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  • 1
    Electronic Resource
    Electronic Resource
    Impact of the Distribution and Structure of Myocardium in the Pulmonary Veins for Radiofrequency Ablation of Atrial Fibrillation (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: WEISS, C., et al.: Impact of the Distribution and Structure of Myocardium in the Pulmonary Veins for Radiofrequency Ablation of Atrial Fibrillation. Focal AF is frequently triggered by ectopic beats mostly originating from the pulmonary veins (PVs). So far, the morphological substrate for this entity is not well defined. Therefore, the distribution of myocardial cells within the PV were examined as potential target sites for RF application. The PVs (118) of 30 human autopsied hearts (age of death 63 ± 13 years, 17 men) were dissected in their complete circumference starting 1 cm from the ostium. Tissue sections of the PV were stained with hematoxylin-eosin and with Masson's trichrome. To characterize the developmental state of the myocardial tissue in the PV, immunohistochemistry was performed with antibodies reacting with antigens which are stage specifically expressed during cardiac development (HNK1/Leu7, α-SMA, calponin and desmin). Furthermore, proliferative activity was assessed using antibodies against the Ki-67 antigen (MIB-1). In two hearts a left-sided common PV ostium was found. The other hearts showed four separated PV ostia. The ostium diameter of the right inferior PV (1.2 ± 0.3 cm) was significantly smaller (P 〈 0.05) than remaining PV ostia (right superior 1.5 ± 0.2, left superior, 1.5 ± 0.3 and left inferior 1.4 ± 0.3 cm) of the 118 specimen. There was no significant difference in the presence of myocardium in the PV 1-cm distant from the ostium comparing the right superior (78%), the right inferior (81%), the left superior (81%), and the left inferior (81%) PV. In 54% of cases the myocardial bundles covered the complete PV circumference. In up to 38% of the small extensions of the myocardial bundles myocardial cells, characterized by distinct cross-striations and spindle shape were found. However, since these cells could not be labeled for other markers than desmin, their immature state seems unlikely. The anatomic distribution of myocardium in the PV suggests that RF applied to the entire circumference may be frequently required for its electrical isolation. Whether spindle-shaped myocytes have different electrophysiological behavior has to be further investigated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01352.x
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  • 2
    Electronic Resource
    Electronic Resource
    Impact of the ECG for Detection of Intraatrial Conduction Block after Atrial Flutter Ablation (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 22 (1999), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Induction of complete bidirectional conduction block via the posterior isthmus of the right atrium is introduced as a standard endpoint for catheter ablation of atrial flutter. The present study sought to investigate the impact of changes in P wave duration and morphology detected by the surface ECG during coronary sinus and posterolateral right atrial stimulation as a marker for conduction block. Morphology and duration changes of the paced P wave before and after radiofrequency catheter (RFC) ablation were estimated in 22 patients referred for ablation of atrial flutter. We looked for a morphology change of the terminal portion in the 12-lead ECG and an increment of P wave duration. In 16 of 22 patients in whom atrial flutter ablation resulted in a complete bidirectional block, the conduction block was unidirectional in 4 patients and conduction times remained unchanged in 2 patients. After induction of complete bidirectional block a change of the terminal portion of the P wave towards a more positive morphology in one or more inferior leads was detected in 14 (88%) of 16 patients during coronary sinus stimulation and in 15 (94%) of 16 patients during posterolateral right atrial stimulation. These changes were predominantly observed in the inferior leads. Positive morphology changes of the terminal P wave portion in the inferior leads indicating conduction block with a sensitivity of 86% and a specificity of 100% were observed. An increment of 10 ms or more in P wave duration indicates conduction block with a specificity of 100% and a sensitivity of 67%. There was a significantly larger increment of P wave duration during coronary sinus (CS) stimulation compared to posterolateral right atrial stimulation (38 ± 21 vs 16 ± 21 ms). The analysis of P wave duration and morphology in the inferior leads of the surface ECG is a reliable tool to assess the intraatrial conduction after atrial flutter ablation. Different conduction during coronary sinus and pos-terolateral right atrial pacing may cause a different P wave duration after ablation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00349.x
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  • 3
    Electronic Resource
    Electronic Resource
