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Berlin Calling. 柏林召唤
Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1007/s00399-024-01018-w
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引用次数: 0
[Digital precision medicine in rhythmology : Risk prediction of recurrences, sudden cardiac death, and outcome]. [心律学中的数字精准医学:复发、心脏性猝死和预后的风险预测]。
Q4 Medicine Pub Date : 2024-06-01 Epub Date: 2024-04-19 DOI: 10.1007/s00399-024-01015-z
Ann-Kathrin Rahm, Patrick Lugenbiel

Digital precision medicine is gaining increasing importance in rhythmology, especially in the treatment of cardiac arrhythmias. This trend is driven by the advancing digitization in healthcare and the availability of large amounts of data from various sources such as electrocardiograms (ECGs), implants like pacemakers and implantable cardioverter-defibrillators (ICDs), as well as wearables like smartwatches and fitness trackers. Through the analysis of this data, physicians can develop more precise and individualized diagnoses and treatment strategies for patients with cardiac arrhythmias. For example, subtle changes in ECGs can be identified, indicating potentially dangerous arrhythmias. Genetic analyses and resulting large datasets also play an increasingly significant role, especially in hereditary ion channel disorders such as long QT syndrome (LQTS) and Brugada syndrome (BrS), as well as in lone atrial fibrillation (AF). Precision medicine enables the development of individualized treatment approaches tailored to the specific needs and risk factors of each patient. This can help improve screening strategies, reduce adverse events, and ultimately enhance the quality of life for patients. Technological advancements such as big data, artificial intelligence, machine learning, and predictive analytics play a crucial role in predicting the risk of arrhythmias and sudden cardiac death. These concepts enable more precise and personalized predictions and support physicians in the treatment and monitoring of their patients.

数字精准医疗在心律学领域的重要性与日俱增,尤其是在心律失常的治疗方面。推动这一趋势的是医疗数字化的不断发展,以及来自心电图(ECG)、起搏器和植入式心律转复除颤器(ICD)等植入物以及智能手表和健身追踪器等可穿戴设备等各种来源的大量数据。通过分析这些数据,医生可以为心律失常患者制定更精确、更个性化的诊断和治疗策略。例如,可以识别心电图中的细微变化,提示潜在的危险性心律失常。基因分析和由此产生的大型数据集也发挥着越来越重要的作用,尤其是在长 QT 综合征 (LQTS) 和布鲁加达综合征 (BrS) 等遗传性离子通道疾病以及孤独性心房颤动 (AF) 方面。精准医学能够根据每位患者的具体需求和风险因素制定个性化治疗方法。这有助于改进筛查策略,减少不良事件,并最终提高患者的生活质量。大数据、人工智能、机器学习和预测分析等技术进步在预测心律失常和心脏性猝死风险方面发挥着至关重要的作用。这些概念可实现更精确和个性化的预测,为医生治疗和监测患者提供支持。
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引用次数: 0
[Technical principles of ablation therapy]. [消融治疗的技术原理]
Q4 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-21 DOI: 10.1007/s00399-024-01028-8
Felix Bourier

Catheter ablation is a standard procedure in modern cardiology. It can significantly improve the quality of life and life expectancy of cardiac arrhythmia patients. Besides cardiac mapping, ablation itself is a fundamental step to successfully treat cardiac arrhythmias. There are various ablation technologies at hand: In traditional radiofrequency (RF) ablation, electrical current flow generates coagulation necrosis. When understanding the biophysical principles of RF ablation, the investigator is capable to adapt lesion geometry and size to the requirements of the procedure and vary them individually. In addition, lesion metric indices evaluate and integrate important parameters such as power, duration, impedance and contact force to standardize and control RF lesions. Cryoablation induces ice crystals within myocardial tissue, which lead to destruction and electrical scarring of the treated tissue. Histologically, cryolesions are well-delineated with preserved tissue architecture and intact endocardium. Pulsed field ablation (PFA) is a novel rising technology, particularly used for pulmonary vein isolation. In contrast to classic thermal technologies (RF and cryoablation), PFA uses pulsed electrical fields to electroporate cardiac tissue and thereby creates damage on a cellular level only.

