Herzschrittmachertherapie und Elektrophysiologie最新文献

Background: Conducted energy weapons (CEW, TASER) are increasingly used by law enforcement agencies in Germany. The CEWs are intended to reduce violence against police officers and to reduce moderate to severe injuries of police officers and aggressors. The delivery of repetitive electrical impulses causes neuromuscular paralysis and incapacitation; however, there are safety concerns due to deaths related to CEWs.

Objective: The aim of this article is to provide an overview of the medical risks associated with the use of CEWs.

Methods: A literature search was carried out using relevant databases.

Results: The CEWs offer a good overall safety profile but in rare cases can have serious or life-threatening health risks. These include injuries to vulnerable body regions and falls. Myocardial capture and malignant arrhythmia can be triggered in animal experiments. The cause of death following the use of a conducted energy device (CED) can often not be clearly attributed due to competing causes; however, in studies with volunteers arrhythmia has not been observed so far. Overall, the risk of life-threatening cardiac arrhythmia in humans appears to be low, although still present. Particularly vulnerable risk groups include children, people with a history of mental illness or with intoxication, pregnant women and cardiac device wearers.

Conclusion: Even though in principle CEWs can trigger malignant arrhythmia, the risk is low and the causality of death after CEW deployment often remains unclear. In the medical care of patients after CEW use, comorbidities such as intoxication or mental illness must be considered.

The new 2024 ESC guidelines on the management of patients with atrial fibrillation (AF) introduces the AF-CARE pathway as the central acronym for AF management. As a result, the management of Comorbidities and risk factors is moving to the forefront of AF management. However, the new guideline also includes important changes in Avoidance stroke and thromboembolism, such as a modified risk score (CHA₂DS₂-VA) and a statement on anticoagulation in subclinical atrial fibrillation. There are also changes in the concepts of Rhythm and rate control with an upgrading of rhythm control and catheter ablation. Finally, the guideline recommends regular Evaluation and reassessment of the patient's course for optimal AF management. Here, we summarize key points of the new guidelines and discusses some recommendations on aspects that can also be assessed differently.

Cardiac resynchronisation therapy (CRT) is an effective method for increasing quality of life and life expectancy for many patients with heart failure. Due to the good results, this procedure is used frequently in Germany and has established itself as a class I indication in heart failure therapy. In addition to His bundle pacing, left bundle branch pacing has now also made a name for itself, as it shows a good success rate and can be used in a wider range of patients. Now the question arises as to whether left bundle branch pacing is superior to classic biventricular pacing and what the evidence situation is in this respect. This question shall be discussed in this article considering current studies and guideline recommendations.

During the ablation of ventricular arrhythmias (VA) complications can occur, albeit rather rarely, and their occurrence depends on various factors. On the one hand the patient's condition and comorbidities play a role, on the other hand the access site and the procedure itself can lead to complications which have to be addressed adequately. This article will discuss whether complex ablations with epicardial access should only be performed at centres with the appropriate expertise and a cardiac surgery department.

In patients with congenital heart disease, cardiac arrhythmias are complex and require a thorough understanding of the anatomy, past surgical and interventional procedures, and the specific electric processes. Supraventricular tachycardias commonly present as emergency situations and should be treated immediately, particularly when there is an underlying complex malformation. Establishing sinus rhythm is usually superior to pure frequency control for hemodynamic reasons. Catheter ablation should be preferred over medical treatment, even though several procedures are often necessary. In addition, bradycardia is seen more frequently in congenital heart defects; this could be aggravated by antiarrhythmic drugs. There are significant differences between the indications and techniques used for pacemaker implantation in patients with congenital heart defects and those without. Patients with complex congenital heart diseases have an increased risk of thromboembolism; therefore, an individual and early indication for low-threshold oral anticoagulation is necessary; direct oral anticoagulants can also be used for this purpose. In risk stratification for sudden cardiac death, the principles of general guidelines are often not applicable, and individualized decisions are required. Recently, a new general risk score for congenital heart disease has been developed. The treatment of cardiac arrhythmias in patients with congenital heart disease should always be performed in close cooperation with specialized centers.

Holter monitoring represents a valuable diagnostic tool to document intermittent arrhythmias in the work-up of, for example, syncope, presyncope, collapse, falls, dizziness, stroke, palpitations, and a rapid heartbeat. In addition, it may help in the diagnosis of intermittent ischemia and channelopathies, particularly in the form of 12-lead Holter monitoring. Continuous ECG registration typically lasts from 24-48 h. The use of Holter monitoring is limited in patients with rare symptoms (< 1 × per month) and in recordings full of artifacts. The interpretation of a Holter recording combines an automatic analysis with a manual reassessment. The clinical relevance of many arrhythmias can only be considered together with symptoms and activity of the patient at the time of the event. Therefore, a patient diary accompanying the ECG recording is crucial. Systematic assessment of the ECG recording and knowledge about a number of pitfalls in Holter monitoring can optimize the interpretation of the recording.

Patients with chronic kidney disease face a high risk of sudden cardiac death, particularly in more advanced stages of renal dysfunction. Ventricular arrhythmias are prevalent and contribute to the heightened cardiovascular mortality. This review aims to explore the intricate interplay of disease-specific risk factors, arrhythmic triggers, and electrolyte disorders that amplify susceptibility to ventricular arrhythmias and sudden cardiac death in this population and influence the efficacy of available treatments.

Cardiac amyloidosis is an infiltrative cardiomyopathy characterized by the extracellular deposition of amyloid fibrils within the myocardium. Beyond heart failure, patients with cardiac amyloidosis commonly present with arrhythmias and conduction system disorders. Atrial fibrillation is observed in up to 80% of patients at the time of diagnosis, with patients typically maintaining normal heart rates due to concurrent atrioventricular nodal disease. The thromboembolic risk is particularly high in patients with cardiac amyloidosis, and left atrial thrombi have been observed even in the absence of atrial fibrillation. Conduction system diseases are also highly prevalent, often necessitating permanent pacemaker implantation. The use of implantable defibrillators in this population remains controversial. This overview of published data and therapeutic strategies related to arrhythmias and conduction system disorders aims to assist readers in decision-making in complex clinical scenarios.