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Ventricular arrhythmias in the context of chronic kidney disease and electrolyte imbalance. 慢性肾病和电解质失衡导致的室性心律失常。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1007/s00399-024-01029-7
Ines Masmoudi, Zouhir Dindane, Sergio Richter, Micaela Ebert

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.

慢性肾病患者面临心脏性猝死的高风险,尤其是在肾功能不全的晚期。室性心律失常很普遍,是导致心血管死亡率升高的原因之一。本综述旨在探讨疾病特异性风险因素、心律失常诱因和电解质紊乱之间错综复杂的相互作用,这些因素增加了这一人群对室性心律失常和心脏性猝死的易感性,并影响了现有治疗方法的疗效。
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引用次数: 0
Missing markers and electrogram deflections in a recording from a CRT-D device: what is the mechanism? CRT-D 设备记录中的标记缺失和电图偏转:其机制是什么?
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-07-11 DOI: 10.1007/s00399-024-01025-x
S Serge Barold, Andreas Kucher
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引用次数: 0
[Arrhythmias and amyloidosis]. [心律失常与淀粉样变性]。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-13 DOI: 10.1007/s00399-024-01016-y
Maria Papathanasiou, Lara S Schlender, Victoria Louise Johnson, Reza Wakili

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.

心脏淀粉样变性是一种浸润性心肌病,其特点是淀粉样纤维在心肌细胞外沉积。除心力衰竭外,心脏淀粉样变性患者还常伴有心律失常和传导系统紊乱。高达 80% 的患者在确诊时会出现心房颤动,由于并发房室结疾病,患者通常保持正常心率。心脏淀粉样变性患者的血栓栓塞风险尤其高,即使没有心房颤动,也能观察到左心房血栓。传导系统疾病也很常见,通常需要植入永久起搏器。在这类人群中使用植入式除颤器仍存在争议。本文概述了与心律失常和传导系统疾病相关的已发表数据和治疗策略,旨在帮助读者在复杂的临床情况下做出决策。
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引用次数: 0
[Arrhythmias in sarcoidosis]. [肉样瘤病中的心律失常]。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.1007/s00399-024-01032-y
Borislav Dinov, Nikolaos Tsianakas, Laura Ueberham

Cardiac sarcoidosis (CS) is difficult to diagnose and often requires a careful evaluation of numerous diagnostic findings. Typical features at initial presentation are a high-grade atrioventricular (AV) block and ventricular tachycardias that cannot be explained by other common entities, especially in younger patients. CS is frequently misdiagnosed and inappropriately treated, which may have deleterious consequences for the patients. In this review article, we focus on special features of the arrhythmias typical of sarcoidosis and also discuss the underlying substrate and the approach in special situations. Furthermore, we provide recommendations from our daily clinical experience, discuss open questions, and explain the need for research.

心脏肉样瘤病(CS)很难诊断,通常需要对许多诊断结果进行仔细评估。初次发病时的典型特征是房室传导阻滞和室性心动过速,其他常见疾病无法解释,尤其是年轻患者。CS 经常被误诊和治疗不当,这可能会给患者带来不良后果。在这篇综述文章中,我们重点讨论了肉样瘤病典型心律失常的特殊特征,还讨论了潜在的基质和特殊情况下的处理方法。此外,我们还将根据日常临床经验提出建议,讨论未决问题,并说明研究的必要性。
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引用次数: 0
[Practical guidance for the implantation of non-transvenous ICD systems]. [非经脉 ICD 系统植入实用指南]。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-21 DOI: 10.1007/s00399-024-01042-w
David Duncker, Karolin Albert, Andreas Rillig, Philipp Sommer, Christian-Hendrik Heeger, Melanie Gunawardene, Sascha Rolf, Henning Jansen, Heidi Estner, Till Althoff, Tilman Maurer, Roland Tilz, Leon Iden, Victoria Johnson, Daniel Steven

As an alternative to transvenous ICD systems, two non-transvenous ICD systems have been established in recent years: The subcutaneous ICD (S-ICD), which has been established for several years, has a presternal electrode that is implanted subcutaneously and offers a shock function and, to a limited extent, post-shock pacing. In addition, the extravascular ICD (EV-ICD) has been available in Europe since 2023 which does not require transvenous electrodes and offers the option of providing patients with antibradycardic and antitachycardic stimulation in combination with a conventional ICD function. The lead of this device is implanted substernally. Initial implantation results are promising in terms of safety and effectiveness. Both systems avoid possible complications of transvenous electrodes. This article provides practical guidance for the implantation technique and possible complications.