    Several Unsuccessful Internal and External Defibrillations During Active Can ICD Implantation in a Patient with Pneumothorax (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: During implantable cardioverter defibrillator (ICD) implantation of an active can ICD several defihrillations with 20 J and 34 J as well as 360 J externally were ineffective. The implant criteria were finally met with a second defibrillation lead and reversed polarity. A left-sided pneumothorax due to subclavian vein puncture was detected soon after ICD implantation. It is assumed that especially in the active can alignment the developing pneumothorax made defibrillation current flow more difficult. In case of several unsuccessful defibrillations during active can ICD implantation in which the subclavian vein was punctured, the possibility of a pneumothorax should be considered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb00076.x
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  • 4
    Electronic Resource
    Electronic Resource
    Atrial Flutter Ablation using a Technique for Detection of Conduction Block within the Posterior Isthmus (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 22 (1999), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Catheter ablation orientated on the induction of a functional intraatrial block within the posterior isthmus of the tricuspid annulus has been shown to effectively abolish atrial flutter. In order to improve and simplify the current technique, a strategy based on an electrode catheter for combined right atrial and coronary sinus mapping and stimulation was explored prospectively. Twenty-four consecutive patients referred for catheter ablation of recurrent type I atrial flutter were included. A steerable 7 Fr catheter (Medtronic/Cardiorhythm) composed of two segments with 20 electrodes was used for right atrial and coronary sinus activation mapping and stimulation. Multiple steering mechanisms allowing intubation and positioning of the distal part within the coronary sinus were incorporated into the device. Adequate positioning of the mapping catheter was achieved solely via a transfemoral approach in all patients after 7.7 ± 4.6 minutes, providing stable electrogram recordings during the entire ablation procedure. Radiofrequency current ablation (16.3 ± 9.6 pulses) caused a significant bidirectional increase of the mean intraatrial conduction times via the posterior isthmus irrespective to the stimulation interval. Significant changes of intraatrial conduction properties were induced during ablation in 22 of 24 patients (bidirectional block: n = 18, unidirectional block: n = 3, conduction delay: n = 1, unchanged conduction: n = 2). Following ablation atrial flutter was noninducible in all patients. Twenty-two of 24 patients (92%) remained free of atrial flutter episodes during a follow-up of 12.5 ± 5.7 months. Two of six patients without a bidirectional conduction block had a recurrence of atrial flutter. Atrial flutter ablation guided by the induction of an intraatrial conduction block can be effectively performed with this novel strategy for combined mapping of the posterior tricuspid isthmus, including coronary sinus and right atrial free wall. This transfemoral approach has a high accuracy with respect to the detection of radiofrequency current-induced changes of intraatrial conduction patterns.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00539.x
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  • 5
    Electronic Resource
    Electronic Resource
    Catheter Ablation of Atrial Flutter Guided by Electroanatomic Mapping (CARTO): A Randomized Comparison to the Conventional Approach (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 11 (2000), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Electroanatomic vs Conventional Mapping for Atrial Flutter Ablation. Introduction: Three-dimensional electroanatomic (CARTO) activation mapping of the cavotricuspid isthmus can be helpful to guide atrial flutter ablation, but to date has not heen investigated in comparison to conventional strategies. The aim of the present study was to assess the efficacy of the CARTO navigation system, especially with respect to the fluoroscopy time required for successful atrial flutter ablation.Methods and Results: Eighty patients with recurrent common-type atrial flutter were randomly assigned to temperature-controlled radiofrequency (RF) catheter ablation, either guided by conventional criteria (group 1) or additionally oriented on electroanatomic mapping (group 2). In all patients, similar multipolar catheters were inserted into the coronary sinus and placed at the tricuspid annulus. respectively. In group 2, positioning of the mapping electrode and delivery of RF pulses within the cavotricuspid isthmus was mainly oriented on the CARTO map to achieve the most linear and continuous RF lesions. Abolition of intra-atrial conduction verified by conventional criteria (group 1) and electroanatomic mapping (group 2) could be verified in all patients. The overall number of RF pulses (group 1: 16.7 ± 6.5; group 2: 13.2 ± 5.3) and mean procedure duration (group 1: 172.5 ± 47.4 min; group 2: 169.3 ± 47.3 min) were not different between the two groups, but mean fluoroscopy time was significantly shorter when the CARTO tecbnology was used (group 1: 29.2 ± 9.4 min; group 2: 7.7 ± 2.8 min; F = 0.0001). Recurrence of atrial flutter was observed in 3 (9%) patients in each group after a mean follow-up of 8.5 ± 2.months.Conclusion: Atrial flutter can be abolished effectively using the conventional technique as well as oriented on electroanatomic mapping. However, overall X-ray exposure can he significantly reduced by the CARTO-guided approach without prolongation of procedure duration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2000.01223.x
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  • 6
    Electronic Resource
    Electronic Resource
