Thomas Gaspar

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Allison K Thomason

Southern Illinois University Edwardsville

Ahmed Farag

Agriculture Research Center, Egypt

Ursula Rothe

The Open University

Chloe Middleton-Metcalfe

University Of Roehampton

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UNIVERSITAS NEGERI MANADO

Sangram Dhumal

Michigan State University

Mudhir Surchi

Salahaddin University-Erbil

Giovanni Di Giacomo

Università degli Studi "La Sapienza" di Roma

Helene Paarup

University of Southern Denmark

Lucia Florio

Universidad de la República (Uruguay)

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Papers by Thomas Gaspar

Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia

by Gerhard Hindricks and Thomas Gaspar

Heart rhythm: the official journal of the Heart Rhythm Society

Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identi... more Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identification of the area of slow conduction. The purpose of this study was to evaluate a new concept for analysis and treatment of macroreentrant tachycardia based on color-coded three-dimensional (3D) entrainment mapping and subsequent placement of strategic lesion lines. Twenty-six patients presented with macroreentrant tachycardia (cycle length 329 +/- 70 ms). Using nonfluoroscopic systems (CARTO 12, NavX 14), sequential mapping of the target atrium was performed. On each mapping point, the 3D location was paired with color-coded entrainment information so that the reentrant circuit could be directly visualized. Procedural duration, fluoroscopy time, and radiofrequency time measured 181 +/- 58, 37 +/- 19, and 31 +/- 17 minutes, respectively. Thirty-nine macroreentrant tachycardias were ablated: perimitral 9, around pulmonary vein ostium 6, through left atrial roof 5, around left atrial ap...

Epicardial Ventricular Tachycardia Ablation in a Patient With Brugada ECG Pattern and Mutation of PKP2 and DSP Genes

Circulation. Arrhythmia and electrophysiology, 2015

Reduction of Fluoroscopy Exposure during Atrial Fibrillation Ablation using a Novel Fluoroscopy Image Integrated 3-dimensional Electroanatomical Mapping System: - A prospective, randomized, single blind and controlled study

Heart rhythm : the official journal of the Heart Rhythm Society, Jan 19, 2015

We explored whether a novel fluoroscopy image integrated 3-dimensional electroanatomical mapping ... more We explored whether a novel fluoroscopy image integrated 3-dimensional electroanatomical mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation. Eighty patients (44 men, age 63±10 years), who underwent catheter ablation due to paroxysmal AF, were recruited consecutively in the current study. Patients were randomized 1:1 into two arms for AF ablation, using a conventional 3-dimensional electroanatomical mapping (EAM) system or the F-EAM system, respectively. Fluoroscopy time (10:42 (IQR 8:45-12:46) vs. 1:45 (IQR 1:05-2:22) min:sec, p<0.001) and doses (2440 (IQR 1593-3091) vs. 652 (IQR 326-1489) cGycm(2), p<0.001) in the EAM group were significantly greater than those in the F-EAM group. The majority of reduction of radiation exposure was achieved after transseptal puncture, which was nearly zero-fluoroscopy exposure. In total, approximately 84% of fluoroscopy time and 73%...

Left ventricular wall motion analysis to guide management of CRT non-responders

by Thomas Gaspar, Michael Döring, and Gerhard Hindricks

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 29, 2015

A discordant left ventricular (LV) lead position can be responsible for cardiac resynchronization... more A discordant left ventricular (LV) lead position can be responsible for cardiac resynchronization therapy (CRT) non-response. In this study, tailored optimization of the individual LV wall motion was evaluated for the outcome in these patients. Two hundred and forty-six CRT outpatients were screened for non-response due to a discordant LV lead. In 17 patients, three-dimensional data of fluoroscopic rotation scan and echocardiography were integrated to analyse the individual LV wall motion with respect to the LV lead position. Optimization was guided by the systolic dyssynchrony index (SDI) and LV ejection fraction (LVEF) during different interventricular (VV)-delay programming. If re-programming failed, implantation of a second LV lead was performed. A discordant or partly concordant LV lead position was found in nearly all patients (16/17, 94%), which contributed to an unchanged baseline amount of LV dyssynchrony with either CRT on or off (SDI 11.3 vs. 11.0%; P = 0.744). In the maj...

Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias

The American journal of gastroenterology, 2010

Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal da... more Radiofrequency catheter ablation in patients with left atrial arrhythmias may cause esophageal damage because of the close proximity between the posterior wall of the left atrium and the esophagus. The aim of this prospective study was to determine the incidence, endoscopic characterization, and endoluminal temperature dependency of esophageal thermal lesions after catheter ablation. In all, 185 consecutive patients with symptomatic atrial fibrillation or left atrial macro-re-entrant tachycardia who underwent left atrial radiofrequency catheter ablation were scheduled for upper gastrointestinal endoscopy. During the ablation procedure, a non-fluoroscopic three-dimensional system for catheter orientation, computed tomography (CT) image integration, and activation mapping was used. The esophagus was intubated with a temperature probe for visualization within the three-dimensional image and for real-time intraluminal temperature monitoring. A total of 27 (14.6%) asymptomatic ulcer-like...

Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study

by Thomas Gaspar and Sascha Rolf

Circulation. Arrhythmia and electrophysiology, 2011

Steerable sheath technology is designed to facilitate catheter access, stability, and tissue cont... more Steerable sheath technology is designed to facilitate catheter access, stability, and tissue contact in target sites of atrial fibrillation (AF) catheter ablation. We hypothesized that rhythm control after interventional AF treatment is more successful using a steerable as compared with a nonsteerable sheath access. One hundred thirty patients with paroxysmal or persistent drug-refractory AF undergoing their first ablation procedure were prospectively included in a randomized fashion in 2 centers. Ablation was performed by 10 operators with different levels of clinical experience. Treatment outcome was measured with serial 7-day Holter ECGs and additional symptom-based arrhythmia documentation. Single procedure success (freedom from AF and/or atrial macroreentrant tachycardia) was significantly higher in patients ablated with a steerable sheath (78% versus 55% after 3 months, P=0.005; 76% versus 53% after 6 months, P=0.008). Rate of pulmonary vein isolation, procedure duration, and ...

Three-dimensional real-time MRI-guided intracardiac catheter navigation

European heart journal, 2014

Nonfluoroscopic catheter visualization in atrial fibrillation ablation: experience from 375 consecutive procedures

by Thomas Gaspar and Gerhard Hindricks

Circulation. Arrhythmia and electrophysiology, 2014

A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tr... more A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tracking. No data on the safety of this technology are yet available in a large cohort of patients. Data from a prospective ablation registry were analyzed. All patients undergoing atrial fibrillation ablation procedures supported by nonfluoroscopic catheter visualization technology were included. Patient characteristics and procedural data and complications within the first 3 months were recorded. Between May 2012 and February 2014, a total of 375 patients underwent atrial fibrillation ablation using nonfluoroscopic catheter visualization technology. The patients were predominantly men (68%); the majority were ablated for the first time (71%); left atrium was 43±6 mm; and left ventricular function was normal (59±9%). The median ablation procedure time was 135 (113-170) minutes, median fluoroscopy time 2.8 (1.5-4.4) minutes, and median radiation dose 789 (470-1466) cGy*cm(2). Regression an...

Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation

by Thomas Gaspar and Gerhard Hindricks

Circulation. Arrhythmia and electrophysiology, 2014

Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a... more Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LV...

Real-life anticoagulation treatment after catheter ablation of atrial fibrillation: possible overtreatment of low-risk patients

by Thomas Gaspar and Gerhard Hindricks

Thrombosis and Haemostasis, 2009

Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: Incidence, characteristics, and risk factors

by Arash Arya, Jedrzej Kosiuk, Sascha Rolf, and Thomas Gaspar

Heart Rhythm, 2014

BACKGROUND Thromboembolic complications remain one of the most severe adverse events associated w... more

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Computed tomography model-based treatment of atrial fibrillation and atrial macro-re-entrant tachycardia

by Thomas Gaspar and Gerhard Hindricks

Europace, 2008

Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias

Europace, 2015

Variability of P-wave morphology predicts the outcome of circumferential pulmonary vein isolation in patients with recurrent atrial fibrillation

by Thomas Gaspar, Pyotr Platonov, and Gerhard Hindricks

Journal of electrocardiology, Jan 28, 2014

Severe atrial structural remodeling may reflect irreversible damage of the atrial tissue in patie... more Severe atrial structural remodeling may reflect irreversible damage of the atrial tissue in patients with atrial fibrillation (AF) and is associated with changes of P-wave duration and morphology. Our aim was to study whether variability of P-wave morphology (PMV) is associated with outcome in patients with AF after circumferential PV isolation (CPVI). 70 consecutive patients (aged 60±9years, 46 men) undergoing CPVI due to symptomatic AF were studied. After cessation of antiarrhythmic therapy, standard 12-lead ECG during sinus rhythm was recorded for 10min at baseline and transformed to orthogonal leads. Beat-to-beat P-wave morphology was subsequently defined using a pre-defined classification algorithm. The most commonly observed P-wave morphology in a patient was defined as the dominant morphology. PMV was defined as the percentage of P waves with non-dominant morphology in the 10-min sample. At the end of follow-up, 53 of 70 patients had no arrhythmia recurrence. PMV was greater ...

Catheter Ablation of Electrical Storm Due to Monomorphic Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy: Acute Results and Its Effect on Long-Term Survival

by Thomas Gaspar and Gerhard Hindricks

Pacing and Clinical Electrophysiology, 2010

Safety of Remote Magnetic Navigation in Patients With Pacemakers and Implanted Cardioverter Defibrillators

Journal of Cardiovascular Electrophysiology, 2010

First in Human Validation of Impedance-Based Catheter Tip-to-Tissue Contact Assessment in the Left Atrium

Journal of Cardiovascular Electrophysiology, 2009

Complications of Atrial Fibrillation Ablation in a High-Volume Center in 1,000 Procedures: Still Cause for Concern?

by Thomas Gaspar and Gerhard Hindricks

Journal of Cardiovascular Electrophysiology, 2009