Search

Antonia Kellnar,1 Stephanie Fichtner,2 Lauren Sams,1 Christopher Stremmel,1 Heidi L Estner,1 Korbinian Lackermair1 1Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Munich, Germany; 2Department of Cardiology, Krankenhaus Landshut-Achdorf, Landshut, GermanyCorrespondence: Antonia Kellnar, Department of Medicine I, University Hospital Munich, Marchioninistr. 15, Munich, DE-81377, Germany, Tel +49 89 4400 712621, Email antonia.kellnar@med.uni-muenchen.deBackground: Treatment with wearable cardioverter defibrillators (WCD) is a non-invasive, transient therapy option for prevention of sudden cardiac death (SCD) in patients with temporary contraindications for implantation of a permanent cardioverter defibrillator. Due to the constant risk of fatal arrhythmias, compliance is the fundamental requirement for effectiveness of a WCD, but this might be hindered by the poor quality-of-life (QoL) during WCD therapy. In this retrospective single-center study, we examined if a standardized WCD training and adherence surveillance programme could enhance compliance and QoL.Methods: All patients with a prescription for WCD treatment from January 2017 to August 2019 were included and received a standardized WCD training programme. QoL was validated using the modified EQ-5D-3L questionnaire. The findings were compared to a historical, previously published, retrospective cohort from our center (WCD prescription period 03/2012– 02/2016), not receiving the additional training programme. Endpoints comprised therapy adherence, arrhythmic episodes, and dimensions of QoL.Results: Ninety-two patients underwent WCD treatment in the study cohort for a median of 49 days. Median daily wear time was enhanced in the study cohort (historical cohort vs study cohort 21.9 vs 23.3 hours/per day, p< 0.01) and artefact alarms occurred less frequently (67.9% vs 48.9%, p 0.01). Major restrictions in QoL in the study cohort were found in mobility (48%), daily routine (4

Manuela Thienel,1,&ast; Magda Haum,1,&ast; Sebastian Sadoni,2 Julia Novotny,1 Heidi L Estner,1 Stephanie Fichtner,1 Korbinian Lackermair1 1Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany; 2Department of Cardiac Surgery, Munich University Hospital, Ludwig-Maximilian-University, Munich, Germany&ast;These authors contributed equally to this workCorrespondence: Korbinian Lackermair, Department of Medicine I, Munich University Hospital, Ludwig-Maximilian-University, Marchioninistr. 15, Munich, 81377, Germany, Email Korbinian.lackermair@med.uni-muenchen.deBackground: The subcutaneous cardioverter defibrillator (S-ICD) has been shown to be a viable alternative to transvenous ICDs (TV-ICD) in all patients at risk of sudden cardiac death (SCD) but without pacing indication.Aim: The aim of this study was to examine the impact of therapy with current S-ICD devices on quality of life (QoL) in comparison to patients with TV-ICD devices.Methods: In our single-centre study, 52 consecutive patients with S-ICD and 52 matched patients with TV-ICD were analysed. QoL has been assessed by a standardized questionnaire (EQ-5D-3L, modified). Additionally, clinical baseline and follow-up data were evaluated.Results: Two-thirds of the total study population reported restrictions in daily routine compared to their life before ICD implantation. A total of 27.7% of S-ICD patients stated to expect an improvement of QoL by deactivation or explantation of their defibrillator compared to only 6.4% of patients with TV-ICD (p=0.006), which was mainly caused by discomfort and pain from the S-ICD pocket (relevant discomfort and pain in 32.6% vs 11.5%; p< 0.01).Limitations: Main limitation of the study is that quality of life was assessed for one single time point only and time since implantation differed significantly between S-ICD and TV-ICD. Furthermore our collective is younger, and, due to the high proportion of patients without car

In der Dachauer Reanimationsstudie konnten in einem Zeitraum von 5 Jahren Ergebnisse von 539 Reanimations-Patienten erhoben werden, davon 405 kardialer Genese. Von diesen Patienten überlebten 11,6% bis zur Klinikentlassung. Im internationalen Vergleich lagen die Überlebensraten im Landkreis Dachau im oberen Niveau. Dennoch ist dieser Anteil deutlich niedriger, als die theoretisch denkbaren Überlebensraten nach Reanimation. Entscheidend ist jedoch das neurologische Ergebnis: 91% unserer Patienten wiesen ein gutes neurologisches Outcome auf. Nach wie vor schwierig ist die Versorgung traumatologischer Reanimationen, die trotz maximaler Therapie eine infauste Prognose aufwiesen., The prehospital resuscitation study in Dachau included the outcome of 539 Patients with out-of-hospital cardiac arrest, of those 405 with cardiac cause. Of these 11.6% survived till release from hospital. Compared to international studies the survival rate in the area of Dachau was in the upper level. Even though this rate is quite lower than the thinkable survival rate after out-of-hospital cardiac arrest. But most deciding is the neurological outcome: 91% of our patients had a favorable neurological outcome. Still difficult is the treatment of trauma patients with cardiac arrest, which in spite of getting maximum therapy still have a very bad prognoses.

