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[Albert L. Waldo, the explorer of entrainment-an obituary]. [阿尔伯特·L·沃尔多,携带讣告的探险家]。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-24 DOI: 10.1007/s00399-023-00971-2
Thomas Deneke, Carsten W Israel, Thorsten Lewalter
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引用次数: 0
[Leadless pacemakers : A "permanently" good solution?] [无导线起搏器:一个“永久”好的解决方案?]
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-23 DOI: 10.1007/s00399-023-00970-3
Clemens Steinwender, Hermann Blessberger, Karim Saleh

The two currently available leadless pacemakers are highly effective and safe in the respective approval studies and also real-world registries. Compared to conventional pacemakers, there are lower long-term complication rates compared to conventional pacemaker systems (especially regarding lead dislocations and systemic infections). Increasing evidence (currently largely for the Micra™ [Medtronic, Minneapolis, MN, USA] device) shows that these advantages are also valid in the long-term. Leadless pacemakers can therefore be regarded a "permanently good solution", when appropriately implanted in suitable patients.

目前可用的两种无引线起搏器在各自的批准研究和现实世界的注册中都非常有效和安全。与传统起搏器相比,与传统起搏器系统相比,长期并发症发生率较低(尤其是导线脱位和全身感染)。越来越多的证据(目前主要针对Micra™ [Medtronic,Minneapolis,MN,USA]设备)表明,这些优势在长期内也是有效的。因此,当适当地植入合适的患者体内时,无导线起搏器可以被视为“永久性的好解决方案”。
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引用次数: 0
Use of mexiletine in therapy-refractory recurrent ventricular tachycardia storm. 美西律治疗难治性复发性室性心动过速。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-02 DOI: 10.1007/s00399-023-00976-x
Mihaly D Szonyi, Robert Pap, Mate Vamos

Electrical storm due to recurrent ventricular tachycardias (VTs) is a life-threatening arrhythmic emergency. The authors present a case report of a 69-year-old male patient with VT storm of non-ischemic etiology. Despite optimal medical treatment escalated by amiodarone antiarrhythmic drug therapy, the patient experienced multiple implantable cardioverter defibrillator (ICD) shocks. An electrophysiological study revealed an epicardial substrate; however, considering the patient's extreme obesity and active anticoagulant effect, catheter ablation was deemed to be unfeasible. Subsequently, mexiletine was added to the patient's drug regimen, resulting in successful control of arrhythmias during the following 6 months. Although the most recent European guidelines for the management of patients with ventricular arrhythmias mention mexiletine only for the treatment of LQT3 patients, its use for treatment-refractory VT storm seems to also be an important indication area.

复发性室性心动过速引起的电风暴是一种危及生命的心律失常紧急情况。作者报告一例69岁男性非缺血性室性心动过速患者。尽管胺碘酮抗心律失常药物治疗使最佳药物治疗升级,但患者经历了多次植入式心律转复除颤器(ICD)电击。一项电生理学研究显示心外膜基质;然而,考虑到患者的极度肥胖和积极的抗凝作用,导管消融被认为是不可行的。随后,将美西律加入患者的药物方案中,在随后的6个月内成功控制了心律失常。尽管最近的欧洲室性心律失常患者管理指南提到美西律仅用于治疗LQT3患者,但其用于治疗难治性室性心动过速风暴似乎也是一个重要的适应症领域。
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引用次数: 0
Transient loss of atrial capture: the "atrial pacemaker stunning" phenomenon. 心房捕获的短暂丧失:“心房起搏器电击”现象。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-06 DOI: 10.1007/s00399-023-00978-9
S Serge Barold

Atrial loss of capture in the chronic phase after implantation may be permanent due to various causes, e.g. technical lead problems or increased scar tissue formation around the lead tip. However, it may also be transient after atrial ischemia in the context of occlusion of the right coronary artery. In this case, it may be preferable to wait for recovery, which may take up to 45 days, instead of immediately performing an atrial lead revision.

