Artemisia Karagianni

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The incidence of atrial fibrillation in patients with interatrial shunt: is it reduced after surgical or transcatheter closure of the shunt?

European Heart Journal (2024)

Artemisia Karagianni Per Eriksson Symeon Papadopoulos M Dellborg Zacharias Mandalenakis

Abstract Background Atrial fibrillation (AF) is a prevalent diagnosis among individuals with interatrial shunts, and the prevalence increases with age (1). Since the 1990s, interventionists have introduced transcatheter techniques, to close interatrial shunts, while surgical procedures reserved in cases of technical complexity (2). Despite the potential reduction in AF incidence post interatrial shunt closure, discernible modifications in the cardiac conduction system may persist (3). Notwithstanding, reports indicate an incidence of new-onset AF in approximately 10-25% of patients after interatrial shunt closure, with a pronounced prevalence among elderly (4). This study aims to delineate the incidence of AF subsequent to interatrial shunt, surgical och transcatheter, closure within a national cohort in Sweden. Methods The study includes all patients diagnosed with an interatrial shunt, atrial septal defect and patent foramen ovale, classified using the International Classification of Diseases, 10th edition (ICD-10), as documented in the Swedish National Patient Register, along with data sourced from the Cause of Death Register. Patients with multiple diagnoses of other congenital heart diseases are excluded, and interventions performed between 1997 and 2017 are identified using the NOMESCO surgical classification. Comorbidities such as chronic ischemic heart disease, myocardial infarction, heart failure, hypertension, and diabetes are considered, with the primary endpoint being the incidence of AF post-intervention. Results A total of 3,426 patients with interatrial shunts underwent intervention between 1997 and 2017, with a mean follow-up duration of 6.2 years. Among these, 49% (n=1,725) underwent transcatheter closure, while 41 patients underwent both transcatheter and surgical procedures. The mean age was 36 years, with 9% presenting with heart failure at baseline. Before the intervention, 14% (n=483) had AF, increasing to 22% (n=755) post-intervention. Of those developing AF post-intervention, 16% (n=119) experienced the AF event within 60 days, evenly distributed between transcatheter and surgical procedures. Over 40% of patients with post-intervention AF had an average age of 62. The incidence of AF post-intervention was 1.6 per 100 patient-years (see Figure). Stroke incidence was 3.6 per 100 patient-years and the mortality rate was 7% (n=257) during follow up (see Table). Conclusions Patients with interatrial shunts exhibit a high incidence of AF, which further escalates following closure of the interatrial shunt, not only within the first few days post-intervention, particularly among the elderly population. This can relate to high incidence of ischemic stroke.Figure

Interatrial septum

10.1093/eurheartj/ehae666.2140

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Intraabdomineller Druck und kardiorespiratorisches System während Ösophagogastroduodenoskopie und NOTES „Natural Orifice Transluminal Endoscopic Surgery“

Artemisia Karagianni

In der vorliegenden Arbeit wurde die Auswirkung der Luftinsufflation wahrend Osophagogastroduodenoskopie und des Pneumoperitoneums wahrend NOTES „Natural Orifice Transluminal Endoscopic Surgery“ auf den intraabdominellen Druck sowie das kardiorespiratorische System in zwei tierexperimentell kontrollierten Studien uberpruft. Die Studien wurden an jungen, gesunden Schweinen in Allgemeinanasthesie und unter volumenkontrollierter Beatmung durchgefuhrt. Beide Studien zeigen, dass die signifikanten Anderungen der hamodynamischen Parameter sowie die enge Korrelation zwischen dem intraabdominellen Druck und dem inspiratorischen Spitzendruck ernst zunehmende kardiorespiratorische Komplikationen wahrend OGD bzw. NOTES hervorrufen konnen.

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TCT-401 A Comprehensive Easily Applicable Approach to Graduation of Radial Artery Spasm Related to Transradial Interventions

Journal of the American College of Cardiology (2012)

Tim Schäufele Artemisia Karagianni Ina Wenzelburger Ali Yılmaz Udo Sechtem

Graduation (instrument)

10.1016/j.jacc.2012.08.430

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A novel and practicable ERCP training system with simulated fluoroscopy

Endoscopy (2008)

E. Frimberger Stefan von Delius T Rösch Artemisia Karagianni Roland M. Schmid

Simulators facilitate the acquisition of technical skills for endoscopy. Here, we describe the development, introduction, and first evaluation of a novel generation of mechanical endoscopic retrograde cholangiopancreatography (ERCP) simulation models with simulated fluoroscopy, the X-Vision ERCP Training System.A custom-made modular ERCP simulation system was built with the use of universally obtainable materials and tools. The trainee controls ERCP activities on two screens: the aspect of the papilla and duodenum is shown on the conventional endoscopy monitor, and the trainee's actions in the equivalents of the pancreaticobiliary ducts are shown on the viewing screen of the model. Thereby, the latter screen serves as a substitute for fluoroscopy. Currently, four different models are available, allowing simulation of selective cannulation of the pancreatic or bile duct, intubation of differently arranged papillae, stent placement, and sphincterotomy of a biopapilla. The X-Vision ERCP Training System was first used during an ERCP course attended by 26 endoscopists. Trainees were supervised by an ERCP expert and an experienced ERCP nurse at each training model. The training system was evaluated by the participants and experts using a specific questionnaire.During the course there were no technical problems related to the X-Vision ERCP Training System. After sphincterotomy the organic papillae could easily be exchanged within less than 15 seconds. Overall, the X-Vision ERCP Training System achieved favorable results in all categories assessed.The new X-Vision ERCP Training System is simple and effective. A first evaluation in the context of an ERCP course showed impressive results.

