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[Asymptomatic atrial fibrillation : Screening and therapy]. 无症状心房颤动:筛查和治疗。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00933-8
Melanie Gunawardene, Jens Hartmann, Stephan Willems

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide and poses a significant burden to the health care system. AF screening of the general population or of a specific higher-risk population could not only lead to earlier detection of AF but also to a prompt initiation of an adequate therapy to prevent complications such as stroke or death and consecutively to a potential reduction of health care costs, especially in asymptomatic AF patients. To conduct screening programs, accessible new technology devices such as "wearables", smartwatches, and implantable event recorders provide an innovative solution. However, as data regarding screening are inconclusive, routine AF screening of the population is currently not recommended by the European Society of Cardiology. Recently published studies have indicated that anticoagulation and early rhythm control of asymptomatic AF could avoid occurrence of clinical endpoints. This article reports on the scientific results of the current literature as well as gaps of evidence and discusses possible treatment options of asymptomatic AF.

心房颤动(AF)是影响全世界数百万人的最常见的心律失常,对卫生保健系统造成了重大负担。对普通人群或特定高危人群进行房颤筛查,不仅可以早期发现房颤,还可以及时开始适当的治疗,以防止中风或死亡等并发症,并可能降低医疗保健费用,特别是对无症状房颤患者。为了开展筛查项目,可穿戴设备、智能手表和植入式事件记录仪等无障碍新技术设备提供了一种创新的解决方案。然而,由于关于筛查的数据尚无定论,欧洲心脏病学会目前不建议对人群进行常规房颤筛查。最近发表的研究表明,对无症状房颤进行抗凝和早期心律控制可以避免临床终点的发生。本文报道了目前文献的科学结果以及证据的差距,并讨论了无症状房颤的可能治疗方案。
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引用次数: 0
[How to manage asymptomatic arrhythmias in the digital era]. 【数字时代无症状心律失常如何处理】。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00942-7
Sonia Busch, Harilaos Bogossian
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引用次数: 0
[Sudden cardiac death after cardioversion]. [心脏复律后的心脏性猝死]。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00935-6
Felix Bertram, Jochen Buchholz

An 83-year-old woman with heart failure due to atrial tachycardia with reduced left ventricular ejection fraction died after cardioversion. Holter monitoring showed a massive prolongation of the QT interval resulting in torsade de pointe tachycardia with lethal outcome. The only reason of the QT prolongation was impaired left ventricular (LV) function and atrial ectopy.

一名83岁妇女因心房心动过速和左心室射血分数降低而心力衰竭,在心脏复律后死亡。动态心电图监测显示QT间期大幅延长,导致点扭转性心动过速,结果致命。QT延长的唯一原因是左室功能受损和心房异位。
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引用次数: 0
["Asymptomatic WPW" : Is treatment necessary?] “无症状WPW”:需要治疗吗?]
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00930-x
Gabriele Hessling, Marta Telishevska, Sarah Lengauer, Isabel Deisenhofer

The term "asymptomatic WPW" (Wolff-Parkinson-White) is often used as a synonym for ventricular pre-excitation of the WPW type due to an accessory pathway characterized by a short PR interval and a delta wave on the electrocardiogram (ECG) without the clinical occurrence of paroxysmal tachycardia. Asymptomatic WPW is often diagnosed in young and otherwise healthy people. There is a small associated risk of sudden cardiac death due to rapid antegrade conduction over the accessory pathway during atrial fibrillation. This paper highlights aspects of noninvasive and invasive risk stratification, therapy by catheter ablation, and the ongoing risk-benefit discussion in asymptomatic WPW.

“无症状性WPW”(Wolff-Parkinson-White)常被用作WPW型心室预兴奋的同义词,因为其附属通路以短PR间期和心电图上的δ波为特征,而临床未发生阵发性心动过速。无症状WPW通常在年轻人和其他健康人群中被诊断出来。在房颤期间,由于副通路上的快速顺行传导,心源性猝死的相关风险很小。本文重点介绍无创和有创风险分层、导管消融治疗以及无症状WPW的持续风险-收益讨论。
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引用次数: 0
[Initiation and maintenance of atrial fibrillation]. [心房颤动的发生和维持]。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00939-2
Harilaos Bogossian, Sebastian Robl, Nana-Yaw Bimpong-Buta, Konstantinos Iliodromitis
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引用次数: 0
[Pacemaker infection in fragile patients]. [脆弱患者的起搏器感染]。
Q4 Medicine Pub Date : 2023-06-01 Epub Date: 2023-04-28 DOI: 10.1007/s00399-023-00940-9
Ernesto Casorelli, Ilaria Pescatori, Gaetano Ruocco, Hendrik Bonnemeier, Ojan Assadian, Franco Bui

