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[Cardiac implantable electric devices in forensic medicine : Overview from the forensic and cardiology perspective]. [法医学中的心脏植入式电子装置:从法医学和心脏病学角度概述]。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-04 DOI: 10.1007/s00399-023-00952-5
Florian Fischer, Laurent Lafleur, Korbinian Lackermair

In 2021, about 75,000 persons in Germany died unnaturally or due to unexplained reasons. As a consequence, there are difficulties in more precisely identifying the time, cause and circumstances of death. Nevertheless, clarification is crucial not only from the clinical perspective, but these data are of considerable importance in the context of investigative procedures as they can be used to answer numerous legally relevant questions. Cardiac implantable devices (CIED) are of vital importance in the treatment of cardiac arrhythmias. In 2020 about 100,000 patients underwent CIED implantation in Germany. Therefore, CIED are present in a relevant proportion of the deceased mentioned above. The valuable source of information represented by postmortal CIED interrogation has been shown in numerous studies. Nevertheless, postmortal CIED interrogation is not routinely performed in the context of forensic medical examinations for reasons of practicability. This article summarizes benefits and limitations of postmortal CIED interrogation from the perspective of forensic medicine and cardiology and gives a recommendation for realization.

2021 年,德国约有 7.5 万人非正常死亡或死因不明。因此,很难更准确地确定死亡时间、原因和情况。然而,不仅从临床角度来看,澄清这些数据至关重要,而且这些数据在调查程序中也相当重要,因为它们可用于回答许多法律相关问题。心脏植入设备(CIED)对治疗心律失常至关重要。2020 年,德国约有 10 万名患者接受了 CIED 植入手术。因此,CIED 在上述死者中占有相当大的比例。大量研究表明,死后 CIED 检测是宝贵的信息来源。然而,出于实用性的考虑,死后 CIED 审讯并没有在法医检查中常规进行。本文从法医学和心脏病学的角度总结了死后 CIED 检测的优点和局限性,并提出了实现建议。
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引用次数: 0
[Echocardiography in cardiac arrhythmias]. [心律失常的超声心动图]。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-08-16 DOI: 10.1007/s00399-023-00956-1
Roland R Brandt, Stephan Stöbe, Aydan Ewers, Andreas Helfen

Echocardiography plays a key role in planning and guidance of electrophysiological procedures. After exclusion of structural heart disease, echocardiography provides insight into the extent of left atrial remodeling by determining left atrial metrics. This "biomarker" is associated with the risk of new-onset atrial fibrillation and predictive of atrial fibrillation recurrence after ablation. Transesophageal echocardiography is necessary to exclude left atrial thrombi and is able to guide a transseptal puncture. In case of a rare but life-threatening cardiac tamponade, an echocardiographic-guided pericardiocentesis ensures quick and effective treatment. Left ventricular ejection fraction and deformation analysis determined by echocardiography are established methods for risk stratification in patients with systolic dysfunction and used to guide pharmacological and device therapy.

超声心动图在规划和指导电生理程序中起着关键作用。在排除结构性心脏病后,超声心动图可通过测定左心房指标来了解左心房重塑的程度。这一 "生物标志物 "与新发心房颤动的风险有关,并可预测消融术后心房颤动的复发。经食道超声心动图是排除左心房血栓的必要手段,并能指导经房间穿刺。如果发生罕见但危及生命的心脏填塞,在超声心动图引导下进行心包穿刺可确保快速有效的治疗。通过超声心动图确定的左心室射血分数和变形分析是对收缩功能障碍患者进行风险分层的既定方法,并用于指导药物和器械治疗。
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引用次数: 0
[Sixty-five years of pacemaker therapy]. [心脏起搏器治疗 65 年]。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-31 DOI: 10.1007/s00399-023-00958-z
Walter Seeger

Sixty-five years ago, the first pacemakers were implanted. Swedish developments paved the way for implantation of the first epicardial pacemaker with a rechargeable battery unit; however, there was a battery defect within 3 h. Further developments in the USA allowed for the first transvenous, endocardial lead to be implanted with an external pacemaker battery. Following these pioneering implantations, further improvements of the battery and electrical elements and also of lead technology (flexibility and fixation mechanism) allowed the implantation of pacemaker systems similar to those we still implant today.

