische Untersuchungen durchzuführen. Aufgrund der operativen Entfernung eines Ekchondroms der Rippen und Zustand nach Resektion der linken vor- deren Thoraxwand war das Herz der Patientin nur von einer dünnen Hautschicht bedeckt. Prof. von Ziemssen unternahm zahlreiche Elektrostimulationen am Her-zen der Kranken sowohl mit Faraday’schem wie auch Galvani’schem Strom und konnte zeigen, dass Strom-stöße – adäquat am Herzen appliziert – zu einer Ver-änderung der Herzfrequenz führen. Es war im Rahmen dieser Untersuchung zudem möglich – wenn auch un-regelmäßig – die Frequenzen zu senken. Die sehr sorg-fältigen Registrierungen aus jener Zeit dokumentieren eindeutig, dass die Ventrikelaktionen willkürlich über elektrische Impulse auf der Herzoberfläche gesteuert werden können. Prof. von Ziemssen gehört damit zu den wichtigsten Pionieren der diagnostischen und the-rapeutischen Elektrophysiologie des Herzens.
DiskussionsleiterProf. Dr. D. Andresen (Berlin) Prof. Dr. M. Borggrefe (Mannheim) Prof. Dr. D. Dobrev (Essen)
Der Hugo-von-Ziemssen-Posterpreis wird für das beste Poster der Jahrestagung der AG Rhythmologie vergeben. Weitere acht Poster gelangten dieses Jahr in die Vorauswahl.
Preisträger
L. Pirouzmandi, HildesheimH.-P. Remmlinger, F. Grothues, W. Schöbel,C. Fleischmann, A. Schäfer, D. Hausmann, B. Lein, C. Zellerhoff, J. Tebbenjohanns
Für die PosterpräsentationProspektiv-multizentrisches Register zur Therapie von neu aufgetretenem Vorhofflimmern mit spezifischer Berücksichtigung der leitlinienzentrierten Therapieadhärenz
PP135Arrhythmia recurrence after pulmonary vein isolation for paroxysmal atrial fibrillation: importance and role of extra-pulmonary vein foci
S. Ammar, A. Buiatti, T. Reents, S. Kathan, R. Dillier, V. Semmler, M. Hofmann, C. Kolb, G. Heßling, I. Deisenhofer
Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter, Deutsches Herzzentrum München, München
Introduction. Procedure success of pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) remains < 85 % even after reabla- tions. A possible reason is undiagnosed extra-pulmonary vein (extra-PV) foci.Methods. We included 124 patients presenting for reablation after PVI for paroxysmal AF. A total of 26 extra-PV foci in 19 patients were iden-tified during 2.3 ± 0.6 ablation procedures. We thought to identify the characteristics of extra-PV foci and the impact on acute and long term results of ablation.Results. The most common location for extra-PV foci was the crista terminalis (n = 8), followed by the superior vena cava (n = 6), the sep-tum (n = 6) and the coronary sinus (n = 5). One patient had an extra-PV focus on the LA-roof. The focus was revealed by AF bursts (n = 6), bursts of atrial extrasystoles (n = 12) or focal atrial tachycardia (n = 8).Extra-PV foci were identified in 5/124 (4 %) patients during the first ablation procedure. During the 1st redo procedure, PVs were recon- nected in 121/124 (98 %) and extra-PV foci were identified in 12/124 (10 %) of patients. More than one repeat ablation was performed in 30 patients (24 %). 27/30 pts (90 %) had reconnected PVs during second redo procedure. Extra-PV foci were diagnosed in 3/30 (10 %) patients. Nine patients underwent a third repeat ablation. 4/9 (44 %) of patients had a PV reconnection. Extra-PV foci were identified in 6/9 (67 %) pa-tients. Early arrhythmia recurrence (< 3 months) occurred more often in pts with extra-PV foci (14/19; 74 %) than in pts without extra-PV fo-ci (52/105; 49.5 %; p = 0.04). At 20 months, freedom from arrhythmia recurrence was lower in patients with extra-PV foci compared to pa-tients without extra-PV foci (44 % vs. 66 %, p = 0.01). Patients with ex-tra-PV foci had more often multiple procedures (> 1 reablation; 37 % vs. 22 %, p = 0.13).Conclusion. Extra-PV foci could explain a part of early and late arrhyth-mia recurrence after pulmonary vein isolation. The presence of extra-PV ectopic foci is associated with a lower freedom from arrhythmia re-currence and a higher rate of multiple procedures.