    Can Radiofrequency Current Isthmus Ablation Damage the Right Coronary Artery? Histopathological Findings Following the Use of a Long (8 mm) Tip Electrode (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: WEISS, C., et al.: Can Radiofrequency Current Isthmus Ablation Damage the Right Coronary Artery? Histopathological Findings Following the Use of a Long (8 mm) Tip Electrode. This report describes the histopathological findings following successful RF isthmus ablation for common atrial flutter in a 68-years-old man using a long 8-mm tip ablation catheter. No acute complication was observed. The patient died 3 weeks after ablation due to severe heart failure and consecutive pneumonia. Lesion width (1.0 and 2.4 cm) and depth (0.4 and 0.8 cm) was measured. The right coronary artery showed an intramural hemorrhage adjacent to the side of the lesion. However, despite this finding no apparent injury of other layers of the coronary artery was detectable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.00860.x
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  • 7
    Electronic Resource
    Electronic Resource
    Dissociated Activity and Pulmonary Vein Fibrillation Following Functional Disconnection: (2003)
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: 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. (PACE 2003; 26:1363–1370)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.t01-1-00195.x
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  • 8
    Electronic Resource
    Electronic Resource
    Autoimmune diabetes as a consequence of locally produced interleukin-2 (1992)
    [s.l.] : Nature Publishing Group
    Nature 359 (1992), S. 547-549 
    Details
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] We have previously shown that mice expressing the allogeneic class I protein, H-Kb, in islet /3-cells (RIP-Kb mice) did not develop autoimmunity, although a completely nonimmune form of diabetes ensued as a result of the overexpression of transgene product2. These mice were tolerant of Kb-bearing ...
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1038/359547a0
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  • 9
    Electronic Resource
    Electronic Resource
    Separation of (R)- and (S)-tert-butyl 2-tert-butyl-4-methoxy-2,5-dihydro-1,3-imidazole-1-carboxylate (building block for amino acid synthesis) by preparative high performance liquid chromatography on a polysaccharide stationary phase (1998)
    New York, NY [u.a.] : Wiley-Blackwell
    Chirality 10 (1998), S. 217-222 
    Details
    ISSN: 0899-0042
    Keywords: amylose ; 3,5-dimethylphenyl-carbamate ; polysaccharide phase ; tert-butyl 2-tert-butyl-4-methoxy-2,5-dihydro-1,3-imidazole-1-carboxylate; amino acid ester synthesis ; Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The preparative separation of the enantiomers of the title compound, a versatile chiral building block for the synthesis of unnatural amino acid esters, by high performance liquid chromatography on a chiral stationary phase (CSP), is reported for the first time. The CSP consists of amylose-(3,5-dimethylphenyl-carbamate), which has been coated onto the surface of macroporous aminopropyl-functionalized silica gel. The effect of mobile phase composition and the amount of amylose derivative on the silica gel has been thoroughly investigated. Using 2-propanol as organic modifier in hexane as mobile phase, on a semi-preparative column (200 mm × 40 mm ID, containing 192 g of stationary phase) about 200 mg of the racemate was separated per injection. Running the equipment under automatic conditions with repetitive injection mode allowed for the separation of 30 g per day. Both enantiomers were obtained with enantiopurities 〉99.75:0.25. Chirality 10:217-222, 1998. © 1998 Wiley-Liss, Inc.
    Additional Material: 5 Ill.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    The phylogeny ofActaea (Ranunculaceae): A biogeographical approach (1999)
    Springer
    Plant systematics and evolution 216 (1999), S. 251-263 
    Details
    ISSN: 1615-6110
    Keywords: Ranunculaceae ; Cimicifugeae ; Actaea ; Cimicifuga ; Souliea ; Anemonopsis ; Biogeography ; morphology ; ecology ; phylogeny
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract Phylogenetic analyses of the genusActaea were performed using morphological, ecological and biogeographical characters. Using solely morphological characters, the relationships of the three identified species-groups remain uncertain. Close biogeographical examination and comparison of the areas with ecological peculiarities as well as climate data gave important insight into the phylogeny ofActaea and the whole tribe. Consequently, the obtained biogeographical data were used for phylogenetic reconstructions. Both, from the point of view of morphological and biogeographical data,A. pachypoda andA. asiatica are the most ancestral species. They grow on the east sides of the continents, mainly in broad-leaved forests. In West Eurasia the apomorphicA. spicata andA. acuminata occur under similar climatic and ecological conditions, but these species are adapted to another climate rhythm. The most advanced species (A. erythrocarpa, A. rubra) are to be found in the boreal forests where they are widely distributed. This biogeographical approach revealed that the evolution of the species led to a gradual widening and shifting of their ecological constitutions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01084402
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