This study was conducted to analyze the meaning of AF frequency obtained from the surface ECG for prediction of energy requirements and early arrhythmia relapse in patients undergoing internal cardioversion of persistent AF. Nineteen consecutive patients (mean age 58 +/- 11 years; 11 men, 8 women) with persistent AF (> 7 days) underwent internal cardioversion. A biphasic shock synchronized to the R wave was delivered between two catheters positioned in the high right atrium (HRA) and the coronary sinus (CS). AFfrequency was estimated prior to cardioversion from surface ECG lead V1. After filtering, QRST complexes were subtracted using a template matching and averaging algorithm. The resulting fibrillatory baseline signal was subjected to Fourier transformation, displayed as a frequency power spectrum and the peak frequency was determined in the 3-12 Hzfrequencyband. Atrial defibrillation threshold (ADFT) was determined using a step-up protocol. All patients were cardioverted successfully with a mean ADFT of 7.6 +/- 6.5 J(range 0.5-25). There was a strong positive correlation between fibrillatory frequency and ADFT (R = 0.71, P = 0.001). AF recurrence within 30 days after successful cardioversion occurred in 11 (58%) patients. Receiver operating characteristic (ROC) analysis revealed a fibrillatory frequency > or = 7 Hz to be 64% sensitive and 88% specific to predict AF recurrence. It was observed in 4 (36%) of 11 cases with a fibrillatory frequency < 7 Hz, as opposed to 7 (88%) of 8 cases with a fibrillatory frequency > or = 7 Hz (P = 0.02). Fibrillatory frequency obtained from the surface ECG predicts ADFT and early AF recurrence in patients with persistent AF undergoing internal cardioversion.

BackgroundThe aim of this observational, single-center study was to evaluate the impact of gender on surgical outcome in patients with active infective endocarditis (AIE) of the aortic valve.Material/MethodsBetween October 1994 and January 2011, 755 patients (558 men and 297 women) underwent surgery for AIE at the Leipzig Heart Center, Germany, according to the modified Duke criteria. Data were collected before surgery and as the study was ongoing. Gender influence on survival was evaluated (Kaplan-Meier curves). Cox proportional models were used to evaluate gender differences in relation to early mortality (within 30 days) and late mortality (up to 10 years).ResultsThe early mortality rate was 15.0% among men and 23.0% among women, which was statistically significant different (p=0.01). In male patients, variables associated with overall mortality were age (HR 1.63, 95% CI 1.43–1.86; p<0.001), insulin-dependent diabetes mellitus (HR 2.02, 95% CI 1.48–2.75; p<0.001), preoperative low ejection fraction (OR 0.99, 95% CI 0.98–0.99; p=0.002), previous cardiac surgery (OR 1.62, 95% CI 1.22–2.13; p=0.001), preoperative ventilation (OR 1.77, 95% CI 1.14–2.75; p=0.012), preoperative dialysis (OR 1.89, 95% CI 1.20–2.98; p=0.006), NYHA Class IV (OR 1.56, 95% CI 1.12–2.15; p=0.008), and involvement of multiple valves (OR 1.65, 95% CI 1.24–2.19; p=0.001) had a statistically significant influence on the late mortality. Focus identification (OR 1.75, 95% CI 1.08–2.77; p=0.023), involvement of multiple valves (OR 1.52, 95% CI 1.02–2.26; p=0.040), preoperative dialysis (OR 3.65, 95% CI 1.96–6.77; p<0.001), and age (OR 1.53, 95% CI 1.28–1.82; p<0.004) were predictive risk factors for late mortality in women with AIE (OR 3.6, 95% CI 1.5–8.4; p<0.004).ConclusionsThis study demonstrated distinct gender-based differences in risk of mortality in patients with AIE (who were undergoing surgical treatment) with different early and long-term outcomes.

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The fractional flow reserve as a criterion to intervention in patients with 50% LAD stenoses and impaired myocardial perfusionSummary Background: A fractional flow reserve (FFRmyo) < 0.75 is a well validated parameter for significance of coronary stenoses in cases of normal myocardial function. We used the FFRmyo limit in patients with impaired myocardial perfusion by myocardial infarction and/or hypertension for intermediate stenoses of the LAD for decision to PTCA and checked the indication by clinical follow-up.Methods: In 20 pts (5 women) with chest pain and visual 50 D% LAD stenoses, the FFR myo was obtained by using a RADI-PressureWire, the CFR by a densitometric technique (HODGSON), and the geometry of stenosis (minimal lumen diameter and diameter stenosis) by quantitative coronary angiography (QCA). EF and the kinetics of the anterolateral wall (expressed as radial shortening fraction) were measured by laevography.Results: The mean age of our 20 pts. was 59.4 years: 13 of the pts. (65%) had a history of hypertension, 9 (45%) pts. a history of myocardial infarction. The mean diameter stenosis was 50.8%. The mean value of CFR was 2.9. The FFR myo ranged from 0.66 to 0.90, the mean value was 0.78. The 12 pts. with FFR myo ≥ 0.75 (60%, group A) were treated with the usual antianginal medications. A PTCA was performed only in patients with FFR myo < 0.75 (N = 8 (40%), group B). Except for one pt. with instent restenosis, in the 7 pts. with denovo stenoses stent implantation was performed. Significant differences between the groups A and B were seen only for the total number of myocardial infarctions (8/12 vs. 1/8) and diameter stenosis (48.5% vs. 54.3%). All lesions of group B had a diameter stenosis of 50% or higher. CFR correlated significantly with the radial shortening fraction (r = 0.75), minimal lumen diameter (r = -0.51) and diameter stenosis (r = -0.46). FFR myo correlated with diameter stenosis (r = -0.47) only. All pts. treated with PTCA were primarily free of pain or reduced angina at least 1 CCS stage; only one developed an angina due to a restenosis (74D%) 2 months after PTCA and stent implantation. The pts. of group A did not get worse, nor were they readmitted within 6 to 13 months after catheterization.Conclusions: Pts. with 50 D% stenoses, impaired myocardial perfusion and FFR myo < 0.75 had a good long-term benefit concerning clinical and angiographic result. No pts. with FFR myo < 0.75 had a D% lower than 50; therefore, the PTCA of intermediate stenoses without quantification must be avoided. CFR is not helpful for a decision to PTCA in such cases, because a normal value of CFR is relevant only.Key words PTCAstent implantationquantitative coronary angiographyfractional flow reservecoronary flow reserve Zusammenfassung Fragestellung: Eine fraktionelle Flussreserve (FFR myo ) < 0,75 ist ein validierter Parameter für die Relevanz von Koronarstenosen, wenn die Myokardfunktion normal ist. Wir verwendeten den FFR myo -Grenzwert bei Pa-308 Zeitschrift für Kardiologie, Band 89, Heft 4 (2000) © Stein...

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