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[Ventricular tachycardia-without structural heart disease: History]. [室性心动过速-无结构性心脏病:病史]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-26 DOI: 10.1007/s00399-024-01007-z
Christian-Hendrik Heeger, Roland Richard Tilz

This article focuses on ventricular arrythmias without evidence for structural heart disease. There are many different reasons for this type of arrythmia and there is still a gap of knowledge. Starting with the first description of this disease, we present the diagnosis and management with medication, and finally catheter ablation procedures from the beginning to how it is currently treated and how it possibly will be treated in the near future.

本文重点讨论无结构性心脏病证据的室性心律失常。导致这种类型的心律失常的原因有很多种,而相关知识仍是空白。我们首先描述了这种疾病,然后介绍了诊断和药物治疗,最后介绍了导管消融术,从开始到目前的治疗方法以及在不久的将来可能的治疗方法。
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引用次数: 0
[History of the implantable cardioverter-defibrillator in Germany]. [德国植入式心律转复除颤器的历史]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-29 DOI: 10.1007/s00399-024-01001-5
Michael Block, Helmut U Klein

The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.

植入式心律转复除颤器(ICD)是预防心脏性猝死方面的一项突破。在美国经过多年的技术研发后,米歇尔-米洛斯基(Michel Mirowski)克服重重困难,于 1980 年通过首次人体植入成功证明了室性快速性心律失常自动除颤的可靠性。将近 4 年后,第一批患者在德国的多个中心接受了 ICD。随后,在美国之外,德国成为植入率最高的国家。由于植入 ICD 需要心外膜除颤电极,因此需要心脏外科医生进行开胸手术,因此植入的绝对数量仍然很少。20 世纪 90 年代初,使用经静脉除颤电极和胸腔 ICD 进行起搏器式植入变得可行,将植入率推向了新的高度。在技术进步的同时,德国也开展了临床研究,并且经常在德国进行首次人体研究。1991 年,美国和德国制定了第一份适应症指南。1996 年至 2009 年间,发表了几项关于适应症的随机研究,大部分由美国团队领导,德国团队参与,但也有德国领导的研究(CASH、CAT、DINAMIT、IRIS)。2016 年的丹麦研究对这些长期研究的结果提出了质疑。未来的工作目标是确定哪些患者尽管接受了最佳的药物治疗、心脏再同步化治疗(CRT)和/或导管消融治疗,但仍需要保护以防心脏性猝死,而不是根据广泛的适应症为患者提供 ICD。结合磁共振成像(MRI)中的心肌疤痕和遗传信息的风险评分有望促进更个性化和更有效的适应症。
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引用次数: 0
[Historical developments in the diagnosis and treatment of pre-excitation syndromes (WPW)]. [预激综合征(WPW)诊断和治疗的历史发展]。
Q4 Medicine Pub Date : 2024-03-01 DOI: 10.1007/s00399-024-01000-6
Boris Rudic, Martin Borggrefe

In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant electrocardiography interpretation by Pick and Langendorf. Wellens and Durrer using electrophysiologic studies analyzed the tachycardia mechanism invasively. In Germany the group by Seipel and Breithardt as well as Neuss and Schlepper studied the tachycardia mechanisms and response to antiarrhythmic drugs invasively by electrophysiological studies. Following the first successful interruption of an accessory pathway by Sealy in 1967, surgeons and electrophysiologists cooperated in Germany. Two centers, Hannover and Düsseldorf were established. Direct current (DC) ablation of accessory pathways was introduced by Morady and Scheinman. Because of side effects induced by barotrauma of DC, alternative strategies were studied. In 1987, radiofrequency ablation was introduced and thereafter established as curative therapy of accessory pathways in all locations.