导管消融术是现代心脏病学的标准程序。它能大大提高心律失常患者的生活质量和预期寿命。除了心脏图谱,消融本身也是成功治疗心律失常的基本步骤。目前有多种消融技术:在传统的射频(RF)消融中,电流会产生凝固性坏死。在了解射频消融的生物物理原理后,研究人员就能根据手术要求调整病灶的几何形状和大小,并对其进行个别调整。此外,病灶度量指数可评估和整合功率、持续时间、阻抗和接触力等重要参数,以规范和控制射频病灶。冷冻消融会在心肌组织内诱导冰晶,导致治疗组织的破坏和电瘢痕。从组织学角度看,冷冻灶界限清晰,组织结构和心内膜完好无损。脉冲场消融(PFA)是一种新型的新兴技术,尤其适用于肺静脉隔离。与传统的热技术(射频和低温消融)不同,脉冲场消融利用脉冲电场对心脏组织进行电穿孔,从而只对细胞造成损伤。
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引用次数: 0
[Characterization of atrial fibrillation burden using wearables]. [利用可穿戴设备确定心房颤动负担的特征]。
Q4 Medicine Pub Date : 2024-06-01 Epub Date: 2024-02-09 DOI: 10.1007/s00399-024-00995-2
Konstanze Betz, Dominik Linz, David Duncker, Henrike A K Hillmann

The characterization of atrial fibrillation (AF) according to current guidelines categorically refers to the differentiation between paroxysmal, persistent, and permanent AF. A more precise characterization of AF, including the evaluation of AF burden, is playing an increasingly significant role in both scientific research and clinical practice. Digital devices, especially those with the capability of passive (semi-)continuous recording, can contribute to a more accurate quantification of AF burden. Particularly in patients with an already established diagnosis of AF, the evaluation of AF burden can be used to monitor the success of antiarrhythmic therapy including antiarrhythmic drugs or pulmonary vein isolation. However, important questions remain unanswered: In addition to a uniform, evidence-based definition of AF burden, clinically relevant cut-offs for AF burden and resulting therapeutic consequences (e.g., subclinical AF) need to be elaborated. Furthermore, the establishment and evaluation of care structures for assessing and integrating AF burden in clinical care, especially by incorporating data from wearable medical devices, should take place.

根据现行指南,心房颤动(AF)的特征描述是指阵发性、持续性和永久性心房颤动之间的区别。对心房颤动进行更精确的定性,包括对心房颤动负荷的评估,在科学研究和临床实践中发挥着越来越重要的作用。数字设备,尤其是具有被动(半)连续记录功能的设备,有助于更准确地量化房颤负荷。特别是对于已经确诊为房颤的患者,房颤负荷的评估可用于监测抗心律失常治疗(包括抗心律失常药物或肺静脉隔离)的成功与否。然而,一些重要的问题仍未得到解答:除了房颤负荷的统一循证定义外,还需要详细制定与临床相关的房颤负荷临界值以及由此产生的治疗后果(如亚临床房颤)。此外,还应建立和评估用于评估心房颤动负担并将其纳入临床护理的护理结构,特别是通过纳入可穿戴医疗设备的数据。
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引用次数: 0
[Telemedicine for patients with cardiac implants : Insights into everyday practice of remote monitoring in Germany in 2022]. [为心脏植入物患者提供远程医疗 :2022 年德国远程监护日常实践的启示]。
Q4 Medicine Pub Date : 2024-06-01 Epub Date: 2024-05-24 DOI: 10.1007/s00399-024-01020-2
Bianca Steiner, Bettina Zippel-Schultz, Erna Thoden, Christoph J Geller, Thomas Klingenheben, Annett Kröttinger, Volker G Leonhardt, Jens Placke, Thomas M Helms

Background: As telemedical structures continues to be developed in the German healthcare system, remote monitoring is becoming increasingly important to ensure comprehensive, outpatient, and tailored care. The national quality assurance measure "DOQUVIDE-Documentation of quality in the assessment of vital parameters by implanted devices" is used to provide insight into everyday care for patients with telemedicine-enabled devices in Germany.

Methods: DOQUVIDE is a measuring instrument for recording outpatient remote monitoring for patients with implanted pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy with a pacemaker (CRT-P), CRT defibrillator (CRT-D) devices and event recorder. DOQUVIDE records telemedically measured vital signs as well as cardiac events and the associated procedures initiated by cardiologists using standardized forms.

Results: In 74 practices/clinics in 14 federal states, 6687 patients received telemedical care in 2022; 937 were newly enrolled. These (60% male) were on average 77.8 years old, mainly with New York Heart Association (NYHA) class II (62.6%). A total of 5801 electronic records were generated as a result of telecardiology events, of which 3590 were due to pathological atrial fibrillation and 1812 due to ventricular high-frequency episodes. 295 events were triggered by event recorders and 95 by device therapies. The main measures taken were telephone contacts or outpatient visits.

Conclusion: Remote monitoring has become a reality in German healthcare. Standardized processes and the establishment of quality assurance measures enable the definition of common quality standards and the identification of the potential for further development and simplify implementation in day-to-day care for practices.

