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Previous leadless pacemaker systems were confined to the right ventricle, thus limiting the clinical applications. With the introduction of the first leadless atrial cardiac pacemaker, new perspectives in antibradycardia treatment were introduced. This device enables leadless atrial stimulation and electrical atrial sensing with the potential to reduce complications of cardiac pacemaker treatment. The atrial leadless atrial pacemaker is implanted transvenously with a delivery catheter via the femoral vein into the base of the right atrial appendage. In combination with a ventricular leadless pacemaker, a complete dual chamber pacemaker system can be created through galvanically coupled intracorporeal communication. This can be created as an upgrade from an already implanted ventricular or atrial leadless cardiac pacemaker or the system can be implanted directly (de novo). The possibility of an upgrade enables a flexible treatment adapted to the individual progression of the underlying disease. Current limitations for wider clinical use include economic considerations, limited battery capacity and insufficient data concerning retrievability after the battery is exhausted.

Background: Studies assessing transcatheter edge-to-edge mitral valve repair (M-TEER) suggest lower rates of in-hospital mortality (IHM) at high-volume hospitals, and guidelines recommend minimum caseloads to assure quality standards.

Methods: Data from all patients undergoing M‑TEER procedures at 154 hospitals in the German mandatory quality assurance registry in 2020 were analyzed. The observed IHM was adjusted against the expected mortality predicted by the German MKL-KATH score (O/E) and EuroScore II (O/E2). Regression analyses and volume quartile analyses were performed on hospital volume (HV), IHM rate, O/E, and intra-hospital complications. Additionally, binomial analysis was performed to verify results.

Results: A total of 5099 patients (age 77.9 ± 2.5 years, mean EuroScore II 17.9 ± 5.9%) underwent M‑TEER procedures during the study period. The mean observed IHM was 1.79 ± 3.4%. Neither unadjusted nor risk-adjusted IHM was related to HV in linear regression (adjusted p = 0.56) or logistic regression (p = 0.515) analyses. The IHM rates for the first and fourth quartiles were nearly identical (p = 0.842). Any selected volume cut-off could not differentiate between hospitals with unacceptable (> 95th percentile O/E of all hospitals), acceptable (O/E ≤ 95th percentile), or better-than-average quality (O/E < 1). A caseload cut-off of 30cases per year would exclude 83 hospitals with acceptable or 72 with better-than-risk-adjusted quality (54% and 47% of all hospitals, respectively).

Conclusion: Hospital volume is an imprecise surrogate for assessing the quality of hospitals performing M‑TEER. The association between HV and IHM in patients undergoing elective M‑TEER in Germany was weak and not consistent across various analytical approaches. Other instruments may be more suitable for identifying hospitals with critical performance levels.

Background: This study focused on exploring the correlation between the electrical and mechanical dyssynchrony of the right ventricle (RV) in patients with pre-capillary pulmonary hypertension (PcPH). It also aimed to compare the predictive capabilities of these dyssynchronies for risk stratification.

Methods: From April 2017 to March 2018, PcPH patients at Fuwai Hospital were consecutively enrolled. They were divided into low-risk and non-low-risk groups according to the 2015 European Society of Cardiology Guidelines. Off-line software (GE EchoPAC version 201) was used to measure RV mechanical dyssynchrony (standard deviation of the time from QRS onset to peak strain for the six RV segments [RV-SD6]), while QRS duration representing electrical dyssynchrony was measured manually.

Results: In total, 66 PcPH patients (average 35 years, 19 males and 47 females) were enrolled, 37 in the low-risk group and 29 in the non-low-risk group. QRS duration was significantly correlated with RV-SD6 (r = 0.25, p = 0.047). Both RV-SD6 and QRS duration were significantly correlated with N‑terminal pro-brain natriuretic peptide levels (r = 0.44, p < 0.001 vs. r = 0.26, p = 0.039). Furthermore, RV-SD6 (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.64-0.87, p < 0.001) and QRS duration (AUC: 0.65, 95% CI: 0.52-0.78, p = 0.036) had the potential to predict non-low-risk stratification. Multivariate logistic regression analyses identified RV-SD6 (odds ratio [OR]: 1.02, 95% CI: 1.01-1.03, p = 0.009) and QRS duration (OR: 1.07, 95% CI: 1.00-1.15, p = 0.045) as independent predictors of non-low-risk PcPH.