1930 年,沃尔夫、帕金森和怀特描述了以他们名字命名的综合征。Pick 和 Langendorf 通过出色的心电图解读分析了室上性心动过速的机制。Wellens 和 Durrer 利用电生理学研究对心动过速的机制进行了有创分析。在德国,由 Seipel 和 Breithardt 以及 Neuss 和 Schlepper 组成的小组通过电生理学研究对心动过速的机制以及对抗心律失常药物的反应进行了有创研究。1967 年,Sealy 首次成功阻断了一条辅助通路,此后,外科医生和电生理学家在德国展开了合作。汉诺威和杜塞尔多夫两个中心相继成立。莫拉迪(Morady)和谢因曼(Scheinman)引入了直流电(DC)消融术。由于直流电的气压创伤会引起副作用,人们开始研究替代策略。1987 年,射频消融术问世,此后被确定为治疗所有位置的分支通路的方法。
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引用次数: 0
[Genetic testing in daily clinical practice according to the guidelines : How do we proceed?] [根据指南在日常临床实践中进行基因检测:我们该如何进行?]
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-05 DOI: 10.1007/s00399-023-00988-7
Christian Wolpert

Genetic testing and counselling has become a fundamental part of the diagnostic work-up and risk stratification in ion channel diseases. The diagnostic yield varies among the different entities. For the most common diseases, there is a class I recommendation for the initiation of genetic testing and counseling. The German law for genetic diagnostics defines all steps of the pathway in detail. In clinical practice, coordination of the different levels of clinical guidance and genetic diagnostics and testing poses a logistic challenge. Involving human geneticists in the procedure is mandatory. For predictive genetic testing, human genetic counseling is mandatory before initiation of the testing and after obtaining the results. As far as causality of genetic variants for the arrhythmic phenotypes is concerned, repeated curations are undertaken to avoid misinterpretation and overdiagnosis.

基因检测和咨询已成为离子通道疾病诊断工作和风险分层的基本组成部分。不同疾病的诊断率各不相同。对于最常见的疾病,启动基因检测和咨询的建议等级为 I 级。德国基因诊断法详细规定了基因诊断的所有步骤。在临床实践中,协调不同级别的临床指导和基因诊断与检测是一项后勤挑战。人类遗传学家必须参与这一程序。对于预测性基因检测,在检测开始前和获得结果后,必须进行人类遗传咨询。至于基因变异与心律失常表型的因果关系,则要进行反复验证,以避免误读和过度诊断。
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引用次数: 0
Prognosis of pacing-dependent patients with cardiovascular implantable electronic devices. 植入心血管电子设备的起搏依赖患者的预后。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.1007/s00399-024-00996-1
Wolfram Grimm, Barbara Erdmann, Kathrin Grimm, Julian Kreutz, Mariana Parahuleva

Background: Data on the prognostic significance of pacing dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse.

Methods: The prognostic significance of pacing dependency defined as absence of an intrinsic rhythm ≥ 30 bpm was determined in 786 patients with CIEDs at the authors' institution using univariate and multivariate regression analysis to identify predictors of all-cause mortality.

Results: During 49 months median follow-up, death occurred in 63 of 130 patients with pacing dependency compared to 241 of 656 patients without pacing dependency (48% versus 37%, hazard ratio [HR] 1.34; 95% confidence interval [CI]: 1.02-1.78, P = 0.04). Using multivariate regression analysis, predictors of all-cause mortality included age (HR 1.07; 95% CI: 1.05-1.08, P < 0.01), history of atrial fibrillation (HR 1.32, 95% CI: 1.03-1.69, P < 0.01), chronic kidney disease (HR 1.28; 95% CI: 1.00-1.63, P = 0.048) and New York Heart Association (NYHA) class ≥ III (HR 2.00; 95% CI: 1.52-2.62, P < 0.01), but not pacing dependency (HR 1.15; 95% CI: 0.86-1.54, P = 0.35).

Conclusions: In contrast to age, atrial fibrillation, chronic kidney disease and heart failure severity as indexed by NYHA functional class III or IV, pacing dependency does not appear to be an independent predictor of all-cause mortality in patients with CIEDs.