65 年前,人类植入了第一个心脏起搏器。瑞典的发展为植入第一个带有可充电电池单元的心外膜起搏器铺平了道路;然而,3 小时内就出现了电池故障。美国的进一步发展使得第一个经静脉心内膜导联与外置起搏器电池得以植入。继这些开创性的植入技术之后,电池和电子元件以及导联技术(柔韧性和固定机制)的进一步改进使得起搏器系统的植入与我们今天仍在植入的起搏器系统相似。
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引用次数: 0
Mitteilungen aus der Arbeitsgruppe Elektrophysiologie und Rhythmologie (AGEP). 电生理学和心律失常工作组(AGEP)的通讯。
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1007/s00399-023-00961-4
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引用次数: 0
Evaluation of a semiautomated App Store analysis for the identification of health apps for cardiac arrhythmias. 评估用于识别心律失常健康应用程序的半自动应用程序商店分析。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-06-28 DOI: 10.1007/s00399-023-00947-2
Dennis Lawin, Ute von Jan, Evgenii Pustozerov, Thorsten Lawrenz, Christoph Stellbrink, Urs-Vito Albrecht

Background: Smartphone apps are increasingly utilised by patients and physicians for medical purposes. Thus, numerous applications are provided on the App Store platforms.

Objectives: The aim of the study was to establish a novel, expanded approach of a semiautomated retrospective App Store analysis (SARASA) to identify and characterise health apps in the context of cardiac arrhythmias.

Materials and methods: An automated total read-out of the "Medical" category of Apple's German App Store was performed in December 2022 by analysing the developer-provided descriptions and other metadata using a semiautomated multilevel approach. Search terms were defined, based on which the textual information of the total extraction results was automatically filtered.

Results: A total of 435 of 31,564 apps were identified in the context of cardiac arrhythmias. Of those, 81.4% were found to deal with education, decision support, or disease management, and 26.2% (additionally) provided the opportunity to derive information on heart rhythm. The apps were intended for healthcare professionals in 55.9%, students in 17.5%, and/or patients in 15.9%. In 31.5%, the target population was not specified in the description texts. In all, 108 apps (24.8%) provided a telemedicine treatment approach; 83.7% of the description texts did not reveal any information on medical product status; 8.3% of the apps indicated that they have and 8.0% that they do not have medical product status.

Conclusion: Through the supplemented SARASA method, health apps in the context of cardiac arrhythmias could be identified and assigned to the target categories. Clinicians and patients have a wide choice of apps, although the app description texts do not provide sufficient information about the intended use and quality.

背景:智能手机应用程序越来越多地被病人和医生用于医疗目的。因此,App Store 平台上提供了大量应用程序:研究的目的是建立一种新颖、扩展的半自动回顾性应用商店分析(SARASA)方法,以识别和描述心律失常方面的健康应用:2022 年 12 月,通过使用半自动多层次方法分析开发者提供的描述和其他元数据,对苹果公司德国应用商店的 "医疗 "类别进行了一次自动总阅读。在定义搜索条件的基础上,自动过滤了所有提取结果的文本信息:结果:在 31,564 个应用程序中,共识别出 435 个与心律失常有关。在这些应用程序中,81.4%涉及教育、决策支持或疾病管理,26.2%(另外)提供了获取心律信息的机会。55.9%的应用程序面向医护人员,17.5%面向学生,和/或15.9%面向患者。31.5%的应用程序在说明文字中未指明目标人群。总共有 108 个应用程序(24.8%)提供了远程医疗治疗方法;83.7%的说明文本没有透露任何有关医疗产品状态的信息;8.3%的应用程序表示它们具有医疗产品状态,8.0%表示它们不具有医疗产品状态:结论:通过补充 SARASA 方法,可以识别心律失常方面的健康应用程序并将其归入目标类别。临床医生和患者有多种应用程序可供选择,尽管应用程序的描述文本没有提供有关预期用途和质量的足够信息。
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引用次数: 0
[Big hype about ChapGPT in medicine : Is it something for rhythmologists? What must be taken into consideration?] [大肆炒作 ChapGPT 在医学中的应用:它是节律学家的专利吗?必须考虑哪些因素?]
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-31 DOI: 10.1007/s00399-023-00960-5
W Haverkamp, N Strodthoff, J Tennenbaum, C Israel

ChatGPT, a chatbot based on a large language model, is currently attracting much attention. Modern machine learning (ML) architectures enable the program to answer almost any question, to summarize, translate, and even generate its own texts, all in a text-based dialogue with the user. Underlying technologies, summarized under the acronym NLP (natural language processing), go back to the 1960s. In almost all areas including medicine, ChatGPT is raising enormous hopes. It can easily pass medical exams and may be useful in patient care, diagnostic and therapeutic assistance, and medical research. The enthusiasm for this new technology shown even by medical professionals is surprising. Although the system knows much, it does not know everything; not everything it outputs is accurate either. Every output has to be carefully checked by the user for correctness, which is often not easily done since references to sources are lacking. Issues regarding data protection and ethics also arise. Today's language models are not free of bias and systematic distortion. These shortcomings have led to calls for stronger regulation of the use of ChatGPT and an increasing number of similar language models. However, this new technology represents an enormous progress in knowledge processing and dissemination. Numerous scenarios in which ChatGPT can provide assistance are conceivable, including in rhythmology. In the future, it will be crucial to render the models error-free and transparent and to clearly define the rules for their use. Responsible use requires systematic training to improve the digital competence of users, including physicians who use such programs.

