Herzschrittmachertherapie und Elektrophysiologie最新文献

Background: The left atrial appendage (LAA) is the origin of thrombi in patients with atrial fibrillation (AF). Various techniques are available for surgical LAA occlusion. Current guidelines recommend surgical LAA closure as concomitant procedure in patients undergoing cardiac surgery or endoscopic or hybrid ablation for AF.

Objectives: This review article summarizes the current scientific evidence regarding surgical LAA closure and provides an outlook into its potential role in the future.

Materials and methods: A literature review was performed for LAA closure, indications, techniques, clinical outcomes, and ongoing studies.

Results: Different techniques are performed for surgical LAA closure. In a large randomizes study surgical LAA closure was associated with a reduction in thromboembolism in patients with AF. There are ongoing studies that examine the potential role of surgical LAA closure in patients with sinus rhythm and increased risk for stroke.

Conclusions: Surgical closure as a concomitant procedure in patients with AF undergoing cardiac surgery is now well established. It is unclear whether these patients require anticoagulation after successful closure. Currently, a few randomized trials are ongoing to evaluate whether prophylactic surgical LAA closure in patients with sinus rhythm and increased risk for stroke effectively reduces the incidence of stroke. At present, there are no data that support surgical LAA closure in patients with sinus rhythm and low risk for stroke.

Background: Left ventricular assist devices (LVAD) are used to treat patients with advanced heart failure. A significant fraction of these patients simultaneously fulfill the indication for an implantable cardioverter-defibrillator (ICD).

Objectives: It is currently unclear whether patients require an ICD after LVAD implantation. In addition, it remains uncertain whether patients with an LVAD are suitable candidates for a subcutaneous ICD (S-ICD).

Materials and methods: The aforementioned questions were addresses using studies, case reports, and our own experience.

Results: Studies have yielded varying findings on the above question. While some investigations suggest that an ICD may also be beneficial for LVAD patients, other studies highlight potential risks with limited benefit. This underscores the complexity of clinical decision-making in this specific patient cohort. S‑ICDs can suffer from significant functional impairments after LVAD implantation, making this combination controversial.

Conclusions: Due to the inconclusiveness of current studies, a general recommendation regarding the role of an ICD (both conventional and S‑ICD) after LVAD implantation cannot be established at this time. Therefore, it should involve individualized and interdisciplinary decision making.

The implantation of pacemakers and internal cardioverter-defibrillators (ICDs) is now carried out by specialists in surgical and conservative disciplines. The specialist training regulations for both cardiology and cardiac surgery currently include at least basic training in this area. Numerous offers of further training and specialization enable knowledge and practical techniques to be learned or optimized. The number of specialists with broad knowledge of less frequently used and current developments in rhythm implants is decreasing, particularly in surgical disciplines. An ideal way of utilizing the strengths of the respective specialist disciplines in terms of optimal patient care and training of young colleagues is close cooperation between the respective players. There are numerous "success models" for interdisciplinary cooperation that have been established for all procedures-including, in particular, complex revisions and electrode extractions-known as the "electrophysiological heart team".

Atrial fibrillation ablation is an established procedure for the treatment of atrial fibrillation, in which Pulsed Field Ablation (PFA) is a novel method alongside radiofrequency and cryoablation. The article explains the technical basics of PFA, describes different types of catheters and gives detailed instructions on how to perform the procedure, from patient selection to sedation strategies and imaging. Important safety aspects and possible complications are also covered. Finally, the further development of PFA technology for the treatment of other arrhythmias and integration into 3D mapping systems is discussed. This work is part of a series of articles on further training in special rhythmology.

Cardiovascular diseases remain one of the leading causes of death worldwide, placing a significant burden on individuals, families and healthcare systems. Telemedicine, in particular remote monitoring of patients with cardiovascular diseases, reduces this burden as it links the continuous monitoring of the health status with individual education and adaptation of the therapy to the needs of the patients. This improves patient outcomes and facilitates access to specialised healthcare services, independent of time and distance. Furthermore, telemedicine enables improvements in efficiency and promotes patients' self-care. However, the widespread adoption of remote patient monitoring faces several hurdles. A round table of experts from seven European countries (France, Germany, Italy, Poland, Spain, the Netherlands and the United Kingdom) reviewed the current state of telemedicine within the participating countries in order to learn from each other with an impetus for European co-operation. The creation of reliable regulations, overcoming regional differences, the redefinition of roles and processes, the personalisation of healthcare services, the promotion of innovation and research, the use of artificial intelligence and, finally, the efficient management and safeguarding of healthcare data were identified as key levers for further development of telemedicine. This discussion paper emphasises the need for cross-national research activities, involving all stakeholders, such as researchers, industry and patients, to foster the integration of telemedicine in clinical pathways.