植入后慢性期心房捕获丧失可能是由于各种原因造成的永久性丧失,例如技术性导线问题或导线尖端周围瘢痕组织形成增加。然而,在右冠状动脉闭塞的情况下,心房缺血后也可能是短暂的。在这种情况下,最好等待恢复,这可能需要长达45天的时间,而不是立即进行心房导线翻修。
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引用次数: 0
Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation. 零氟房室结折返性心动过速消融。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1007/s00399-023-00977-w
Christina Soether, Andreas A Boehmer, Bianca C Dobre, Bernhard M Kaess, Joachim R Ehrlich

Background: Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance.

Objective: The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM).

Methods: The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed.

Results: Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm2 vs. 134 ± 137 cGycm2, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred.

Conclusion: Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.

背景:房室结折返性心动过速(AVNRT)是一种常见的室上型心动过速,尤其是在年轻患者中。选择的治疗方法是射频导管消融(RFCA),传统上需要电离辐射进行导管引导。目的:验证EnSite对房室结折返性心动过速进行零透视RFCA的可行性和安全性™ NavX™ 方法:回顾性分析68例AVNRT-RFCA患者的临床资料。其中一组被先验地分配到常规荧光透视标测(convFluoro,n = 30)。在38例病例中,电生理学家选择使用3D-EAM进行消融。在这些患者中,20名患者可以在不使用荧光镜的情况下进行消融(zeroFluoro)。在最初打算作为3D-EAM的18例病例中,由于解剖条件困难(转换为Fluoro),需要额外使用荧光镜检查。分析手术持续时间、透视持续时间和剂量以及并发症。结果:convFluoro和zeroFluoro组的手术持续时间相似(74 ± 24 最小值与80 ± 26 最小值,p = ns)。与convFluoro组相比,convertedFluoro治疗组的手术持续时间更长(94 ± 30 最小值对74 ± 24 最小值,p 2对134 ± 137 cGycm2,p = ns)。在zeroFluoro病例中,根本没有使用任何辐射。3D EAM引导的RFCA主要在所有患者中获得成功。总的来说,在不同的组中只有很少的轻微并发症。没有发生重大并发症。结论:零氟RFCA治疗AVNRT是可行和安全的。3D-EAM可以减少大多数患者的辐射暴露,而不会延长手术时间或增加并发症。
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引用次数: 0
[Lead extraction in cardiac implantable electronic devices]. [心脏植入式电子设备中的铅提取]。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-11-02 DOI: 10.1007/s00399-023-00963-2
Adrian Reinhardt, Henning Jansen, Till Althoff, Heidi Estner, Leon Iden, Sonia Busch, Andreas Rillig, Victoria Johnson, Philipp Sommer, Roland R Tilz, Daniel Steven, David Duncker

Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.

近年来,由于感染或铅功能障碍而导致的铅提取变得越来越重要。有严重和危及生命并发症高风险的患者只能在有适当人员和设备的经验丰富的中心接受手术。本文综述了安全、成功地进行经静脉铅提取的不同技术和方法。
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引用次数: 0
[Long-term success after catheter ablation of atrial fibrillation]. 【心房颤动导管消融术后的长期成功】。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-20 DOI: 10.1007/s00399-023-00972-1
Laura Rottner, Andreas Metzner

Ablation is an established treatment option for atrial fibrillation (AF) and is associated with convincing success rates and a reasonable safety profile. Ablation strategies going beyond pulmonary vein isolation in patients with chronic forms of AF are less well established and reproducible. Especially in patients with progressed AF forms multiple ablation procedures might be mandatory to achieve reasonable clinical success. An early ablation strategy might stop or prolong the progress from paroxysmal to persistent AF. In addition, ablation is more effective than drug-based treatment and comparably safe. Long-term success rates after a single and after multiple ablation procedures in paroxysmal AF are reported with 60-70% and up to 80%, while success rates in persistent or long-standing persistent AF are less favorable (single procedure 40-50%, multiple procedures 70%). However, currently non-recurrence of AF is the most established but potentially not the best endpoint. The burden of AF after ablation as assessed by novel monitoring modalities might gain further clinical importance.