基于大型语言模型的聊天机器人 ChatGPT 目前正备受关注。现代机器学习(ML)架构使程序能够回答几乎任何问题,总结、翻译甚至生成自己的文本,所有这些都是在与用户进行基于文本的对话时完成的。其基础技术可追溯到 20 世纪 60 年代,其缩写为 NLP(自然语言处理)。在包括医学在内的几乎所有领域,ChatGPT 都带来了巨大的希望。它可以轻松通过医学考试,并可能在病人护理、诊断和治疗协助以及医学研究方面发挥作用。即使是医学专家对这项新技术表现出的热情也令人惊讶。虽然该系统知道很多,但并不是什么都知道;它输出的也不是什么都准确。用户必须仔细检查每项输出的正确性,而这往往不容易做到,因为缺乏来源参考。数据保护和道德问题也随之而来。当今的语言模型并非没有偏差和系统性失真。这些缺陷导致人们呼吁加强对 ChatGPT 和越来越多的类似语言模型使用的监管。然而,这项新技术代表了知识处理和传播领域的巨大进步。可以想象,ChatGPT 可以在包括节律学在内的众多领域提供帮助。未来,使模型无差错、透明化并明确定义其使用规则至关重要。要负责任地使用,就必须进行系统培训,以提高用户(包括使用此类程序的医生)的数字能力。
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引用次数: 0
Mobitz type II second-degree atrioventricular block during sleep: true or false? 睡眠中的莫比茨 II 型二度房室传导阻滞:真还是假?
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-08-04 DOI: 10.1007/s00399-023-00959-y
S Serge Barold

A number of publications have claimed that Mobitz type II second-degree atrioventricular (AV) block can occur during sleep apnea. None has provided a definition of type II block used in the articles, and representative electrocardiograms have been generally missing. Despite these reports, the existence of type II AV block during sleep must remain questionable.

许多出版物都声称,睡眠呼吸暂停时会出现莫比茨 II 型二度房室传导阻滞。这些文章都没有提供所使用的 II 型房室传导阻滞的定义,也普遍缺乏具有代表性的心电图。尽管有这些报道,但睡眠中是否存在 II 型房室传导阻滞仍值得怀疑。
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引用次数: 0
Legal aspects of genetic testing in the evaluation of ventricular tachycardias. 评估室性心动过速时基因检测的法律问题。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-31 DOI: 10.1007/s00399-023-00948-1
Regina Duryagina, Sergio Richter, Micaela Ebert

There is increasing knowledge of the genetic basis of distinct cardiac pathologies that are related to ventricular tachyarrhythmias (VT) and sudden cardiac death (SCD). The identification of genes responsible for inherited cardiac diseases has led to the organization of cardiogenetic consultations in many countries worldwide. The 2022 European Society of Cardiology (ESC) guidelines for the management of patients with ventricular arrhythmias and the prevention of SCD and the international 2022 Expert Consensus Statement on the state of genetic testing for cardiac diseases emphasize the importance of genetic testing in cardiology practice along with appropriate information provision to affected individuals and their relatives. However, the context of genetic examination raises particular ethical, practical (including economic or financial), and legal challenges. This review aims to elucidate practical considerations related to legal aspects relevant for the evaluation of patients presenting with VT in Germany.

人们对与室性心动过速(VT)和心脏性猝死(SCD)有关的不同心脏病变的遗传基础有了越来越多的了解。遗传性心脏病基因的确定促使世界上许多国家组织了心脏遗传学会诊。2022 年欧洲心脏病学会(ESC)室性心律失常患者管理和 SCD 预防指南以及 2022 年国际心脏病基因检测现状专家共识声明都强调了基因检测在心脏病学实践中的重要性,以及向受影响的个体及其亲属提供适当信息的重要性。然而,基因检查在伦理、实践(包括经济或财务)和法律方面都提出了特殊的挑战。本综述旨在阐明在德国对 VT 患者进行评估时与法律问题相关的实际考虑因素。
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引用次数: 0
[Legal aspects of telemedicine in cardiology in Germany]. [德国心脏病学远程医疗的法律问题]。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-11 DOI: 10.1007/s00399-023-00949-0
F W G Wenzelburger, B Schumacher

