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Article ; Conference proceedings: Diagnostischer Nutzen eines modifizierten fokussierten Herzultraschalls bei tachykarden Herzrhythmusstörungen an der Notaufnahme – eine Pilotstudie

Simon, Alexander / Spiel, Alexander / Tumnitz, Elvis

Ultraschall in der Medizin - European Journal of Ultrasound

2022 Volume 43, Issue S 01

Event/congress	Interdisziplinärer Kongress \| Ultraschall 2022, Zürich, 2022-06-29
Language	German
Publishing date	2022-06-01
Publisher	Georg Thieme Verlag
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	801064-x
ISSN	1438-8782 ; 0172-4614 ; 1439-0914 ; 1431-4894
ISSN (online)	1438-8782
ISSN	0172-4614 ; 1439-0914 ; 1431-4894
DOI	10.1055/s-0042-1749525
Database	Thieme publisher's database

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Article: Carotid Artery Ultrasound in the (peri-) Arrest Setting-A Prospective Pilot Study.

Koch, Moritz / Mueller, Matthias / Warenits, Alexandra-Maria / Holzer, Michael / Spiel, Alexander / Schnaubelt, Sebastian

Journal of clinical medicine

2022 Volume 11, Issue 2

Abstract: Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and ... ...

Abstract	Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with and without color doppler, and pulsed-wave doppler loops. The feasibility of carotid US during (peri-)arrest and type and frequency of diagnostic findings were examined. We recruited 16 patients and recorded utilizable US images in 14 cases (88%; complete imaging protocols in 11 patients [69%]). In three of all patients (19%) and in 60% (3/5) of cases during CPR plus a full imaging protocol, we observed: (i) in one patient a collapse of the common carotid artery linked to hypovolemia, and (ii) in two patients a biphasic flow during CPR linked to prolonged low-flow time prior to admission and adverse outcome. Carotid artery morphology and carotid blood flow characteristics may serve as therapeutic target and prognostic parameters. However, future studies with larger sample sizes are needed.
Language	English
Publishing date	2022-01-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11020469
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Body Weight Counts-Cardioversion with Vernakalant or Ibutilide at the Emergency Department.

Lindmayr, Teresa / Schnaubelt, Sebastian / Sulzgruber, Patrick / Simon, Alexander / Niederdoeckl, Jan / Cacioppo, Filippo / Schuetz, Nikola / Domanovits, Hans / Spiel, Alexander Oskar

Journal of clinical medicine

2022 Volume 11, Issue 17

Abstract: Aim: Medication for the pharmacological cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) is applied either in a fixed dose or adapted to body weight. Individual body weight might be a relevant confounder for anti-arrhythmic treatment ... ...

Abstract	Aim: Medication for the pharmacological cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) is applied either in a fixed dose or adapted to body weight. Individual body weight might be a relevant confounder for anti-arrhythmic treatment success. Therefore, the aim of this study was to elucidate the impact of body weight on pharmacological cardioversion success, comparing weight adapted (Vernakalant) and fixed dose (Ibutilide) pharmacotherapeutic cardioversion regimes. Methods: Within this prospective observational trial, a total of 316 episodes of AF and AFL were enrolled. Patients were stratified in either a Vernakalant ( Results: Conversion to sinus rhythm was achieved in 76.3% of all cases. Of note, there was no difference comparing the Vernakalant and Ibutilide treatment arms (Vernakalant 76.2% vs. Ibutilide 76.3%; Conclusion: Both, the Vernakalant and Ibutilide treatment arms showed comparable rates of treatment success in pharmacotherapeutic cardioversion of AF and AFL. Of utmost importance, we observed that the fixed dose of Ibutilide-as compared to the weight-adapted dose of Vernakalant-showed a reduced treatment success with increasing body weight.
Language	English
Publishing date	2022-08-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11175061
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Article: Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation-An 11-Year Experience from an Academic Emergency Department.