PP136Prospektiv-multizentrisches Register zur Therapie von neu aufgetretenem Vorhofflimmern mit spezifischer Berücksichtigung der leitlinienzentrierten Therapieadhärenz
L. Pirouzmandi1, H.-P. Remmlinger2, F. Grothues3, W. Schöbel4, C. Fleischmann5, A. Schäfer6, D. Hausmann7, B. Lein7, C. Zeller-hoff 8, J. Tebbenjohanns1
1Med. Klinik I, Klinikum Hildesheim GmbH, Hildesheim, 2Kardio-logie, DRK-Krankenhaus Clementinenhaus, Hannover, 3Medizini-sche Klinik I, Klinikum Peine gGmbH, Peine, 4Med.Klink II, Klinikum Salzgitter GmbH, Salzgitter, 5Klinikum der Stadt Wolfsburg, Wolfs-burg, 6Kardiologie und Angiologie, Medizinische Hochschule Han-nover, Hannover, 7Medizinische Klinik, Städt. Klinikum Wolfenbüttel GmbH, Wolfenbüttel, 8Innere Medizin/Kardiologie, Vinzenzkranken-haus, Hannover
Einleitung. Etwa 1 Jahr nach Publikation der neuen Leitli-nien zum Vorhofflimmern (VHF), untersuchten wir, inwieweit CHA2DS2VASc- und HASBLED-Scores zur individuellen The-rapieentscheidung/Leitlinienadhärenz bei Erstdiagnose von VHF herangezogen wurden und werteten die ambulante Therapietreue aus.Methodik. Prospektives, konsekutives, „All-comer“-Multizen-terregister über 3 Monate in jeder Klinik; Datenerhebung 06/12–02/13 inkl. Risikofaktoren zur späteren Berechnung der Scores. Standardisierter Fragebogen mit telefonischer Follow-up-Abfra-ge nach 3 Monaten.Ergebnisse. Eingeschlossen wurden 209 Patienten (88 weiblich, 42 %) mit erstmals dok. VHF, mittleres Alter 64 ± 14 Jahre. 181 Pat. wurden mit dem Ziel der Rhythmuskontrolle (RK) und 28 mit dem Ziel einer Frequenzkontrolle (FK) behandelt.In der RK-Gruppe (FK-Gruppe) lag der mittlere CHA2DS2VASc-Score bei 3 ± 2 (3 ± 2) und der HASBLED-Score bei 1 ± 1 (2 ± 1).Bei einem CHA2DS2VASc-Score 0/1 (n = 48) erhielten die Pat. unterschiedliche Therapie bzgl. der Gerinnungshemmung (KH-Entlassung vs. 3 Monate): ASS (11 vs. 27 %), OAK (29 vs. 21 %), NOAK (22 vs. 6 %), andere Kombinationen (2 vs. 2 %) und kei-ne Therapie (36 vs. 44 %). Bei einem CHA2DS2VASc-Score ≥ 2 (n = 130): ASS (18 vs. 24 %), OAK (51 vs. 43 %), NOAK (17 vs. 10 %), andere Kombinationen (8 vs. 9 %) und keine Therapie (6 vs. 14 %). Bei CHA2DS2VASc-Score ≥ 2 + HASBLED ( < 3 vs. ≥ 3) bekamen 92 vs. 17 % gerinnungshemmende Substanzen bei Ent-lassung empfohlen. 6 % aller Patienten (n = 10) hatten geringfügi-ge Blutungskomplikationen (Gusto C), ASS (n = 1), OAK (n = 5), ASS + OAK (n = 1), NOAK (n = 3). Ein Patient (NOAK) mit ED eines Tumors erlitt eine periphere Thrombembolie.Schlussfolgerung. Die Therapietreue zeigte sich bei CHA2DS2VASc-Score 0/1 ( ≥ 2) nach einem Zeitraum von 3 Mo-naten mit 98 vs. 94 % sehr hoch. Dennoch findet bei einem Sco-re ≥ 2 lediglich bei der Hälfte der Patienten eine leitlinienkonfor-me Fortführung der Therapie statt. Bei Score 0/1 lässt sich die Zu-nahme der ASS-Monotherapie bzw. der Verzicht auf gerinnungs-hemmende Therapie als Trend ablesen. Schwerwiegende klinische Ereignisse zeigen sich im Untersuchungszeitraum – insbesondere auch in Hinblick bei Anwendung der NOAK nicht. Eine erneute Abfrage nach einem Jahr ist geplant.
