Herzschrittmachertherapie und Elektrophysiologie最新文献

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.

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.

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.

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.

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.

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.

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.