背景:有关心血管植入式电子设备(CIED)患者起搏依赖性预后意义的数据很少:有关心血管植入式电子装置(CIED)患者起搏依赖性预后意义的数据很少:方法:采用单变量和多变量回归分析方法,对作者所在机构的786名心血管植入式电子装置患者进行了研究,确定了起搏依赖性的预后意义,起搏依赖性的定义是内在节律≥30 bpm的缺失,以确定全因死亡率的预测因素:在49个月的中位随访期间,130例起搏依赖患者中有63例死亡,而656例无起搏依赖患者中有241例死亡(48%对37%,危险比[HR]1.34;95%置信区间[CI]:1.02-1.78,P<0.05):1.02-1.78, P = 0.04).通过多变量回归分析,预测全因死亡率的因素包括年龄(HR 1.07;95% CI:1.05-1.08,P 结论:年龄与心房颤动相关性较低:与年龄、心房颤动、慢性肾病和以 NYHA 功能分级 III 或 IV 为指标的心衰严重程度相比,起搏依赖似乎不是 CIEDs 患者全因死亡率的独立预测因素。
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引用次数: 0
[History of clinical electrophysiology in diagnosing and treatment monitoring of high ventricular vulnerability]. [临床电生理学在诊断和治疗监测心室高度易损性方面的历史]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-27 DOI: 10.1007/s00399-024-01005-1
Dietrich Pfeiffer

The paper presents the history of hope from 1980-1995 to predict the risk of sudden arrhythmic death using electrophysiologic techniques in individual patients. Even if this prediction seems possible in selected highly risk cohorts, many more patients will die in ventricular arrhythmia without fulfilling the criteria. Ultimately, high risk of sudden cardiac death can be predicted in selected patient groups, but not in the majority of patients at risk. It is a history of dashed hope.

本文介绍了从 1980 年到 1995 年利用电生理学技术预测个别患者心律失常猝死风险的希望历程。即使这种预测在选定的高危人群中似乎是可行的,但仍有更多的患者会在不符合标准的情况下死于室性心律失常。归根结底,心源性猝死的高风险可以在选定的患者群体中预测,但不能在大多数高危患者中预测。这是一部希望破灭的历史。
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引用次数: 0
[Development of catheter ablation of supraventricular tachycardias with special consideration of contributions from German engineers and electrophysiologists]. [室上性心动过速导管消融术的发展,特别考虑到德国工程师和电生理学家的贡献]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-28 DOI: 10.1007/s00399-024-01009-x
Gerhard Hindricks, Verena Tscholl, Nikolaos Dagres, Philipp Attanasio, Martin Huemer

The development and clinical implementation of catheter ablation of supraventricular tachycardia is one of the outstanding achievements of modern cardiovascular treatment. Over a period of less than 40 years, a curative and safe treatment strategy for almost all forms of atrial arrhythmias has been developed and implemented. German electrophysiologists and engineers have made a significant contribution to this truly outstanding success story in modern medicine. Their contributions should be appropriately acknowledged because without them, the development of ablation technology and its worldwide dissemination would not have been possible. Both the technological contributions and the medical-electrophysiological contributions were at the absolute forefront of worldwide developments and have made a significant contribution to the fact that today more than 500,000 patients with symptomatic and/or threatening cardiac arrhythmias can be successfully treated every year by use of catheter ablation. We would like to thank them all for their achievements.

室上性心动过速导管消融术的发展和临床应用是现代心血管治疗的杰出成就之一。在不到 40 年的时间里,针对几乎所有形式的房性心律失常开发并实施了一种可治愈且安全的治疗策略。德国的电生理学家和工程师为这一现代医学中真正杰出的成功故事做出了重大贡献。他们的贡献应该得到应有的肯定,因为没有他们,消融技术的发展及其在全世界的推广就不可能实现。无论是技术方面的贡献还是医学电生理方面的贡献,他们都走在了世界发展的最前沿,为今天每年有超过 500,000 名有症状和/或有威胁的心律失常患者通过导管消融术得到成功治疗做出了重要贡献。我们对他们取得的成就表示感谢。
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引用次数: 0
[Development and clinical value of programmed ventricular stimulation in coronary artery disease and dilated cardiomyopathy]. [程序性心室刺激在冠心病和扩张型心肌病中的发展和临床价值]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-29 DOI: 10.1007/s00399-024-01003-3
Bernd-Dieter Gonska