PP137The benefits of experience—pulmonary vein isolation with the endoscopic ablation system at a single centre
B. Schmidt1, S. Bordignon1, L. Perrotta1, D. Dugo1, A. Fürnkranz2, K. R. J. Chun1
1Medizinische Klinik III, Markuskrankenhaus, Cardioangiologisches Cen-trum Bethanien – CCB, Frankfurt am Main, 2Medizinisches Versorgungs-zentrum, CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main
Background. Novel ablation devices for pulmonary vein isolation (PVI) need a careful evaluation of its efficacy and safety beyond clinical stud- ies in a real world situation. The endoscopic ablation system (EAS) was recently approved for PVI in Europe.Objective. We sought to determine the safety, efficacy and learning curve effects in a large volume single center.Methods. Between June 2010 and December 2012 all EAS guided PVI procedures were analyzed. Using a single transseptal access visually guided sequential PVI was performed. Ablation lesions were deployed contiguously encircling each individual PV (5.5–12 W for 20–30 s). Electrical PVI was assessed with a circular mapping catheter (CMC). In case of residual LA to PV conduction additional ablations using EAS were performed according to the CMC activation sequence. Safety anal-ysis included all peri-procedural complications. To determine efficacy the number of acutely isolated PVs by as well as 6 months follow-up re-sults were assessed. Consecutive patients were divided in thirds to assess learning curve for all parameters.Results. All major peri-procedural complications occurred in the first tertial: 1 tamponade, 1 femoral venous laceration requiring surgery and 1 TIA. In 3 patients (2 in 1st and 1 in 2nd third) phrenic nerve palsy was observed (2 %). Efficacy and procedural data is displayed in . Table 1.Conclusion. EAS is a safe and efficient novel technology to perform PVI. Increasing experience leads to lower complication rates and higher pro-cedural success with shorter procedure times.
PP138Decennial analysis of safety and complications in epicardial- and endocardial-VT ablation
S. Mathew, M. Kamioka, I. Dotz, A. Metzner, A. Rillig, H. Makimoto, S. Deiß, P. Rausch, E. Wißner, R.R. Tilz, K.-H. Kuck, F. Ouyang
Kardiologie, Asklepios Klinik St. Georg, Hamburg
Background. Endocardial and epicardial VT ablations are increasingly performed, but there are still limited information about its safety and complications.Methods and results. Between 2002 and 2012 complications in 1032 endo- and epicardial VT ablations were analysed. In 765 pts (479 male; 56 ± 15 years) 872 endocardial and in 133 pts (11 male; 52 ± 15 years) 160 epicardial VT ablations were performed. Out of 1032 procedures (proc.) in 769 proc. (75 %) a retrograde transaortic and in 344 proc.
(33 %) an antegrade transseptal approach was performed. A left atri-al appendage perforation was observed in 2/344 proc. (0.6 %) via the transseptal sheeth, whereas in 1/769 proc. (0.1 %) a perforation of the left ventricle (LV) was seen during retrograde transaortic mapping of the LV. A perforation of the right ventricular apex (RVA) during place-ment of the RV Catheter was presented in 3/1032 proc. (0.3 %). Due to epicardial puncture in one patient (0.6 %) a perforation of the right cor-onary artery (RCA) was seen. In two pts (1.3 %) a perforation of the liver and in another patient (0.6 %) a perforation of the colon was observed. In these three patients the epicardial sheeth was inserted via the liver or colon to the epicardial space. Furthermore in another patient (0.6 %) a perforation of the aorta ascendens occurred. Cardiac tamponades/Pericardial effusion were seen in 13/160 proc. (8.1 %) during epicardi-al- and in 10/872 proc. (1.1 %) during endocardial-VT ablation. A non-fatal pulmonary embolism occurred after epicardial VT ablation in one patient. A TIA/Stroke could be observed in 2/872 (0.2 %) after endocar-dial and in 2/160 (1.3 %) after epicardial VT ablation.Conclusions. The risk of potential severe complications in endocardial VT ablation was moderate, whereas in epicardial VT ablation a higher incidence was observed.