Despite the advent of non-fluoroscopic technologies, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies to ablation interventions and device implantation. The purpose of the European Heart Rhythm Association survey was to provide an insight into regulatory policies and physicians' clinical practice when using fluoroscopy during ablation procedures and device implantation. The survey has shown that only 50% of the participating centres worked with low frame rates (3-6 frames per second) and that the left anterior oblique projection, with higher radiation exposure for the physician, is used for nearly every ablation target. Although three-dimensional imaging systems may reduce the radiation exposure, most centres never used these systems for standard ablation procedures and a trend is that non-fluoroscopy technologies are even less frequently used than in 2012, when the use of robotic systems was still rare. Even less costly equipment such as lead gloves, lead glass cabins, or radiation absorbing pads are still not routinely used., Författarna representerar Scientific Initiative Committee, European Heart Rhythm Association

Management of patients with non-valvular atrial fibrillation (AF) presenting with an acute coronary syndrome (ACS) may be particularly challenging. Given the lack of sound evidence-based recommendations for the management of such patients, the aim of this European Heart Rhythm Association survey was to provide an insight into current practice in Europe regarding management of these patients. Overall, 41 centres submitted a valid response. The majority of respondents were university hospitals (85%). The survey has shown that the principal aspects of the European Society of Cardiology guidelines on the management of AF, and those on ACS, have been adopted. The survey highlights two important areas of uncertainty regarding the optimal composition and duration of antithrombotic therapy with multiple drugs and the optimal regimen(s) of novel oral anticoagulants in patients with AF and ACS.

Clinical electrophysiology (EP) and catheter ablation of arrhythmias are rapidly evolving in recent years. More than 50 000 catheter ablations are performed every year in Europe. Emerging indications, an increasing number of procedures, and an expected high quality require national and international standards as well as trained specialists. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the practice of requirements for EP personnel, equipment, and facilities in Europe. Responses to the questionnaire were received from 52 members of the EHRA research network. The survey involved high-, medium-, and low-volume EP centres, performing >400, 100-399, and under 100 implants per year, respectively. The following topics were explored: (i) EP personnel issues including balance between female and male operators, responsibilities within the EP department, age profiles, role and training of fellows, and EP nurses, (ii) the equipments available in the EP laboratories, (iii) source of patient referrals, and (iv) techniques used for ablation for different procedures including sedation, and peri-procedural use of anticoagulation and antibiotics. The survey reflects the current EP personnel situation characterized by a high training requirement and specialization. Arrhythmia sections are still most often part of cardiology departments and the head of cardiology is seldom a heart rhythm specialist. Currently, the vast majority of EP physicians are men, although in the subgroup of physicians younger than 40 years, the proportion of women is increasing. Uncertainty exists regarding peri-procedural anticoagulation, antibiotic prophylaxis, and the need for sedation during specific procedures.

In der Dachauer Reanimationsstudie konnten in einem Zeitraum von 5 Jahren Ergebnisse von 539 Reanimations-Patienten erhoben werden, davon 405 kardialer Genese. Von diesen Patienten überlebten 11,6% bis zur Klinikentlassung. Im internationalen Vergleich lagen die Überlebensraten im Landkreis Dachau im oberen Niveau. Dennoch ist dieser Anteil deutlich niedriger, als die theoretisch denkbaren Überlebensraten nach Reanimation. Entscheidend ist jedoch das neurologische Ergebnis: 91% unserer Patienten wiesen ein gutes neurologisches Outcome auf. Nach wie vor schwierig ist die Versorgung traumatologischer Reanimationen, die trotz maximaler Therapie eine infauste Prognose aufwiesen., The prehospital resuscitation study in Dachau included the outcome of 539 Patients with out-of-hospital cardiac arrest, of those 405 with cardiac cause. Of these 11.6% survived till release from hospital. Compared to international studies the survival rate in the area of Dachau was in the upper level. Even though this rate is quite lower than the thinkable survival rate after out-of-hospital cardiac arrest. But most deciding is the neurological outcome: 91% of our patients had a favorable neurological outcome. Still difficult is the treatment of trauma patients with cardiac arrest, which in spite of getting maximum therapy still have a very bad prognoses.