消融是心房颤动(AF)的一种既定治疗选择,与令人信服的成功率和合理的安全性有关。慢性房颤患者肺静脉隔离之外的消融策略不太成熟,也不太可重复。特别是在房颤形式进展的患者中,为了取得合理的临床成功,多次消融手术可能是强制性的。早期消融策略可能会阻止或延长从阵发性房颤到持续性房颤的进展。此外,消融比药物治疗更有效,也相对安全。据报道,阵发性房颤单次和多次消融后的长期成功率分别为60-70%和80%,而持续性或长期持续性房颤的成功率则较低(单次消融40-50%,多次消融70%)。然而,目前房颤的不复发是最确定的,但可能不是最好的终点。通过新的监测模式评估消融后房颤的负担可能会获得进一步的临床重要性。
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引用次数: 0
[Stress testing: a relevant examination in rhythmology]. [压力测试:韵律学中的一项相关考试]。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-24 DOI: 10.1007/s00399-023-00967-y
Harilaos Bogossian, Diaa Alhanafi, Axel Kloppe, Reinhard Höltgen, Dejan Mijic

In recent years, imaging techniques have improved enormously. This leads to a decrease in stress testing indication for diagnosis and management of coronary artery diseases. However, stress testing remains an indispensable diagnostic tool for assessing patients' physical activity and their circulatory behavior during exercise. Using stress testing helps to assess patients' heart rate behavior or even to detect or trigger cardiac arrhythmias, for example, assessment of chronotropic competency, tachycardia-triggering or detection of a sudden heart rate drop with relevant bradycardia. The present review focuses on the assessment of stress testing in rhythmology. Since abnormal findings, which may indicate the presence of coronary heart disease, may occur during exercise testing, relevant ischemic criteria are also briefly addressed.

近年来,成像技术有了巨大的进步。这导致用于诊断和管理冠状动脉疾病的压力测试指征降低。然而,压力测试仍然是评估患者运动期间身体活动和循环行为的不可或缺的诊断工具。使用压力测试有助于评估患者的心率行为,甚至有助于检测或触发心律失常,例如,评估变时能力、心动过速触发或检测相关心动过缓的心率突然下降。本文主要对韵律学中的压力测试进行评价。由于异常发现可能表明冠心病的存在,可能发生在运动测试期间,因此也简要介绍了相关的缺血性标准。
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引用次数: 0
[Long-term results of catheter ablation for AV nodal reentry tachycardias and accessory pathways]. [导管消融治疗房室结折返性心动过速和旁道的长期结果]。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-20 DOI: 10.1007/s00399-023-00965-0
Fares-Alexander Alken, Katharina Scherschel, Ernan Zhu, Ann-Kathrin Kahle, Christian Meyer

Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia in patients with accessory pathways (AP) are common supraventricular tachycardias. High long-term efficacy of about 97% (AVNRT) and 92% (AP) has been observed in children and adults. The risk of occurring atrioventricular block is low (0.4-0.8% during AVNRT, 0.1-0.2% for AP). Catheter ablation shows a lower efficacy of 87-93% and elevated atrioventricular block risk up to 10% in patient groups with complex congenital heart disease. Nonsynchronized ventricular activation during preexcitation or permanent reentrant tachycardias can induce heart failure, and remission of left ventricular function can be expected in > 90% after successful catheter ablation. Therefore, catheter ablation is the long-term therapy of choice for AVNRT and AP with high efficacy and safety for most patient populations.

房室结折返性心动过速(AVNRT)和伴旁道(AP)患者的房室折返性心动速是常见的室上性心动过快。在儿童和成人中观察到约97%(AVNRT)和92%(AP)的高长期疗效。发生房室传导阻滞的风险较低(AVNRT时为0.4-0.8%,AP时为0.1-0.2%)。在患有复杂先天性心脏病的患者组中,导管消融显示出87-93%的较低疗效和高达10%的房室传导阻滞风险。预激或永久性折返性心动过速期间的非同步心室激活可诱发心力衰竭,左心室功能有望在> 导管消融成功后90%。因此,导管消融是AVNRT和AP的长期治疗选择,对大多数患者群体具有较高的疗效和安全性。
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引用次数: 0
[Manifest accessory pathway: localization and ablation with open window]. 【显性副通路:开窗定位消融】。
Q4 Medicine Pub Date : 2023-12-01 Epub Date: 2023-10-27 DOI: 10.1007/s00399-023-00969-w
Harilaos Bogossian, Sebastian Robl, Konstantinos Iliodromitis, Nana-Yaw Bimpong-Buta
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引用次数: 0
期刊
Herzschrittmachertherapie und Elektrophysiologie
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