PP139Efficiency of a second ablation procedure in patients with atrial fibrillation considering HATCH- and CHA2DS2Vasc score
E.U. Schmidt, R. Schneider, J. Lauschke, I. Wendig, D. Bänsch
Zentrum Innere Medizin, Medizinische Klinik I, Universitätsklinikum Rostock AöR, Rostock
Aims. The HATCH-Score describes the risk of progression of paroxys-mal atrial fibrillation (afib) to persistent afib while the CHA2DS2Vasc score represents the risk of thromboembolic events in patients with afib. We hypothesized that both scores may predict malfunction of the abla-tion therapy and may help to deselect patients for an ablation.Methods and results. This study included 449 consecutive patients (65.5 % male, mean age 61.7 ± 10.1 years). 19.6 % had a HATCH score of zero. A score of one was present in most patients (50.3 %). 9.8 % had two points, 15.6 % three and 4.6 % at least four points (mean HATCH score 1.4 ± 1.2). Most patients had an indication for anticoagulation consid-ering the CHA2DS2Vasc score: Only 9.8 % had no CHA2DS2Vasc-score point, 21.4 % had a score of one, 24.9 % a score of two, 20.9 % presented with a score of three, 14.9 % with a score of four, 5.6 % with five and 2.4 % with a score higher than five (mean CHA2DS2Vasc score 2.4 ± 1.5). After 618 procedures (1.38 ± 0.55/patient) 377 patients (84.3 %) were free of any atrial arrhythmia after a mean follow-up 12.7 ± 7.1 months. The freedom of afib after one ablation procedure ranged between 50.7 % and 60.3 % in patients with a HATCH score between 0 and 3 and decreased to 30.0 % in patients with a HATCH-score greater than 3 (p = 0.041). The freedom of afib after 1.38 procedures per patient ranged between 79.5 % and 88.4 % in patients with HATCH scores between 0 and 3, but dropped to 66.7 % (p = 0.064) in the group with a score of 4 or more points (. Abb. 1). By comparing the success rates of PVI in the different CHA2DS2Vasc score categories, the results showed that abla-tion was equally successful up to a score of 5 points. PVI was less effec-tive in patients with a score greater than 5 (p = 0.013). No confounding factor independently predicted recurrence of afib except for age beyond 74 years (p = 0.001) and diabetes (p = 0.018).Conclusion. Pulmonary vein isolation is equally effective in patients with a low to moderate risk of disease progression. It is equally effec-tive in patients with a low to moderate thromboembolic risk as well.
However, the success rates seem to decrease in patients with very high sores. Complete isolation of the pulmonary veins appears to overrule underlying mechanisms of disease progression to a certain extend, but seems to be more difficult in patients with higher scores.
PP140Favourable long-term prognosis of patients with implantable cardioverter defibrillator for idiopathic ventricular arrhythmia
F.W. Horlbeck, A. Anastasia, J. Kreuz, G. Nickenig, J.O. Schwab
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn
Introduction. Symptomatic idiopathic ventricular tachycardia (VT)/fi-brillation (VF) is an established ICD indication but long term progno-sis after ICD implantation is rarely examined.Methods and results. Based on a prospective database, we analyzed 980 ICD implantations performed in our hospital from 1988 to 2009 and all respective data until 2012. After the exclusion of patients with structural heart disease or primary electrical diseases (e.g. Brugada, long QT), we identified 46 with secondary prevention ICD indication for un-explained VT/VF. These cases were analyzed. During a mean follow-up period of 77 ± 54 months VT/VF recurrence with appropriate ICD therapy occurred in 18 patients (39 %). Electrophysiological stimulation failed to predict subsequent arrhythmic events. Sixteen patients (35 %) suffered inappropriate shocks including 12 episodes of inappropriate shock storming. Overall mortality was very low (4.3 %; . Abb. 1 and 2).Conclusion. Patients with initial idiopathic VT/VF have a high re-currence rate of potentially fatal ventricular arrhythmias. In patients with ICD therapy, the general prognosis is very good but inappropri-ate shocks and other complications remain a major unsolved problem.