Complications associated with cardiac implantable electric devices (CIED) are manifold. They include lead dislocation, twiddler's syndrome, device malfunction, haematoma formation and infection. Infections can be divided into acute, subacute and late infections. Both the time of onset and the route of infection play a crucial role. The consequences of a CIED infection are devastating. The most modern treatment methods include the removal of all implanted implants. If complete removal is not followed in the event of infection, there is a high rate of infection recurrence. Open thoracic surgery to remove infected CIED hardware has been replaced by percutaneous lead extraction procedures. Lead extraction requires specialised equipment and expertise and may not be readily available or feasible for some patients. Each extraction procedure is associated with a small risk of potentially fatal complications (e.g. cardiac avulsion, vascular avulsion, haemothorax and cardiac tamponade). For these reasons, the performance of such procedures should be limited to centres with adequate equipment and experience. Successful salvage of CIED systems with in situ sterilisation of contaminated hardware has been reported. In our case, we report the successful salvage of an exposed generator in a frail patient treated more than 5 years after the last generator replacement.

与心脏植入式电子设备(CIED)相关的并发症是多方面的。其中包括导联脱位、扭转综合征、装置故障、血肿形成和感染。感染可分为急性感染、亚急性感染和晚期感染。发病时间和感染途径都起着至关重要的作用。CIED 感染的后果是毁灭性的。最先进的治疗方法包括移除所有植入物。如果发生感染时不彻底清除,感染复发率很高。移除受感染 CIED 硬件的开胸手术已被经皮引线取出术所取代。引线拔除术需要专业设备和专业知识,对于某些患者来说可能无法随时使用或不可行。每种引线拔除术都存在潜在致命并发症的小风险(如心脏撕脱、血管撕脱、血胸和心脏填塞)。因此,此类手术应仅限于在拥有足够设备和经验的中心进行。有报道称,通过对受污染的硬件进行原位消毒,成功挽救了 CIED 系统。在我们的病例中,我们报告了成功抢救一名暴露在外的发生器的案例,该患者体弱多病,在上一次更换发生器超过 5 年后才接受治疗。
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引用次数: 0
Mitteilungen aus der Arbeitsgruppe Elektrophysiologie und Rhythmologie (AGEP). 电子物理学及物理学特别工作组的来信(《新粒子》)。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00946-3
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引用次数: 0
[Asymptomatic channelopathies : Risk stratification and primary prophylaxis]. [无症状渠道病:风险分层和初级预防]。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00937-4
Assem Aweimer, Andreas Mügge, Ibrahim Akin, Ibrahim El-Battrawy

In general, asymptomatic patients with channelopathies are at increased risk of sudden cardiac death (SCD), due to pathogenic variants in genes encoding ion channels that result in pathological ion currents. Channelopathies include long-QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and short-QT syndrome (SQTS). In addition to the patient's clinical presentation, history and clinical tests, the main diagnostic tools are electrocardiography and genetic testing to identify known gene mutations. Early and correct diagnosis as well as further risk stratification of affected individuals and their relatives are paramount for prognosis. The recent availability of risk score calculators for LQTS and BrS allows SCD risk to be accurately estimated. The extent to which these improve patient selection for treatment with an implantable cardioverter-defibrillator (ICD) system is currently unknown. In most cases, initiation of basic therapy in asymptomatic patients in the form of avoidance of triggers, which are usually medication or stressful situations, is sufficient and contributes to risk reduction. In addition, there are other risk-reducing prophylactic measures, such as permanent medication with nonselective β‑ blockers (for LQTS and CPVT) or mexiletine for LQTS3. Patients and their family members should be referred to specialized outpatient clinics for individual risk stratification in the sense of primary prophylaxis.

一般来说,无症状的通道病患者心源性猝死(SCD)的风险增加,这是由于编码离子通道的基因的致病性变异导致病理性离子电流。通道病变包括长qt综合征(LQTS)、Brugada综合征(BrS)、儿茶酚胺能多形性室性心动过速(CPVT)和短qt综合征(SQTS)。除了患者的临床表现、病史和临床检查外,主要的诊断工具是心电图和基因检测,以确定已知的基因突变。早期和正确的诊断以及进一步的患病个体及其亲属的风险分层对预后至关重要。最近可用的LQTS和BrS风险评分计算器可以准确估计SCD风险。目前尚不清楚这些技术在多大程度上改善了患者对植入式心律转复除颤器(ICD)系统治疗的选择。在大多数情况下,以避免触发因素(通常是药物或压力情况)的形式对无症状患者开始基本治疗就足够了,并有助于降低风险。此外,还有其他降低风险的预防措施,如长期使用非选择性β受体阻滞剂(用于LQTS和CPVT)或美西汀用于LQTS3。患者及其家属应转诊到专科门诊进行初级预防意义上的个体风险分层。
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引用次数: 0
Pleiotropic effects of NOACs with focus on edoxaban: scientific findings and potential clinical implications. 以依多沙班为重点的NOACs的多效效应:科学发现和潜在的临床意义。
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00944-5
Andreas Goette, Martin Mollenhauer, Volker Rudolph, Mathias Lamparter, Martin Meier, Michael Böhm