Gupta, Sophie / Lutnik, Martin / Cacioppo, Filippo / Lindmayr, Teresa / Schuetz, Nikola / Tumnitz, Elvis / Friedl, Lena / Boegl, Magdalena / Schnaubelt, Sebastian / Domanovits, Hans / Spiel, Alexander / Toth, Daniel / Varga, Raoul / Raudner, Marcus / Herkner, Harald / Schwameis, Michael / Niederdoeckl, Jan

Diagnostics (Basel, Switzerland)

2024 Volume 14, Issue 7

Abstract: Background: Computed tomography (CT) could be a suitable method for acute exclusion of left atrial appendage thrombus (LAAT) prior to cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) at the emergency department. Our aim was to present ... ...

Abstract	Background: Computed tomography (CT) could be a suitable method for acute exclusion of left atrial appendage thrombus (LAAT) prior to cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) at the emergency department. Our aim was to present our experiences with this modality in recent years. Methods: This registry-based observational study was performed at the Department of Emergency Medicine at the Medical University of Vienna, Austria. We studied all consecutive patients with AF and AFL who underwent CT between January 2012 and January 2023 to rule out LAAT before cardioversion to sinus rhythm was attempted. Follow-ups were conducted by telephone and electronic medical records. The main variables of interest were the rate of LAAT and ischemic stroke at follow-up. Results: A total of 234 patients (143 [61%] men; median age 68 years [IQR 57-76], median CHA Conclusion: LAAT was rare in patients admitted to the ED with AF and AFL who underwent cardiac CT prior to attempted cardioversion. At follow-up, no patient had suffered an ischemic stroke. Prospective studies need to show whether this strategy is suitable for the acute treatment of symptomatic AF in the emergency setting.
Language	English
Publishing date	2024-03-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics14070699
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Article ; Online: The BRASH syndrome: an interaction of bradycardia, renal failure, AV block, shock and hyperkalemia.

Schnaubelt, Sebastian / Roeggla, Martin / Spiel, Alexander O / Schukro, Christoph / Domanovits, Hans

Internal and emergency medicine

2020 Volume 16, Issue 2, Page(s) 509–511

MeSH term(s)	Atrioventricular Block/physiopathology ; Bradycardia/physiopathology ; Humans ; Hyperkalemia/physiopathology ; Renal Insufficiency/physiopathology ; Shock/physiopathology ; Syndrome ; Terminology as Topic
Language	English
Publishing date	2020-07-25
Publishing country	Italy
Document type	Letter
ZDB-ID	2454173-4
ISSN	1970-9366 ; 1828-0447
ISSN (online)	1970-9366
ISSN	1828-0447
DOI	10.1007/s11739-020-02452-7
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Article ; Online: Pulmonary Findings in Hospitalized COVID-19 Patients Assessed by Lung Ultrasonography (LUS) - A Prospective Registry Study.

Barner, Anna / Burian, Egon / Simon, Alexander / Castillo, Katty / Waschulzik, Birgit / Braren, Rickmer / Heemann, Uwe / Osterwalder, Joseph / Spiel, Alexander / Heim, Markus / Stock, Konrad Friedrich

Ultraschall in der Medizin (Stuttgart, Germany : 1980)

2023 Volume 44, Issue 5, Page(s) e248–e256

Abstract: Purpose: This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters.: Materials and ... ...