Conclusion: Mechanical dyssynchrony presented by RV-SD6 correlates with QRS duration and better predicts risk stratification in PcPH patients without complete bundle branch block.

The management of coronary artery disease (CAD) has become more demanding due to evolving therapeutic options and more complex patient profiles. In this context, the heart team has become established: a structured, interdisciplinary decision-making process that brings together the specialist knowledge from cardiology, cardiac surgery, anesthesia and other specialist fields to enable individual and evidence-based treatment recommendations. While this model is well-established in university medical centers, its implementation in nonuniversity hospitals lacking in-house cardiac surgery presents unique challenges. This article explores practical strategies for successfully establishing heart teams in such institutions, including the formation of a stable organized core team for case coordination, formal cooperation with external cardiac surgery centers (often via telemedicine), integration of experienced cardiac anesthesiologists and the establishment of clear internal processes for communication and documentation. Particular attention is given to the technical infrastructure required to support hybrid or virtual conferencing formats.

Treatment options for mitral regurgitation (MR) have markedly evolved over the past few decades, with mitral valve transcatheter edge-to-edge repair (M-TEER) expanding the clinical armamentarium of guideline-directed medical therapy and surgical techniques. However, the variety of mitral valve anatomies, the presence of heart failure (HF), and consideration of the individual patient risk require a multidisciplinary Heart Team approach to identify the optimal treatment for MR for each patient. Despite the growing field of transcatheter mitral interventions and the longstanding availability of surgical mitral valve repair and replacement, evidence from randomized clinical trials comparing intervention with surgery remains scarce. In the meantime, the increasing safety and experience of surgical and interventional procedures have shifted the perspective on mitral valve disease in terms of when and how to treat it. Therefore, the multidisciplinary Heart Team discussion has become of paramount importance in the evaluation and treatment decisions for patients with mitral valve disease.

In recent years the treatment for heart failure (HF) has become much more complex. This development has highlighted the importance of a multidisciplinary HF team to ensure the best possible individually adapted treatment decisions, taking the patient's personal wishes into account and to achieve optimal results. In Germany, specialized HF practices, clinics and tertiary bespoke HF unit centers were established to ensure qualified care for HF patients. These institutions fulfil defined standards and quality features for outpatient and inpatient treatment and cooperate closely in the framework of HF networks. The interdisciplinary HF team should be involved in the treatment from the initial step of correct diagnosis through availability for changes of the clinical status up to HF-related hospitalization due to acute or advanced HF. The core team encompasses cardiologists, skilled HF nursing personnel, cardiac surgeons and coordinators for heart transplantation and ventricular assist devices and is complimented by other specialists depending on the patient's specific etiology and severity of HF as well as relevant comorbidities. The quality of treatment is also enhanced by personal HF additional qualifications. One of the most essential goals of this multidisciplinary collaboration is patient-centered team-based recommendations and decision making, which aim to improve the prognosis of patients, reduce hospitalization rates and improve the quality of life.

The treatment of heart failure with preserved ejection fraction (HFpEF) involves symptomatic management of congestion with diuretics (class I recommendation) and treatment with sodium-glucose linked transporter 2 (SGLT2) inhibitors for improvement of the prognosis, which have a class I recommendation across the entire spectrum of left ventricular ejection fraction (LVEF) in the current guidelines. The data supporting the recommendation of SGLT2 inhibitors in HFpEF come from the EMPEROR-Preserved and DELIVER studies. The FINEARTS-HF study showed positive effects on cardiovascular death/heart failure hospitalization of the treatment of HFpEF patients with finerenone, a nonsteroidal mineralocorticoid receptor antagonist. The STEP-HFpEF (2023) and SUMMIT (2024) studies investigated the treatment with glucagon-like peptide 1 (GLP-1) analogs in patients with HFpEF and obesity and showed positive outcomes regarding quality of life and, in the latter study, positive effects on heart failure events. The treatment of severe mitral and tricuspid valve regurgitation impacts not only the symptom burden but also hospitalization and overall prognosis in HFpEF patients.