Since 2016, quarterly telemedical remote monitoring of patients with an implanted defibrillator or cardiac resynchronization therapy (CRT) system is part of the Einheitlichen Bewertungsmaßstab (EBM, physician's fee schedule) and is the first telemedical service to be reimbursed in German cardiology. Many publications like the TIM-HF2 or the InTime trial have shown a significant benefit for different endpoints in patients with advanced heart failure. Therefore, the German Society of Cardiology (DGK) has published different recommendations that emphasize an obvious indication of telemedical care with daily control of implantable cardioverter-defibrillator (ICD) information, parameters like blood pressure and weight, and telemedical counselling of patients with heart failure with reduced ejection fraction. This recommendation is also part of the guidelines of the European Society of Cardiology (ESC) published in 2021. It has a level IIb for patients with heart failure. In December 2020 the "Gemeinsame Bundesausschuss" (G-BA) decided to accept telemonitoring as a diagnostic tool and treatment option for patients with heart failure. This service of physicians became part of the EBM and ever since may be offered to patients. This development is accompanied with many questions regarding a physician's accountability, protection of data privacy, and also regarding the structures given by the G‑BA and the "Kassenärztlichen Vereinigungen" (KV). Thus, this paper tries to give an overview of these topics. It will also provide a critical discussion of these structures and their legal foundation because there are many constraints that need to be taken into consideration as a cardiologist. These constraints may ultimately hinder the expansion of this service to patients in Germany.

自 2016 年起,对植入除颤器或心脏再同步化治疗 (CRT) 系统的患者进行每季度一次的远程医疗监控成为 Einheitlichen Bewertungsmaßstab(EBM,医生收费表)的一部分,也是德国心脏病学领域首个获得报销的远程医疗服务。许多出版物(如 TIM-HF2 或 InTime 试验)都显示,晚期心力衰竭患者的不同终点都有显著疗效。因此,德国心脏病学会(DGK)发布了不同的建议,强调了远程医疗的明显优势,即对植入式心律转复除颤器(ICD)信息、血压和体重等参数的日常控制,以及对射血分数降低的心力衰竭患者的远程医疗咨询。这项建议也是欧洲心脏病学会(ESC)于 2021 年发布的指南的一部分。对心力衰竭患者的建议为 IIb 级。2020 年 12 月,"Gemeinsame Bundesausschuss"(G-BA)决定接受远程监护作为心衰患者的诊断工具和治疗方案。医生的这一服务成为 EBM 的一部分,并从此可以提供给患者。在这一发展过程中,出现了许多关于医生责任、数据隐私保护以及 G-BA 和 "Kassenärztlichen Vereinigungen"(KV)组织结构的问题。因此,本文试图概述这些主题。本文还将对这些机构及其法律基础进行批判性讨论,因为作为一名心脏病专家需要考虑到许多限制因素。这些制约因素最终可能会阻碍这项服务在德国向患者的扩展。
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引用次数: 0
[The second opinion procedure in electrophysiology : Legal aspects for treatment providers and second opinion providers]. [电生理学第二意见程序:治疗提供者和第二意见提供者的法律问题]。
Q4 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-14 DOI: 10.1007/s00399-023-00951-6
Eva Rütz, Denise Bartels, Julia Vogler, Roland R Tilz

Patients with statutory health insurance in Germany have the right to obtain a second opinion at the expense of their health insurance in addition to that of their primary practitioner before certain procedures are carried out. This gives rise to various legal obligations and questions on the part of both the practitioner and the second opinion provider. This article outlines, based on the legal situation, which obligations exist for both practitioners and second opinion providers, and who is suitable to provide a second opinion. Focus is placed on informing patients about the possibility of obtaining a second opinion. On the other hand, it explains which requirements second opinion providers have to fulfill and which duties are incumbent on them.

在德国,拥有法定医疗保险的患者有权在某些手术实施之前,在其主治医生的意见之外,由其医疗保险承担费用获得第二意见。这就给医生和第二意见提供者带来了各种法律义务和问题。本文根据法律规定,概述了开业医生和第二意见提供者的义务,以及谁适合提供第二意见。重点在于告知患者获得第二意见的可能性。另一方面,文章还解释了第二意见提供者必须满足的要求以及应承担的责任。
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引用次数: 0
期刊
Herzschrittmachertherapie und Elektrophysiologie
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