作为经静脉 ICD 系统的替代方案,近年来出现了两种非经静脉 ICD 系统:皮下 ICD(S-ICD)已问世数年,其胸骨前电极植入皮下,具有电击功能,并在一定程度上提供电击后起搏。此外,血管外 ICD(EV-ICD)已于 2023 年在欧洲上市,它不需要经静脉电极,可为患者提供抗心动过缓和抗心动过速刺激以及传统的 ICD 功能。该设备的导联是在体下植入的。就安全性和有效性而言,初步植入结果令人满意。这两种系统都避免了经静脉电极可能出现的并发症。本文就植入技术和可能出现的并发症提供实用指导。
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引用次数: 0
[Arrhythmia in sleep apnea]. [睡眠呼吸暂停的心律失常]。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI: 10.1007/s00399-024-01031-z
A-K Gamer, C Grebmer

Background: Sleep apnea is a widespread and yet still underdiagnosed condition. Various studies from the past have provided evidence that there is a link between sleep apnea and various cardiovascular diseases, including arrhythmias.

Objective: The aim of this article is to provide an overview of the current study situation and to point out possible consequences relevant to everyday life.

Material and methods: A systematic search was carried out in various databases using the keywords sleep apnea (OSAS/SA) and arrhythmias/dysrhythmias.

Results: There are several pathophysiological links between sleep-related breathing disorders and cardiac arrhythmias, the most important of which appear to be intrathoracic pressure, increased adrenergic tone as well as recurrent hypoxia and hypercapnia. This results in an increased occurrence of clinically relevant arrhythmias, such as atrial fibrillation, symptomatic bradycardia, high-grade atrioventricular (AV) blocks as well as ventricular arrhythmias in patients with untreated sleep apnea. These pathologies also appear to be positively influenced by the treatment of sleep apnea.

Conclusion: A close correlation between sleep apnea and cardiac arrhythmias is undisputed. Large randomized studies in this respect are so far rare but it is undisputed that a thorough search should be carried out for sleep apnea and consistently treated in patients with a history of cardiac disease as this can have a relevant influence on the treatment and ultimately the prognosis of the patient.

背景:睡眠呼吸暂停是一种普遍存在但仍未得到充分诊断的疾病。过去的多项研究证明,睡眠呼吸暂停与包括心律失常在内的各种心血管疾病之间存在联系:本文旨在概述目前的研究情况,并指出与日常生活相关的可能后果:以睡眠呼吸暂停(OSAS/SA)和心律失常/心律失常为关键词,在各种数据库中进行了系统检索:睡眠相关呼吸障碍与心律失常之间存在多种病理生理学联系,其中最重要的似乎是胸内压、肾上腺素能张力增加以及反复缺氧和高碳酸血症。这导致临床相关心律失常的发生率增加,如心房颤动、症状性心动过缓、高级房室传导阻滞以及未治疗的睡眠呼吸暂停患者的室性心律失常。这些病症似乎也会受到睡眠呼吸暂停治疗的积极影响:结论:睡眠呼吸暂停与心律失常之间的密切关系是毋庸置疑的。但毋庸置疑的是,对于有心脏病史的患者,应进行睡眠呼吸暂停的全面检查和持续治疗,因为这会对治疗产生相关影响,并最终影响患者的预后。
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引用次数: 0
[Arrhythmias in thyroid dysfunction]. [甲状腺功能障碍的心律失常]。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-07-18 DOI: 10.1007/s00399-024-01030-0
Roman Brenner, Stefan Bilz, Sonia Busch, Hans Rickli, Peter Ammann, Micha T Maeder