Programmed ventricular stimulation (PVS), a clinical tool introduced in the early 1980s, aims to prove the electrical vulnerability of the heart and, independent of spontaneous arrhythmia variability, to trigger arrhythmias under controlled conditions. A specific response is the inducibility of monomorphic sustained ventricular tachycardia. This depends on the underlying heart disease, e.g., only for coronary artery disease but not for nonischemic diseases. The value of pharmacologic arrhythmia control as serial electrical testing is uncertain. Up to now there seems to be no prognostic value of PVS concerning sudden cardiac death. PVS is used as a tool to monitor the results of ventricular tachycardia (VT)-catheter ablation in patients who were primarily inducible.

程序性心室刺激(PVS)是 20 世纪 80 年代初引入的一种临床工具,旨在证明心脏的电气脆弱性,并在不受自发性心律失常变异影响的情况下,在受控条件下触发心律失常。一个具体的反应是单形持续性室性心动过速的可诱发性。这取决于潜在的心脏疾病,例如,只有冠状动脉疾病才会诱发心律失常,而非缺血性疾病则不会。药物性心律失常控制作为系列电测的价值尚不确定。到目前为止,PVS 对心脏性猝死似乎还没有预后价值。PVS 被用作监测室性心动过速(VT)导管消融结果的工具,主要针对可诱导的患者。
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引用次数: 0
[Electrophysiological study with a dual chamber pacemaker]. [双腔起搏器的电生理研究]。
Q4 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-02 DOI: 10.1007/s00399-024-00992-5
Harilaos Bogossian, Nana-Yaw Bimpong-Buta, Sebastian Robl, Konstantinos Iliodromitis
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引用次数: 0
[Long-term results of catheter ablation of idiopathic and structural ventricular tachycardia]. [特发性和结构性室性心动过速导管消融的长期结果]。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-19 DOI: 10.1007/s00399-023-00964-1
Philipp Lucas, Vanessa Sciacca, Philipp Sommer, Thomas Fink

Catheter ablation of ventricular tachycardia (VTs) has emerged as an effective treatment modality. Ablation procedures for idiopathic VTs depends on the anatomical origin of the arrhythmias, is highly effective in certain cases, and has been implemented as a first-line therapy in recent European guidelines. In contrast, catheter ablation of VTs in patients with structural heart disease has a significant risk of arrhythmia recurrence. Interventional treatment for patients with ischemic cardiomyopathy was studied in multiple randomized multicenter trials and it was shown that catheter ablation was more effective in arrhythmia suppression compared to conservative treatment modalities. Catheter ablation of nonischemic cardiomyopathy suffers from far higher rates of arrhythmia recurrences as documented in several long-term studies and often needs complex procedures with or without epicardial mapping and ablation. There is still no clear proof of a mortality benefit from catheter ablation of VTs in patients with or without structural heart disease. Nevertheless, recent guidelines recommend catheter ablation as an alternative to implantation of cardioverter-defibrillators (ICD) in selected cases.

室性心动过速(VT)的导管消融已成为一种有效的治疗方式。特发性室性心动过速的消融程序取决于心律失常的解剖起源,在某些情况下非常有效,并且在最近的欧洲指南中已作为一线治疗方法实施。相反,结构性心脏病患者的导管消融术具有心律失常复发的显著风险。在多个随机多中心试验中研究了缺血性心肌病患者的介入治疗,结果表明,与保守治疗方式相比,导管消融在抑制心律失常方面更有效。几项长期研究表明,非缺血性心肌病的导管消融术心律失常复发率要高得多,通常需要复杂的心外膜标测和消融术。目前还没有明确的证据表明,导管消融术对患有或不患有结构性心脏病的患者的死亡率有好处。然而,最近的指南建议,在选定的病例中,导管消融是植入心律转复除颤器(ICD)的替代方案。
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引用次数: 0
期刊
Herzschrittmachertherapie und Elektrophysiologie
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