Title translation	Lungenbefunde bei hospitalisierten COVID-19-Patienten erfasst mittels Lungensonografie (LUS) – Eine prospektive Registerstudie.
Abstract	Purpose: This prospective two-centre study investigated localisation-dependent lesion patterns in COVID-19 with standard lung ultrasonography (LUS) and their relationship with thoracic computed tomography (CT) and clinical parameters. Materials and methods: Between April 2020 and April 2021, 52 SARS-CoV-2-positive patients in two hospitals were examined by means of LUS for "B-lines", fragmented pleura, consolidation and air bronchogram in 12 lung regions and for pleural effusions. A newly developed LUS score based on the number of features present was correlated with clinical parameters (respiration, laboratory parameters) and the CT and analysed with respect to the 30- and 60-day outcome. All patients were offered an outpatient LUS follow-up. Results: The LUS and CT showed a bilateral, partially posteriorly accentuated lesion distribution pattern. 294/323 (91%) of CT-detected lesions were pleural. The LUS score showed an association with respiratory status and C-reactive protein; the correlation with the CT score was weak (Spearman's rho = 0.339, p < 0.001). High LUS scores on admission were also observed in patients who were discharged within 30 days. LUS during follow-up showed predominantly declining LUS scores. Conclusion: The LUS score reflected the clinical condition of the patients. No conclusion could be made on the prognostic value of the LUS, because of the low event rate. The LUS and CT score showed no sufficient correlation. This is probably due to different physical principles, which is why LUS could be of complementary value.
Language	English
Publishing date	2023-01-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	801064-x
ISSN	1438-8782 ; 1439-0914 ; 1431-4894 ; 0172-4614
ISSN (online)	1438-8782
ISSN	1439-0914 ; 1431-4894 ; 0172-4614
DOI	10.1055/a-2013-8045
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Zs.A 1572: Show issues

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Article ; Online: Point-of-Care Ultrasonography in Patients With Acute Dyspnea: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians.

Gartlehner, Gerald / Wagner, Gernot / Affengruber, Lisa / Chapman, Andrea / Dobrescu, Andreea / Klerings, Irma / Kaminski-Hartenthaler, Angela / Spiel, Alexander O

Annals of internal medicine

2021 Volume 174, Issue 7, Page(s) 967–976

Abstract: Background: Dyspnea is a common and often debilitating symptom with a complex diagnostic work-up.: Purpose: To evaluate the benefits, harms, and diagnostic test accuracy of point-of-care ultrasonography (POCUS) in patients with acute dyspnea. ( ... ...

Abstract	Background: Dyspnea is a common and often debilitating symptom with a complex diagnostic work-up. Purpose: To evaluate the benefits, harms, and diagnostic test accuracy of point-of-care ultrasonography (POCUS) in patients with acute dyspnea. (PROSPERO: CRD42019126419). Data sources: Searches of multiple electronic databases without language limitations (January 2004 to August 2020) and reference lists of pertinent articles and reviews. Study selection: Five randomized controlled trials (RCTs) and 44 prospective cohort-type studies in patients with acute dyspnea evaluated POCUS as a diagnostic tool to determine the underlying cause of dyspnea. Two investigators independently screened the literature for inclusion. Data extraction: Data abstraction by a single investigator was confirmed by a second investigator; 2 investigators independently rated risk of bias and determined certainty of evidence. Data synthesis: Point-of-care ultrasonography, when added to a standard diagnostic pathway, led to statistically significantly more correct diagnoses in patients with dyspnea than the standard diagnostic pathway alone. In-hospital mortality and length of hospital stay did not differ significantly between patients who did or did not receive POCUS in addition to standard diagnostic tests. Finally, POCUS consistently improved the sensitivities of standard diagnostic pathways to detect congestive heart failure, pneumonia, pulmonary embolism, pleural effusion, or pneumothorax; specificities increased in most but not all studies. Limitations: Most studies assessed diagnostic test accuracy, which has limited utility for clinical decision making. Studies rarely reported on the proportion of indeterminate sonography results, and no evidence is available on adverse health outcomes of false-positive or false-negative POCUS results. Conclusion: Point-of-care ultrasonography can improve the correctness of diagnosis in patients with acute dyspnea. Primary funding source: American College of Physicians.
MeSH term(s)	Acute Disease ; Critical Pathways ; Dyspnea/diagnostic imaging ; Dyspnea/etiology ; Hospital Mortality ; Humans ; Length of Stay ; Patient Readmission ; Point-of-Care Testing ; Practice Guidelines as Topic ; Sensitivity and Specificity ; Ultrasonography/adverse effects
Language	English
Publishing date	2021-04-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M20-5504
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Article: Association of Interleukin-32 and Interleukin-34 with Cardiovascular Disease and Short-Term Mortality in COVID-19.