PP141Catheter ablation of atrial fibrillation: three-dimensional TEE provides an excellent overview over the left atrial anatomy prior to an ablation procedure—long-term outcome
K. Kettering1, F. Gramley1, R.S. von Bardeleben2
1Med. Klinik III/Kardiologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, 2II. Medizinische Klinik und Poliklinik, Universitätsme-dizin der Johannes-Gutenberg-Universität, Mainz
Introduction. Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrilla-tion (AF). However, it is still challenging because of the high degree of variability of the pulmonary vein (PV) anatomy. Therefore, 3-D imaging systems (CT and MRI) are frequently used prior to an ab-lation procedure. Alternatively, 3-D transesophageal echocardiogra-phy (TEE) provides an excellent overview over the individual left atri-
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PP140 Abb. 1 8 Time until first appropriate ICD intervention
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PP140 Abb. 2 8 Time until first inappropriate ICD shock
HATCH-Score and Freedom of A�b after RF Ablation n=449
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PP139 Abb. 1 8 HATCH score and freedom of Afib after RF ablation
al morphology without some of the limitations associated with other imaging techniques.Methods. In 270 patients, 3-D TEE was performed immediately prior to an ablation procedure (paroxysmal AF: 108 patients, persistent AF: 162 patients). The images were available throughout the ablation proce-dure. Two different ablation strategies were used. In patients with par-oxysmal AF, the cryoablation technique was used (Arctic Front Balloon, Medtronic). In the other patients, a circumferential pulmonary vein ab-lation was performed using the CARTO system (Biosense Webster). The PV isolation was verified using a circular mapping catheter in all cases.Results. A 3-D TEE could be performed successfully in all patients and all PV ostia could be evaluated. The image quality was excellent and sev-eral variations of the PV anatomy could be visualized precisely (e.g. com-mon PV ostia, accessory PVs, varying diameter of the left atrial append-age and its distance to the left superior PV). The image quality was good even if AF with rapid ventricular response was present during the ex-amination. The TEE findings correlated well with the PV angiographies performed during the ablation procedures. All ablation procedures could be performed successfully [mean number of completely isolated PVs: 3.8 ± 0.4 (cryo group), 3.9 ± 0.3 (Carto group)]. At 33-month follow-up, 74.8 % of all patients were free from an arrhythmia recurrence (cryo group: 79.6 %, Carto group: 71.6 %). There were no major complications.Conclusions. Three-dimensional TEE overcomes most of the limita-tions of other imaging techniques (CT/MRI) currently used for evalu-ation of the PV anatomy (such as radiation exposure and inappropriate image quality in the presence of AF). A TEE should be performed pri-or to an AF ablation procedure to rule out the presence of a left atrial thrombus in all patients anyway. Thus, a 3-D TEE does not result in additional patient discomfort or cost and is less time-consuming than other techniques. Therefore, AF ablation procedures can be performed safely and effectively based on prior 3-D TEE imaging.