Die AV-Knoten-Reentry-Tachykardie (AVNRT) ist eine der häufigsten regelmäßigen supraventrikulären Tachykardien. Zugrunde liegend ist hierbei eine funktionelle Aufteilung des AV-Knotens in zwei longitudinale Leitungsbahnen, einen langsam leitenden "slow pathway" und einen schnell leitenden "fast pathway", die bei laufender Tachykardie einen Reentrykreislauf bilden. Die einzig kausale Therapie einer AVNRT ist die Katheterablation einer der beiden Leitungsbahnen, bevorzugt des "slow pathway". Diese Studie hatte zum Ziel sowohl die kurz-als auch die langfristigen Ergebnisse bei 506 Patienten (mittleres Alter 52,6 ± 16 Jahre, 315 Frauen) nach Ablation des langsamen Leitungswegs auszuwerten und Paramter zu bestimmen, anhand derer die Wahrscheinlichkeit für ein Rezidiv der AVNRT nach primär erfolgreicher Ablation bestimmt werden kann. Besonderes Augenmerk wurde dabei auf die residualen Leitungseigenschaften des slow pathway am Ende der Ablation gelegt. Diese Studie zeigt, dass allein das Alter des Patienten als Vorhersagewert für das Auftreten eines Rezidivs herangezogen werden kann - je jünger der Patient, desto häufiger tritt ein Rezidiv auf. Alle anderen klinischen und elektrophysiologischen Parameter erwiesen sich als nicht signifikant für die Wahrscheinlichkeit eines Rezidivs., The AV-Nodal Reentrant Tachykardia (AVNRT) is one of the most common regular supraventricular tachycardias. The underlying basis shall be the functional segmentation of the AV node in two longitudinal pathways, a slowly transmitting "slow pathway" and a rapidly transmitting "fast pathway", which form a reentry circulation during an ongoing tachycardia. The only casual therapy of an AVNRT is the catheter ablation of one of the pathways, preferably the slow pathway. The objective of this study was both the evaluation of the acute and long-term results of 506 patients (mean age 52,6 ± 16 years, 315 women) after ablation of the slow pathway and the determination of parameters which serve as the basis for determing the probability of a recurrence of the tachycardia after a primary successful ablation. In this process, particular attention was paid to the residual conduction of the slow pathway after ablation. This study shows that solely the age of a patient ca be used as a predictive value for the occurence of a recurrence - the younger the patient, the more frequently the occurence of a recurrence. All remaining clinical and electrophysiological parameters prove to be non-significant for the probability of a recurrence.

Die AV-Knoten-Reentry-Tachykardie (AVNRT) ist eine der häufigsten regelmäßigen supraventrikulären Tachykardien. Zugrunde liegend ist hierbei eine funktionelle Aufteilung des AV-Knotens in zwei longitudinale Leitungsbahnen, einen langsam leitenden "slow pathway" und einen schnell leitenden "fast pathway", die bei laufender Tachykardie einen Reentrykreislauf bilden. Die einzig kausale Therapie einer AVNRT ist die Katheterablation einer der beiden Leitungsbahnen, bevorzugt des "slow pathway". Diese Studie hatte zum Ziel sowohl die kurz-als auch die langfristigen Ergebnisse bei 506 Patienten (mittleres Alter 52,6 ± 16 Jahre, 315 Frauen) nach Ablation des langsamen Leitungswegs auszuwerten und Paramter zu bestimmen, anhand derer die Wahrscheinlichkeit für ein Rezidiv der AVNRT nach primär erfolgreicher Ablation bestimmt werden kann. Besonderes Augenmerk wurde dabei auf die residualen Leitungseigenschaften des slow pathway am Ende der Ablation gelegt. Diese Studie zeigt, dass allein das Alter des Patienten als Vorhersagewert für das Auftreten eines Rezidivs herangezogen werden kann - je jünger der Patient, desto häufiger tritt ein Rezidiv auf. Alle anderen klinischen und elektrophysiologischen Parameter erwiesen sich als nicht signifikant für die Wahrscheinlichkeit eines Rezidivs., The AV-Nodal Reentrant Tachykardia (AVNRT) is one of the most common regular supraventricular tachycardias. The underlying basis shall be the functional segmentation of the AV node in two longitudinal pathways, a slowly transmitting "slow pathway" and a rapidly transmitting "fast pathway", which form a reentry circulation during an ongoing tachycardia. The only casual therapy of an AVNRT is the catheter ablation of one of the pathways, preferably the slow pathway. The objective of this study was both the evaluation of the acute and long-term results of 506 patients (mean age 52,6 ± 16 years, 315 women) after ablation of the slow pathway and the determination of parameters which serve as the basis for determing the probability of a recurrence of the tachycardia after a primary successful ablation. In this process, particular attention was paid to the residual conduction of the slow pathway after ablation. This study shows that solely the age of a patient ca be used as a predictive value for the occurence of a recurrence - the younger the patient, the more frequently the occurence of a recurrence. All remaining clinical and electrophysiological parameters prove to be non-significant for the probability of a recurrence.