Herzschrittmachertherapie und Elektrophysiologie最新文献

For more than two decades the left ventricular ejection fraction (LVEF) has been utilized with practically uncritical absolutism for the risk stratification of patients with ischemic and, historically, also nonischemic cardiomyopathy, in order to identify patients who could be threatened by sudden cardiac death. Based on historical data and in the absence of other better predictive parameters, the LVEF continues to appear in the guidelines unchanged, with cut-off values that lie in the region of the measurement accuracy of LVEF as determined by echocardiography. The basic identification of high-risk patients who then really benefit from an implantable cardioverter defibrillator (ICD) must be re-evaluated under the aspect of a meaningfully altered interventional and pharmaceutical treatment of heart failure.

Background: The primary therapeutic approach for severe secondary mitral regurgitation (MR) in combination with atrial fibrillation is often not clear.

Objectives/methods: To create a therapeutic guideline for daily clinical practice based on a case report as well as basic literature.

Results: If a functional component is suspected, restoration of sinus rhythm may lead to a significant improvement in MR. The extent of the improvement and the time required to achieve this improvement are often difficult to predict.

Conclusions: The involvement of an electrophysiologist is recommended in order to assess the likelihood of successful long-term rhythm control aimed at improving MR. In unclear cases, cardioversion combined with short-term administration of antiarrhythmic medication may be useful to demonstrate potential improvement of MR in sinus rhythm.

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and has far-reaching consequences not only for patients, but also for our healthcare system. The prevalence of this condition is expected to double in the coming decades. On the one hand, this is due to our aging population, the increasing number of comorbidities, and the improved technical possibilities for detection. A major complication of AF is stroke, whereby at-risk patients can be protected by oral anticoagulation if AF is diagnosed. The extent to which continuous screening for AF in patients with an increased risk of thromboembolic events should be carried out using wearables remains an important point in the current debate.

An early rhythm stabilization is the primary focus of the current treatment of atrial fibrillation. Based on current studies catheter ablation of pulmonary vein isolation (PVI) is an established component in the treatment of atrial fibrillation. Therefore, in the management of affected patients this procedure should be offered at an early stage in addition to the holistic treatment approach with consistent treatment of cardiovascular risk factors and thromboembolism prophylaxis with anticoagulants. Substances with an antiarrhythmic effect can be included in a supportive role in the management of atrial fibrillation. Pharmacotherapy could also perspectively play an important role in the treatment of the underlying atrial cardiomyopathy of the phenotype of atrial fibrillation. An understanding of the atrial pathophysiology of individual patients with adapted selection of suitable treatment strategies of ablation up to pharmacotherapy is decisive for the successful antiarrhythmic outcome. The decision on the treatment strategy must always be individually made together with the affected patient. The advantages and disadvantages of both options must be explained in detail and pre-existing comorbidities and risk factors must be included. Additionally, the individual wishes of the patient must be taken into account.

Given the background of optimizing financial and personnel resources while aligning with patient needs, the concept of same-day discharge following pulmonary vein isolation (PVI) appears attractive. However, a non-selective approach to different strategies is inappropriate, as is often the case in medicine. A "one size fits all" approach is therefore not advisable for outpatient PVI. Instead, the primary focus should be on identifying which patients can safely and effectively undergo PVI in an outpatient setting and which patients would benefit from inpatient care. Both procedural and patient-specific criteria should be considered in this context. In addition, structural prerequisites must also be met. Ultimately, the decision as to whether outpatient PVI is feasible should remain with the treating physician and the patient.

Background: Conducted energy weapons (CEW, TASER) are increasingly used by law enforcement agencies in Germany. The CEWs are intended to reduce violence against police officers and to reduce moderate to severe injuries of police officers and aggressors. The delivery of repetitive electrical impulses causes neuromuscular paralysis and incapacitation; however, there are safety concerns due to deaths related to CEWs.

Objective: The aim of this article is to provide an overview of the medical risks associated with the use of CEWs.

Methods: A literature search was carried out using relevant databases.

Results: The CEWs offer a good overall safety profile but in rare cases can have serious or life-threatening health risks. These include injuries to vulnerable body regions and falls. Myocardial capture and malignant arrhythmia can be triggered in animal experiments. The cause of death following the use of a conducted energy device (CED) can often not be clearly attributed due to competing causes; however, in studies with volunteers arrhythmia has not been observed so far. Overall, the risk of life-threatening cardiac arrhythmia in humans appears to be low, although still present. Particularly vulnerable risk groups include children, people with a history of mental illness or with intoxication, pregnant women and cardiac device wearers.

Conclusion: Even though in principle CEWs can trigger malignant arrhythmia, the risk is low and the causality of death after CEW deployment often remains unclear. In the medical care of patients after CEW use, comorbidities such as intoxication or mental illness must be considered.

The new 2024 ESC guidelines on the management of patients with atrial fibrillation (AF) introduces the AF-CARE pathway as the central acronym for AF management. As a result, the management of Comorbidities and risk factors is moving to the forefront of AF management. However, the new guideline also includes important changes in Avoidance stroke and thromboembolism, such as a modified risk score (CHA₂DS₂-VA) and a statement on anticoagulation in subclinical atrial fibrillation. There are also changes in the concepts of Rhythm and rate control with an upgrading of rhythm control and catheter ablation. Finally, the guideline recommends regular Evaluation and reassessment of the patient's course for optimal AF management. Here, we summarize key points of the new guidelines and discusses some recommendations on aspects that can also be assessed differently.

Cardiac resynchronisation therapy (CRT) is an effective method for increasing quality of life and life expectancy for many patients with heart failure. Due to the good results, this procedure is used frequently in Germany and has established itself as a class I indication in heart failure therapy. In addition to His bundle pacing, left bundle branch pacing has now also made a name for itself, as it shows a good success rate and can be used in a wider range of patients. Now the question arises as to whether left bundle branch pacing is superior to classic biventricular pacing and what the evidence situation is in this respect. This question shall be discussed in this article considering current studies and guideline recommendations.

During the ablation of ventricular arrhythmias (VA) complications can occur, albeit rather rarely, and their occurrence depends on various factors. On the one hand the patient's condition and comorbidities play a role, on the other hand the access site and the procedure itself can lead to complications which have to be addressed adequately. This article will discuss whether complex ablations with epicardial access should only be performed at centres with the appropriate expertise and a cardiac surgery department.