PP142Preliminary experience with a new remote catheter system in pulmonary vein isolation
A. Wutzler, A.S. Parwani, M. Huemer, P. Attanasio, W. Haverkamp, L.-H. Boldt
CC13, Medizinische Klinik m. S. Kardiologie, Charité – Universitätsmedi-zin Berlin, Berlin
Purpose. Pulmonary vein isolation (PVI) is widely established as curative treatment option for atrial fibrillation (AF). A wide range of techniques to improve catheter manipulation and steerability has been developed over the past years. A new remote catheter system has recently become avail-able (Amigo Remote Catheter System, Catheter Robotics, Budd Lake, NJ,
USA). We here present first clinical experience with the remote catheter system for left atrial mapping and PVI in patients with symptomatic AF.Methods. 21 patients (mean age 64.1 ± 8.5 years; 81 % men) with symp-tomatic a drug refractory AF were studied. An open irrigated ablation catheter and a circular mapping catheter were positioned in the left atri-um (LA) after double transseptal puncture. Circumferential PVI was performed under electroanatomic guidance with a 3D-Mapping-Sys-tem (Ensite NavX, St. Jude Medical). The ablation catheter was posi-tioned in the robotic arm of the remote catheter system (. Abb. 1). The catheter then was maneuvered via a handheld remote control. Com-plete isolation of pulmonary veins was defined as procedural endpoint.Results. Data were analysed for 20 patients with PVI. Procedure dura-tion was 137.3 ± 24.2 min, total fluoroscopy time was 26.1 ± 6.1 min, oper ator fluoroscopy exposure was 14.8 ± 6.1 min. Isolation of pulmonary veins (PVs) was achieved in all patients with the use of the remote sys-tem. Mean duration of case 11–20 was significantly reduced compared
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PP142 Abb. 2 8 Procedure duration, total fluoroscopy time and operator fluo-roscopy exposure time for procedure 1–10 and 11–20 (* statistically significant)
PP142 Abb. 1 8 Operator and catheter manipulator a in the EP-laboratory. Catheter manipulator with the ablation catheter b during ablation. Handheld controller c for the remote ablation from outside the EP-laboratory
to case 1–10 (125.5 ± 18.1 vs 149 ± 24.6 min, p = 0.029; . Abb. 2 and 3). No complications occurred.Conclusions. These initial results suggest that left atrial mapping and PVI is feasible and effective. Isolation of the PVs was achieved in all cases. The learning curve was short with a significant reduction of pro-cedure time in case 11–20. Operator fluoroscopy exposure was consid-erably reduced.
PP143Cardiac contractility modulation: first experience in patients with advanced systolic heart failure and permanent atrial fibrillation
S. Röger, R. Schneider, B. Rudic, V. Liebe, F. Streitner, R. Schimpf, M. Borggrefe, J. Kuschyk
Med I. – Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Mannheim, Mannheim
Purpose. Cardiac contractility modulation (CCM) is an electrical de-vice therapy for patients with advanced systolic heart failure (HF). Non-excitatory electrical signals applied during the absolute refractory peri-od enhance the strength of left ventricular contraction without increas-ing myocardial oxygen consumption. Sinus rhythm (SR) is mandatory for effective CCM treatment because the CCM algorithm requires se-quential sensing of atrial and ventricular signals in SR through an atrial electrode and two ventricular septal electrodes. In case of atrial fibrilla-tion (AF) CCM therapy is inhibited, permanent AF is therefore a con-traindication for CCM. AF is one of the most frequent comorbidities in patients with advanced HF. The purpose of this study was to dem-onstrate the feasibility of CCM therapy through circumvention of the CCM sensing algorithm in three patients with permanent AF.
Methods. Three of 81 patients who received a CCM system at our hos-pital between March 2004 and January 2012 developed permanent AF after a mean follow-up of 36 months. Via upgrading of the implantable cardioverter defibrillator (ICD) to a cardiac resynchronization ther- apy defibrillator (CRT-D) with a programmed low atrial sensitivity of 4 mV (provoked atrial undersensing) compulsory atrial stimulation of the CRT-D was performed. The CCM system recognised the atrial stim-uli as SR which led to consecutive CCM therapy. In case of permanent stimulation biventricular stimulation is superior to exclusive right ven-tricular stimulation. Therefore CCM stimuli where triggered on the bi-ventricular stimulated QRS-complex.Results. Prior to implantation of CCM the three patients had a mean NYHA class of III, a mean left ventricular ejection fraction (LVEF) of 27 % and a mean peak oxygen uptake (VO2 peak) of 13.6 ml/kg/min. After six months of CCM therapy mean NYHA class increased to II, mean LVEF to 33 % and VO2 peak to 15.1 ml/kg/min. AF caused inhi-bition of CCM which was followed by deterioration of the clinical con-dition of all three patients. In all patients system upgrade to CRT-D was performed without complications. Atrial undersensing with consecu-tive atrial and biventricular stimulation was attained in each patient. CRT stimulation rates of > 98 % and CCM stimulation rates of 60–97 % were achieved. Clinical condition of all patients improved significantly.Conclusions. (1) CCM therapy is feasible in patients with AF through additional application of CRT with circumvention of the CCM sensing algorithm and can improve patient’s clinical condition. (2) This experi- mental approach can be considered in individual cases. (3) A CCM al-gorithm which is independent of an atrial electrode for sensing and triggering of CCM therapy is desirable and currently in development.
PP142 Abb. 3 9 Procedure duration and total fluoroscopy time for procedure 1–20