Kaufmann, Christoph C / Ahmed, Amro / Muthspiel, Marie / Rostocki, Isabella / Pogran, Edita / Zweiker, David / Burger, Achim Leo / Jäger, Bernhard / Aicher, Gabriele / Spiel, Alexander O / Vafai-Tabrizi, Florian / Gschwantler, Michael / Fasching, Peter / Wojta, Johann / Huber, Kurt

Journal of clinical medicine

2023 Volume 12, Issue 3

Abstract: Background: Excess cardiovascular (CV) morbidity and mortality has been observed in patients with COVID-19. Both interleukin-32 (IL-32) and interleukin-34 (IL-34) have been hypothesized to contribute to CV involvement in COVID-19.: Methods: This ... ...

Abstract	Background: Excess cardiovascular (CV) morbidity and mortality has been observed in patients with COVID-19. Both interleukin-32 (IL-32) and interleukin-34 (IL-34) have been hypothesized to contribute to CV involvement in COVID-19. Methods: This prospective, observational study of patients with laboratory-confirmed COVID-19 infection was conducted from 6 June to 22 December 2020 in a tertiary care hospital in Vienna, Austria. IL-32 and IL-34 levels on admission were collected and tested for their association with CV disease and short-term mortality in patients with COVID-19. CV disease was defined by the presence of coronary artery disease, heart failure, stroke or atrial fibrillation and patients were stratified by CV disease burden. Results: A total of 245 eligible patients with COVID-19 were included, of whom 37 (15.1%) reached the primary endpoint of 28-day mortality. Of the total sample, 161 had no CV disease (65.7%), 69 had one or two CV diseases (28.2%) and 15 patients had ≥three CV diseases (6.1%). Median levels of IL-32 and IL-34 at admission were comparable across the three groups of CV disease burden. IL-32 and IL-34 failed to predict mortality upon both univariable and multivariable Cox regression analysis. The two CV disease groups, however, had a significantly higher risk of mortality within 28 days (one or two CV diseases: crude HR 4.085 (95% CI, 1.913-8.725), Conclusion: In our study population of hospitalized patients with COVID-19, IL-32 and IL-34 did not show any associations with CV disease or 28-day mortality in the context of COVID-19. Patients with multiple CV diseases, however, had a significantly increased risk of short-term mortality.
Language	English
Publishing date	2023-01-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12030975
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Article ; Online: Association of Intravenous Potassium and Magnesium Administration With Spontaneous Conversion of Atrial Fibrillation and Atrial Flutter in the Emergency Department.

Cacioppo, Filippo / Reisenbauer, Denise / Herkner, Harald / Oppenauer, Julia / Schuetz, Nikola / Niederdoeckl, Jan / Schnaubelt, Sebastian / Gupta, Sophie / Lutnik, Martin / Simon, Alexander / Spiel, Alexander O / Buchtele, Nina / Domanovits, Hans / Laggner, Anton N / Schwameis, Michael

JAMA network open

2022 Volume 5, Issue 10, Page(s) e2237234

Abstract: Importance: Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is ... ...