10.1055/s-2007-995456

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Percutaneously assisted endoscopic surgery using a new PEG-minitrocar for advanced endoscopic submucosal dissection (with videos)

Gastrointestinal Endoscopy (2008)

Stefan von Delius Artemisia Karagianni Claus Hann von Weyhern Hubertus Feußner Tibor Schuster

Submucosa

Endoscopic submucosal dissection

Endoscopic mucosal resection

Ex vivo

10.1016/j.gie.2008.02.093

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Citations (27)

Changes in intra-abdominal pressure, hemodynamics, and peak inspiratory pressure during gastroscopy in a porcine model

Endoscopy (2007)

Stefan von Delius Artemisia Karagianni J. Henke Anne-Kathrin Preissel Alexander Meining

See also: Commentaire de travail de S. von Delius et al., pp. 962Endoscopy 2007; 39(11): 1029-1029DOI: 10.1055/s-0032-1308881

10.1055/s-2007-966973

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Transradial left ventricular endomyocardial biopsy: assessment of safety and efficacy

Clinical Research in Cardiology (2015)

Tim Schäufele Raphael Spittler Artemisia Karagianni Peter Ong Karin Klingel

Cardiac catheterization

Interventional cardiology

10.1007/s00392-015-0844-1

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SESSION 59: EMBRYOLOGY - DEVELOPMENT AND QUALITY

Human Reproduction (2012)

S. Davies Dimitra Christopikou E. Tsorva Artemisia Karagianni Alan H. Handyside

Embryology

10.1093/humrep/27.s2.58

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Hämodynamik (H), inspiratorische Spitzendrücke (Pinsp) und intraabdomineller Druck (IAD) während Ösophagogastroduodenoskopie (ÖGD) im Schweinemodell

Zeitschrift für Gastroenterologie (2007)

Stefan von Delius Artemisia Karagianni J. Henke A Preisel Alexander Meining

Hintergrund: Die ÖGD ist ein Standardverfahren zur Diagnostik und Therapie gastrointestinaler Erkrankungen. Es wurde untersucht, ob es über eine Erhöhung des IAD (in Folge der Luftinsufflation) zu hämodynamischen Änderungen kommt, die ursächlich für (wenn auch seltene) kardiovaskuläre Komplikationen sein könnten (ähnlich den Auswirkungen bei Anlage eines Pneumoperitoneums).

10.1055/s-2007-992731

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Hemodynamics after endoscopic submucosal injection of epinephrine in a porcine model

Endoscopy (2012)

Christoph Schlag Artemisia Karagianni Michael Grimm M. Stangassinger Tibor Schuster

Background and study aims: Endoscopic submucosal injection of epinephrine may cause systemic effects on the cardiovascular system. The aim of this experimental study was to assess systemic hemodynamic changes after submucosal injection of epinephrine during upper gastrointestinal endoscopy in a porcine model. Methods: Measurements were taken from 12 pigs under general anesthesia. During gastroscopy 5 mL of normal saline, and 2.5 mL and 5 mL of epinephrine (1:10 000) were injected into the submucosal layers of the gastric antrum, corpus, and distal esophagus. After each injection, the cardiac index and global end diastolic volume index (GEDVI, reflecting preload) were measured every 3 minutes by transpulmonary thermodilution for a minimum of 12 minutes. The following parameters were also recorded: heart rate, mean arterial pressure (MAP), and systemic vascular resistance index (SVRI, reflecting afterload). Results: Significant hemodynamic changes were observed after submucosal injection of epinephrine into the esophagus, including heart rate (maximum + 4 %) and MAP (maximum – 4 %) after injection of 2.5 mL epinephrine, and stronger changes in heart rate (maximum + 13 %), cardiac index (maximum + 21 %), MAP (maximum – 4 %), and SVRI (maximum – 12 %) after the injection of 5 mL epinephrine. After submucosal injection of epinephrine into the gastric antrum and corpus, hemodynamic effects were less evident. Here significant changes were observed in heart rate (maximum + 3 %), MAP (maximum – 2 %), cardiac index (maximum + 7 %), and SVRI (maximum – 8 %) only after the injection of 5 mL epinephrine into the antrum. Conclusion: Endoscopic submucosal injection of epinephrine is associated with changes in systemic hemodynamic parameters, especially when performed in the esophagus, and the procedure might therefore induce harmful side effects.

Cardiac index

Afterload

Mean arterial pressure

Preload

10.1055/s-0031-1291441

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Citations (4)