背景:随着远程医疗结构在德国医疗系统中的不断发展,远程监控对于确保全面、门诊和量身定制的医疗服务变得越来越重要。国家质量保证措施 "DOQUVIDE--植入式设备生命参数评估质量记录 "用于深入了解德国远程医疗设备患者的日常护理情况:DOQUVIDE 是一种测量仪器,用于记录植入式起搏器、植入式心律转复除颤器 (ICD)、带起搏器的心脏再同步治疗 (CRT-P)、CRT 除颤器 (CRT-D) 设备和事件记录器患者的门诊远程监控情况。DOQUVIDE 使用标准化表格记录远程测量的生命体征、心脏事件以及心脏病专家启动的相关程序:结果:2022 年,14 个联邦州的 74 家诊所/诊所的 6687 名患者接受了远程医疗服务;其中 937 人是新注册的。这些患者(60% 为男性)的平均年龄为 77.8 岁,主要属于纽约心脏病协会(NYHA)II 级(62.6%)。远程心电图事件共产生了 5801 份电子记录,其中 3590 份由病理性心房颤动引起,1812 份由心室高频率发作引起。295起事件由事件记录器触发,95起由设备疗法触发。采取的主要措施是电话联系或门诊就诊:结论:远程监控在德国医疗保健领域已成为现实。标准化流程和质量保证措施的建立有助于确定共同的质量标准,识别进一步发展的潜力,并简化日常护理实践中的实施。
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引用次数: 0
[Postmortem genetic analysis following sudden cardiac death : Background, approach, and future]. [心脏性猝死的死后基因分析:背景、方法和未来]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-10 DOI: 10.1007/s00399-023-00986-9
Silke Kauferstein, Britt-Maria Beckmann

Background: Sudden cardiac death (SCD) is defined as an unexpected, nontraumatic death with a possible cardiac or unknown cause. The lowest incidence is observed in infancy and childhood (1 per 100,000), and the incidence is approximately 50 per 100,000 in the middle-aged population, reaching a plateau around the age of 80 (200 per 100,000). While most SCD cases occur in older people with coronary artery disease, there is a predominance of monogenetic and polygenetic diseases in the young.

Methods: Postmortem genetic analysis (molecular autopsy) using next-generation sequencing reveals a definite pathogenic genetic alteration, which can explain SCD of young patients in near 20% of the cases. Hence, postmortem genetic analysis has become an important tool to unravel the inheritable cause of death. Furthermore, early identification of a pathogenic genetic sequence variant in the deceased is crucial to reduce risk in relatives due to preventive personalized measures.

Results and conclusion: Postmortem genetic analysis forms together with the clinical assessment the basis for early identification of at-risk relatives. A new guideline for the management of ventricular arrhythmias and prevention of sudden death was recently published by the European Society of Cardiology. The new recommendations give genetic testing, also in deceased patients a much higher priority reflecting increasing relevance of genetic testing for diagnostic evaluation, risk stratification and prevention.

背景:心脏性猝死(SCD)是指非创伤性意外死亡,死因可能是心脏原因或不明原因。婴幼儿时期的发病率最低(每 10 万人中 1 例),中年人群的发病率约为每 10 万人中 50 例,到 80 岁左右达到高峰(每 10 万人中 200 例)。虽然大多数 SCD 病例发生在患有冠状动脉疾病的老年人身上,但年轻人中的单基因和多基因疾病占多数:方法:使用新一代测序技术进行死后基因分析(分子尸检)可发现明确的致病基因改变,这可以解释近 20% 年轻患者的 SCD。因此,死后基因分析已成为揭示遗传性死因的重要工具。此外,早期发现死者的致病基因序列变异对于降低亲属因采取个性化预防措施而面临的风险至关重要:结果与结论:尸检基因分析与临床评估共同构成了早期识别高危亲属的基础。欧洲心脏病学会最近发布了一份新的室性心律失常管理和猝死预防指南。新建议将基因检测(包括已故患者的基因检测)置于更高的优先地位,这反映出基因检测在诊断评估、风险分层和预防方面的重要性日益增加。
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引用次数: 0
[You can only understand today if you know yesterday : The history of rhythmology in Germany]. [只有了解昨天,才能理解今天:德国韵律学的历史]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-08 DOI: 10.1007/s00399-024-01013-1
M Borggrefe, F de Haan, C W Israel
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引用次数: 0
More than 30 years of Brugada syndrome: a critical appraisal of achievements and open issues. Brugada 综合征 30 多年:对成就和未决问题的批判性评估。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-12 DOI: 10.1007/s00399-023-00983-y
Lars Eckardt, Christian Veltmann

