Herzschrittmachertherapie und Elektrophysiologie最新文献

Electrical cardioversion represents a cornerstone of rhythm control strategies in patients with atrial fibrillation. However, in patients with obesity and specific anatomical variations, e.g. post heart transplantation, the standard flow of this procedure may need to be altered. This includes employing technical deviations of shock delivery and paying special attention to potential, unexpected complications. In light of the current position paper of the German Cardiac Society (Deutsche Gesellschaft für Kardiologie, DGK) on electrical cardioversion of atrial fibrillation, two cases with unconventional course of elective electrical cardioversion of atrial fibrillation are presented: dual direct current cardioversion in severe obesity and the occurrence of ventricular fibrillation in the presence of heterotopic heart transplant.

Electrical cardioversion (ECV) is an established and effective method for restoring sinus rhythm in patients with persistent atrial fibrillation. A position paper by the German Cardiac Society provides practical, evidence-based recommendations to guide clinical implementation of ECV and is summarized here. Key topics include appropriate patient selection, pre- and postprocedural management, anticoagulation strategies, sedation protocols, and technical considerations (such as electrode placement and energy levels). The document emphasizes the role of ECV as part of a broader rhythm control strategy. This paper aims to standardize and improve quality of care by translating current scientific knowledge and expert consensus into clear, practical clinical guidance.

Technological advances in medicine now enable wireless antibradycardia myocardial stimulation. Leadless pacemakers (LP) have already been introduced by Abbott (Abbott Park, IL, USA; Nanostim™, Aveir™), Medtronic (Minneapolis, MN, USA; Micra AV/VR™), and most recently by Boston Scientific (Marlborough, MA, USA; EMPOWER™). Although case reports have been published using different LP in combination with the EMBLEM™ S‑ICD, only the EMPOWER™ LP provides the technological prerequisites for modular cardiac rhythm management (mCRM). In this modular system, an ATP command can be transmitted from the S‑ICD to the LP when required, potentially reducing the number of S‑ICD shocks. Additionally, long-term antibradycardia pacing can be reliably ensured. Following extensive preclinical studies, the 6‑month results of the first prospective multicenter study (MODULAR-ATP) are now available, analyzing the safety, performance, and necessity of the mCRM system.

Education and training in the fields of cardiology and electrophysiology are undergoing significant changes due to new and digital teaching formats. This article illustrates current developments and challenges in integrating innovative teaching methods into the education of aspiring cardiologists and electrophysiologists at our center in Heidelberg, Germany. With the ongoing digitization of the educational system, virtual simulations, interactive learning platforms, and online-based training programs are becoming increasingly important. These new teaching formats enable both effective and flexible knowledge transfer as well as practical experiences in a complex medical specialty. The focus of this review is on presenting various digital teaching approaches at the University Hospital in Heidelberg. By providing a comprehensive overview of current trends and future potentials of these teaching formats, this article aims to contribute to the promotion of new and integrative teaching methods in the fields of cardiology and electrophysiology.

The possibility to correct left bundle branch block by His bundle pacing seems to contradict our understanding of the conduction system. However, we present a series of 6 consecutive patients in which distal, nonselective His bundle pacing led to partial or complete correction of left bundle branch block which suggests a damage of fibers of the left bundle within the His bundle proximal to the pacing site. Also left bundle branch block morphologies with electrocardiogram (ECG) criteria predictive of diffuse or distal conduction block were successfully corrected by His bundle pacing. Therefore, we postulate that His bundle pacing can have a positive impact even on left bundle branch block with multiple, diffuse, and distal conduction disturbances. Mechanisms for this are not clear but may relate to "recruitment" of diffusely disturbed conduction fibers, capture of distal fibers of the left bundle as well as areas of septal myocardium by pacing and concealed conduction. These observations question our understanding of left bundle branch block and suggest that the block is frequently located proximal to the division in right and left Tawara branches and can be corrected by His bundle pacing.

Cardiac resynchronization therapy (CRT) has gained a new partner in the treatment of systolic heart failure with the possibility of lead system stimulation. In parallel, leadless systems for right ventricular stimulation are being used, particularly in cases of venous access problems, infections, or other complications associated with leads. Endocardial, leadless left ventricular stimulation has been in clinical use for over 10 years now and is continuously being developed. It offers the alternative of stimulating the left ventricle endocardially and leadlessly via a co-implant, either posterolateral-basal or at the left (Tawara) branch of the left ventricular endocardium. This article presents the development, previous challenges, and new approaches to the implantation of the WiSE-CRT system (wireless stimulation endocardially). In addition, the clinical data situation and current approvals will be discussed.

Leadless pacemakers (LP) have emerged as a validated alternative to conventional transvenous systems, offering significant complication reduction by eliminating leads and device pockets. Current LP technologies include the Micra™ series (Medtronic, Minneapolis, MN, USA) and the modular Aveir™ system (Abbott Laboratories, Abbott Park, IL, USA), enabling the first fully leadless dual-chamber pacing. Clinical benefits are most evident in patients at high infection risk or with venous access limitations. Advances such as atrioventricular (AV)-synchronous pacing and long battery life have broadened indications, while maintaining stable device performance. Key challenges remain in end-of-life management and guideline integration. Future directions may involve combinations with subcutaneous implantable cardioverter-defibrillators (ICDs) or energy-harvesting technologies, further expanding therapeutic applications.

Leadless pacing entered cardiology with VVI systems. These have been established for years and have overcome weaknesses of transvenous systems (endoplastitis/endocarditis, lead fractures, pocket hematomas and infections, venous access blockade). Many patients with symptomatic bradycardias are in need of a dual chamber system, which establishes the need for true DDD leadless pacemaker systems. These DDD leadless systems are available and there are numerous publications on implant techniques and technical performances as well as a growing number on clinical performances. This article summarizes these data and publications.