Abstract	Importance: Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown. Objective: To assess potassium and magnesium administration and SCV probability in AF and AFL in the emergency department. Design, setting, and participants: A registry-based cohort study was conducted in the Department of Emergency Medicine of the Medical University of Vienna, Austria. All consecutive patients with AF or AFL were screened between February 6, 2009, and February 16, 2020. Interventions: Intravenous administration of potassium, 24 mEq, and magnesium, 145.8 mg. Main outcomes and measures: The primary outcome was the probability of SCV during the patient's stay in the emergency department. Multivariable cluster-adjusted logistic regression was used to estimate the association between potassium and magnesium administration and the probability of SCV. Results: A total of 2546 episodes of nonpermanent AF (median patient age, 68 [IQR, 58-75] years, 1411 [55.4%] men) and 573 episodes of nonpermanent AFL (median patient age, 68 [IQR, 58-75] years; 332 [57.9%] men) were observed. In AF episodes, intravenous potassium and magnesium administration vs no administration was associated with increased odds of SCV (19.2% vs 10.4%; odds ratio [OR], 1.98; 95% CI, 1.53-2.57). In AFL episodes, in contrast, no association was noted for the probability of SCV with potassium and magnesium vs no administration (13.0% vs 12.5%; OR, 1.05; 95% CI, 0.65-1.69). Conclusions and relevance: The findings of this registry-based cohort study on intravenous administration of potassium and magnesium suggest an increased probability of SCV in nonpermanent AF, but not AFL, during a patients' stay in the emergency department.
MeSH term(s)	Male ; Humans ; Aged ; Female ; Atrial Flutter/drug therapy ; Atrial Flutter/epidemiology ; Atrial Flutter/complications ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/complications ; Magnesium ; Cohort Studies ; Treatment Outcome ; Emergency Service, Hospital ; Potassium
Chemical Substances	Magnesium (I38ZP9992A) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.37234
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Article ; Online: Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study.

Cacioppo, Filippo / Schwameis, Michael / Schuetz, Nikola / Oppenauer, Julia / Schnaubelt, Sebastian / Simon, Alexander / Lutnik, Martin / Gupta, Sophie / Roth, Dominik / Herkner, Harald / Spiel, Alexander Oskar / Laggner, Anton Norbert / Domanovits, Hans / Niederdoeckl, Jan

International journal of environmental research and public health

2022 Volume 19, Issue 11

Abstract: Patients with recurrence of atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter constitute a rapidly growing cohort, but study-driven treatment recommendations are lacking. The present study aimed to compare the ... ...

Abstract	Patients with recurrence of atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter constitute a rapidly growing cohort, but study-driven treatment recommendations are lacking. The present study aimed to compare the cardioversion success of ibutilide and amiodarone in patients with post-ablation atrial tachyarrhythmia. We included all episodes of post-ablation atrial tachyarrhythmia in patients treated with either intravenous ibutilide or amiodarone at an academic emergency department from 2010 to 2018. The primary endpoint was the conversion to sinus rhythm. The conversion rates were stratified by arrhythmia type, and multivariable cluster-adjusted logistic regression was used to estimate the effect of ibutilide and amiodarone on cardioversion success, given as the odds ratio (OR) with 95% confidence intervals (95% CI). In total, 109 episodes of 72 patients were analyzed. The conversion rates were 37/49 (76%) for ibutilide and 16/60 (27%) for amiodarone. Compared to amiodarone, ibutilide was associated with higher odds of conversion (multivariable cluster-adjusted OR 5.6, 95% CI 1.3-24.3). The cardioversion success of ibutilide was the highest in atrial flutter (crude OR 19.5, 95% CI 3.4-112.5) and focal atrial tachycardia (crude OR 8.3, 95% CI 1.5-47.2), but it was less pronounced in atrial fibrillation (crude OR 4.5, 95% CI 1.2-17.2). Randomized trials are warranted to confirm our findings.
MeSH term(s)	Amiodarone/therapeutic use ; Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Flutter/drug therapy ; Cohort Studies ; Electric Countershock ; Humans ; Registries ; Sulfonamides ; Tachycardia/drug therapy ; Treatment Outcome
Chemical Substances	Anti-Arrhythmia Agents ; Sulfonamides ; ibutilide (2436VX1U9B) ; Amiodarone (N3RQ532IUT)
Language	English
Publishing date	2022-05-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19116606
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