Over the last three decades, what is referred to as Brugada syndrome (BrS) has developed from a clinical observation of initially a few cases of sudden cardiac death (SCD) in the absence of structural heart disease with ECG signs of "atypical right bundle brunch block" to a predominantly electrocardiographic, and to a lesser extent genetic, diagnosis. Today, BrS is diagnosed in patients without overt structural heart disease and a spontaneous Brugada type 1 ECG pattern regardless of symptoms. The diagnosis of BrS is less clear in those with an only transient or drug-induced type 1 Brugada pattern, but should be considered in the presence of an arrhythmic syncope, family history of BrS, or family history of sudden death. In addition to survived cardiac arrest, syncope is probably the single most decisive risk marker for future arrhythmias. For asymptomatic BrS, risk stratification remains challenging. General recommendations to lower the risk in BrS include avoidance of drugs/agents known to induce and/or increase right precordial ST-segment elevation, including treatment of fever with antipyretic drugs. Several ECG markers that have been associated with an increased risk of SCD have been incorporated into a recently published risk score for BrS. The aim of this article is to provide an overview of the status of risk stratification and to illustrate open issues und gaps in evidence in BrS.

在过去的三十年中,所谓的 Brugada 综合征(BrS)已经从最初临床观察到的几例无结构性心脏病、心电图显示 "非典型右束束状传导阻滞 "的心脏性猝死(SCD)病例,发展为主要由心电图诊断,其次是遗传学诊断。如今,无明显结构性心脏病和自发性 Brugada 1 型心电图模式的患者,无论有无症状,均可诊断为 BrS。对于仅有一过性或药物诱发 1 型 Brugada 模式的患者,BrS 的诊断不太明确,但如果出现心律失常性晕厥、BrS 家族史或猝死家族史,则应考虑诊断 BrS。除了幸存的心脏骤停患者外,晕厥可能是未来发生心律失常的唯一最具决定性的风险标志。对于无症状的 BrS 患者,风险分层仍然具有挑战性。降低 BrS 风险的一般建议包括避免使用已知会诱发和/或增加右心前区 ST 段抬高的药物/制剂,包括使用退烧药治疗发热。一些与 SCD 风险增加相关的心电图指标已被纳入最近公布的 BrS 风险评分中。本文旨在概述风险分层的现状,并说明 BrS 的未决问题和证据差距。
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引用次数: 0
[Genetics in atrial fibrillation and malignant arrhythmia syndromes]. [心房颤动和恶性心律失常综合征的遗传学]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1007/s00399-024-00998-z
Rainer Schimpf, Ursula Ravens
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引用次数: 0
[Historical development of diagnosis of bradyarrhythmias : The early years of clinical electrophysiology in Germany]. [诊断缓慢性心律失常的历史发展 :德国临床电生理学的早期发展]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-28 DOI: 10.1007/s00399-024-01006-0
Günter Breithardt

The introduction of His bundle electrography by Benjamin Scherlag (New York) in 1969, together with programmed stimulation of the heart by Philip Coumel (Paris) in 1967, and Hein Wellens (Amsterdam) in 1972, were decisive turning points on the way to invasive electrophysiology and the development of an independent, now distinctly interventional subspecialty of cardiology. The main topic of the 1970s was bradycardic arrhythmias, promoted by pacemaker therapy, which had been introduced just over 10 years earlier. The recording of the potentials of the bundle of His and other recording locations in the atria and ventricles allowed a differentiated assessment of the excitation process and the refractory periods. High-rate atrial stimulation to determine sinus node recovery time and premature stimulation to determine sinoatrial conduction time were developed to analyze sinoatrial node function. This article describes the introduction of His bundle electrography in a gradually increasing number of centers in Germany and their scientific contribution.

本杰明-舍拉格(Benjamin Scherlag)(纽约)于 1969 年引入 His bundle 电图,菲利普-库梅尔(Philip Coumel)(巴黎)于 1967 年、海因-韦伦斯(Hein Wellens)(阿姆斯特丹)于 1972 年引入程序性心脏刺激,这些都是有创电生理学发展道路上的决定性转折点,也是心脏病学中一个独立的、现在已成为明显的介入亚专科的发展历程。20 世纪 70 年代的主要课题是心动过缓型心律失常,起搏器疗法在 10 多年前刚刚问世。通过记录 His 束以及心房和心室其他记录位置的电位,可以对兴奋过程和折返期进行有区别的评估。为了分析窦房结的功能,还开发了高频率心房刺激以确定窦房结的恢复时间,以及早搏刺激以确定窦房结的传导时间。本文介绍了德国越来越多的中心采用 His 体束电图的情况及其科学贡献。
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引用次数: 0
期刊
Herzschrittmachertherapie und Elektrophysiologie
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