Thyroid dysfunction is associated with characteristic changes in heart rate and arrhythmias. Thyroid hormones act through genomic and non-genomic effects on myocytes and influence contractility, relaxation and action potential duration through a variety of mechanisms. Atrial fibrillation is the most common arrhythmia associated with thyroid dysfunction, it occurs in both euthyroidism and hyperthyroidism in clear association with T4 levels. Mechanistically, in the hyperthyroid state, increased automaticity and triggered activity, together with a shortened refractory period and slowing of the conduction speed, lead to the initiation and maintenance of multiple intraatrial reentry circuits. Influences from the autonomic nervous system and hemodynamics controlled by thyroid hormones act as modulators for arrhythmias, which are promoted by a corresponding substrate (significant impact of comorbidities). Concerning therapy, in addition to treating hyperthyroidism, the initial therapeutic focus is on adequate rate control and anticoagulation in patients with a high risk of thromboembolism. Ablation of atrial fibrillation can be considered later on, although there is an increased likelihood of recurrence compared to patients without hyperthyroidism.Prolongation of the QT interval and increase in QT dispersion are involved in the formation of ventricular arrhythmias. Epidemiological data suggest an association of elevated T4 levels with ventricular arrhythmias and sudden cardiac death. However, this seems to be mainly relevant for patients with underlying cardiac disease (e.g. ICD users).

甲状腺功能障碍与心率和心律失常的特征性变化有关。甲状腺激素通过基因组和非基因组作用于心肌细胞,并通过多种机制影响收缩力、松弛和动作电位持续时间。心房颤动是与甲状腺功能障碍相关的最常见的心律失常,在甲状腺功能正常和甲状腺功能亢进时都会发生,与 T4 水平有明显的关联。从机理上讲,在甲状腺功能亢进状态下,自动性和触发活动增加,加上折返期缩短和传导速度减慢,导致多个心房内再入电路的启动和维持。甲状腺激素控制的自律神经系统和血液动力学的影响是心律失常的调节剂,而相应的基质(合并症的重大影响)又会促进心律失常的发生。在治疗方面,除了治疗甲状腺功能亢进症外,最初的治疗重点是对血栓栓塞风险高的患者进行适当的心率控制和抗凝治疗。随后可考虑对心房颤动进行消融,但与无甲亢的患者相比,复发的可能性会增加。QT间期延长和QT弥散增加参与室性心律失常的形成。流行病学数据表明,T4水平升高与室性心律失常和心脏性猝死有关。不过,这似乎主要与患有基础心脏病的患者(如 ICD 使用者)有关。
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引用次数: 0
Arrhythmias in oncological patients: a compact overview for the clinician. 肿瘤患者的心律失常:临床医生的简要概述。
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-11 DOI: 10.1007/s00399-024-01033-x
Konstantinos Iliodromitis, Mathias Hoiczyk, Nana-Yaw Bimpong-Buta, Melchior Seyfarth, Harilaos Bogossian

Chemotherapy is the cornerstone of antineoplastic treatment in patients with malignancies. The cardiotoxic effect of antineoplastic therapy has been known for many decades. Part of chemotherapy-induced cardiotoxicity is the development of heart rhythm disturbances. This short review aims to provide a compact overview for the clinical cardiologist of the dysrhythmic potential created by antineoplastic agents in cancer survivors.

化疗是恶性肿瘤患者抗肿瘤治疗的基石。抗肿瘤治疗的心脏毒性作用已为人所知数十年。化疗引起的心脏毒性包括心律紊乱。这篇简短的综述旨在为临床心脏病学家提供一个简明的概述,介绍抗肿瘤药物在癌症幸存者中造成心律失常的可能性。
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引用次数: 0
Induction of fast ventricular tachycardia by a CRT-D device: what is the mechanism? CRT-D 设备诱发快速室性心动过速的机制是什么?
Q4 Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1007/s00399-024-01027-9
S Serge Barold, Andreas Kucher
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引用次数: 0
[SVT in the EP lab: electrograms don't always show the reentry circuit]. [EP 实验室中的 SVT:电图并不总是显示再入电路]。
Q4 Medicine Pub Date : 2024-08-30 DOI: 10.1007/s00399-024-01039-5
Harilaos Bogossian, Sebastian Robl, Nana-Yaw Bimpong-Buta, Konstantinos Iliodromitis
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引用次数: 0
期刊
Herzschrittmachertherapie und Elektrophysiologie
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