Thomas Pezawas

Bio: Thomas Pezawas is an academic researcher from Medical University of Vienna. The author has contributed to research in topics: Implantable cardioverter-defibrillator & Sudden cardiac death. The author has an hindex of 12, co-authored 35 publications receiving 434 citations. Previous affiliations of Thomas Pezawas include University of Vienna.

Implantable loop recorder in unexplained syncope: classification, mechanism, transient loss of consciousness and role of major depressive disorder in patients with and without structural heart disease

Abstract: Objective: To stratify mechanisms and predictors of unexplained syncope documented by an implantable loop recorder (ILR) in patients with and without structural heart disease (SHD). Design and setting: Prospective study in consecutive patients of a university cardiac centre. Patients and methods: An ILR was implanted in 70 patients (34 male/36 female, aged 55 (17) years) in whom syncope remained unexplained after thorough testing. SHD was present in 33 patients (ischaemic cardiomyopathy in 16, dilated cardiomyopathy in 9 and hypertrophic cardiomyopathy in 8) and absent in 37 patients (mean (SD) left ventricular ejection fraction 46 (4)% vs 61 (7)%, respectively). Results: A syncopal recurrence occurred during 16 (8) months in 30 patients (91%) with SHD and in 30 patients (81%) without SHD. Fifteen patients (45%) versus 19 patients (51%), respectively, had an ILRdocumented arrhythmia at the time of recurrence which led to specific treatment. The remaining 15 patients (45%) with SHD and 11 patients (30%) without SHD had normal sinus rhythm at the time of the recurrence. On stepwise multivariate analysis only major depressive disorder was predictive for early recurrence during ILR follow-up (p = 0.01, hazard ratio = 3.35, 95% CI 1.1 to 7.1). Fifty seven per cent of patients with major depressive disorder had sinus rhythm during recurrence compared with 31% of patients without the disorder (p = 0.01). Conversely, no patient with major depressive disorder had asystole compared with 33% without (p,0.001). Conclusions: The presence of SHD has little predictive value for the occurrence or type of arrhythmia in patients with unexplained syncope. Patients with major depressive disorder are prone to early recurrence of symptoms and have no evidence of arrhythmia in most cases. The ILR leads to specific treatment in half of all patients. In patients with syncope the presence of structural heart disease (SHD) is considered the main predictive factor for an arrhythmia with a sensitivity of 95% and a specificity of 45%. Its absence makes an arrhythmic cause of syncope highly unlikely. 12

Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantable cardioverter defibrillator therapy

Abstract: Aims To evaluate electrophysiologically guided implantable cardioverter defibrillator (ICD) therapy in patients with syncope, structural heart disease and no documented sustained ventricular tachycardia (sVT). Methods and Results Programmed ventricular stimulation (PVS) was performed in 52 patients (age 62 � 10 years): 40 patients had ischaemic and 12 patients had idiopathic dilated cardiomyopathy. On PVS sVT and ventricular fibrillation were induced in seven and four patients, respectively, and two patients spontaneously experienced symptomatic sVT. These patients received an ICD (ICD group, n ¼ 13). Non-inducible patients were left on conventional therapy (non-ICD group, n ¼ 39). During 5 � 2.8 years five ICD patients received therapies, all appropriate. There were seven non-sudden deaths and overall survival analysis revealed no significant difference. Recurrent syncope occurred in five ICD and four non-ICD patients and did not correlate well with sVT. The positive and negative predictive values of PVS for tachyarrhythmias or sudden death were 36 and 98%, respectively.

Electromagnetic interference by transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study.

Abstract: Neuromuscular electrical stimulation (NMES) is a frequently applied therapy for the treatment of pain and a therapeutic option to increase thigh muscle strength and endurance capacity in patients with heart failure. Electromagnetic interference (EMI) by the signals with sensing of ICDs is possible. Eight patients with subpectoral ICD systems and different transvenous bipolar sensing leads were subjected to electrical stimulation of the neck and shoulder and of the thighs using different stimulation algorithms. EMI with ventricular sensing was detectable in three of eight subjects. EMI occurred during stimulation of the neck (n = 2) and thigh (n = 2). EMI by NMES with atrial sensing was seen in two of four subjects with dual chamber ICDs. The safety of peripheral NMES has to be individually tested as EMI can also occur in ICD patients with bipolar sensing.

Cardiac Autonomic Dysfunction in Multiple Sclerosis: A Systematic Review of Current Knowledge and Impact of Immunotherapies

Abstract: Cardiac autonomic dysfunction (CAD) has been reported in patients with multiple sclerosis (MS). This systematic review summarizes the evidence for the types and prevalence of CAD in MS patients, as well as its association with MS type, disease characteristics, fatigue and immunotherapies used to treat MS. The analysis revealed that CAD is correlated with pathophysiological processes of MS, can trigger serious cardiovascular complications that may reduce life expectancy, and may have implications for treatment with immunotherapies, especially fingolimod. Numerous mainly small case-control or cohort studies have reported various measures of CAD (particularly heart rate variation) in MS patients, showing higher rates of abnormality versus controls. A smaller number of studies have reported on cardiac autonomic symptoms in MS, including orthostatic intolerance/dizziness in around 50% of patients. CAD also appears to be associated with disease duration and to be more common in progressive than relapsing-remitting MS. However, although a substantial evidence base suggests that assessing CAD in people with MS may be important, standardised methods to evaluate CAD in these patients have not yet been established. In addition, no studies have yet looked at whether treating CAD can reduce the burden of MS symptoms, disease activity or the rate of progression.

Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)

Abstract: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been previously discussed. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC Web Site (http://www.escardio.org/guidelines). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed, including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House Headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must be notified …

2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.

Abstract: Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Andrew E. Epstein, MD, FACC, FAHA, FHRS, Chair ; John P. DiMarco, MD, PhD, FACC, FHRS; Kenneth A. Ellenbogen. MD, FACC, FAHA, FHRS; N.A. Mark Estes III, MD, FACC, FAHA, FHRS; Roger A.