Non-vitamin K antagonist oral anticoagulants (NOACs) are well-established as inhibitors of factor Xa (FXa) and thrombin in the treatment and prevention of thrombosis. However, there is growing evidence that beneficial outcomes might be based on additional pleiotropic effects beyond anticoagulation. FXa and thrombin are also known to activate protease-activated receptors (PARs), which can mediate pro-inflammatory and pro-fibrotic effects. Since PAR‑1 and PAR‑2 play an important role in the development of atherosclerosis, the inhibition of this pathway represents an interesting potential target for preventing the progression of atherosclerosis and fibrosis. This review focuses on potential pleiotropic effects of FXa inhibition with edoxaban seen in a variety of studies in different in vitro and in vivo test systems. As common findings from these experiments, edoxaban was able to attenuate FXa- and thrombin-induced pro-inflammatory and pro-fibrotic effects and decrease pro-inflammatory cytokine expression. In some, but not all experiments edoxaban was also shown to decrease the levels of PAR‑1 and PAR‑2 expression. Further studies are required to clarify the clinical implications of the pleiotropic effects mediated by NOACs.

非维生素K拮抗剂口服抗凝剂(NOACs)作为Xa因子(FXa)和凝血酶的抑制剂,在治疗和预防血栓形成中得到了广泛的应用。然而,越来越多的证据表明,有益的结果可能是基于抗凝之外的其他多效性作用。已知FXa和凝血酶也能激活蛋白酶激活受体(PARs),从而介导促炎和促纤维化作用。由于PAR - 1和PAR - 2在动脉粥样硬化的发展中起重要作用,抑制这一途径代表了预防动脉粥样硬化和纤维化进展的一个有趣的潜在靶点。这篇综述的重点是在不同的体外和体内试验系统的各种研究中发现的伊多沙班抑制FXa的潜在多效效应。正如这些实验的共同发现,依多沙班能够减弱FXa和凝血酶诱导的促炎和促纤维化作用,并降低促炎细胞因子的表达。在一些(但不是全部)实验中,伊多沙班也显示出PAR‑1和PAR‑2表达水平的降低。需要进一步的研究来阐明NOACs介导的多效效应的临床意义。
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引用次数: 0
Circulating magnesium as a potential risk stratification tool for sudden cardiac death: a systematic review. 循环镁作为心源性猝死的潜在风险分层工具:一项系统综述
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s00399-023-00941-8
Edward Davis, Bernard C Fernando, Louis Fabio Jonathan Jusni, Kevin R Hendryan, Rexel Kuatama, Denio A Ridjab

Background: Sudden cardiac death (SCD) is one of the main causes of cardiovascular mortality and accounts for 15-20% of deaths worldwide. The current stratification strategy using depressed left ventricular ejection fraction is insufficient to stratify the risk of SCD, especially in the general population. In recent years, there has been increasing evidence showing the antiarrhythmic properties of magnesium. In this systematic review, the authors aim to determine circulating magnesium as a potential risk stratification tool for SCD.

Methods: This systematic review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was conducted in July 2021 with sources from Google Scholar, PubMed, Science Direct, EBSCO Medline, and ProQuest.

Results: A total of six studies were included in this review. Three studies conducted in the general population consistently showed lower risk of SCD in populations with high circulating magnesium. There was no association between circulating magnesium level and risk of SCD in intensive cardiac care unit (ICCU) patients, whilst the results were conflicting in congestive heart failure (CHF) patients.

Conclusion: High circulating magnesium might have the potential to be utilized as a risk stratification tool for SCD, especially in the general population. However, further study is needed to support this evidence.

背景:心源性猝死(SCD)是心血管死亡的主要原因之一,占全世界死亡人数的15-20%。目前使用降低左室射血分数的分层策略不足以对SCD的风险进行分层,特别是在普通人群中。近年来,越来越多的证据表明镁具有抗心律失常的特性。在这篇系统综述中,作者旨在确定循环镁作为SCD的潜在风险分层工具。方法:本系统评价基于系统评价和荟萃分析的首选报告项目(PRISMA),于2021年7月进行,来源包括Google Scholar、PubMed、Science Direct、EBSCO Medline和ProQuest。结果:本综述共纳入6项研究。在普通人群中进行的三项研究一致表明,高循环镁人群患SCD的风险较低。在心脏重症监护病房(ICCU)患者中,循环镁水平与SCD风险之间没有关联,而在充血性心力衰竭(CHF)患者中,结果则相互矛盾。结论:高循环镁可能有潜力作为SCD的风险分层工具,特别是在普通人群中。然而,需要进一步的研究来支持这一证据。
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引用次数: 0
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Herzschrittmachertherapie und Elektrophysiologie
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