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Abstract: Cardiac resynchronization therapy (CRT) is the therapy of choice for patients with symptomatic systolic heart failure (HF) and left bundle branch block (LBBB), despite optimal medical therapy (OMT). The recently published 2021 European Society of Cardiology (ESC) Guidelines on cardiac pacing and cardiac resynchronization therapy highlight the importance of CRT on top of OMT in HF patients with left ventricular ejection fraction (LVEF) ≤ 35%, sinus rhythm and typical LBBB with QRS duration ≥150ms. In the presence of medically intractable or recurrent after catheter ablation atrial fibrillation (AF), AV nodal ablation as an adjuvant therapy becomes more relevant in patients qualifying for the implantation of a biventricular system. Furthermore, CRT may be considered in cases when increased pacing of the right ventricle is not desirable. However, alternative pacing sites and strategies are currently available, if the CRT is not feasible and effective in patients. However, strategies targeting “multi-sides” or using “multi-leads” have shown superiority over classic CRT. On the other hand, conduction system pacing seems to be a promising technique. Although early results are positive, consistency during the long term is pending. The indication for additional defibrillation therapy (ICD) may occasionally be unnecessary and has to be considered individually. Due to the great development and success of heart failure drug therapy, its positive effect on LV function can lead to enormous improvement. Physicians must await these effects and findings, which hopefully could lead to a relevant LV improvement resulting in a definitive decision against an ICD.

Conduction system pacing is an alternative practice to conventional right ventricular apical pacing. It is a method that maintains physiologic ventricular activation, based on a correct pathophysiological basis, in which the pacing lead bypasses the lesion of the electrical fibers, and the electrical impulse transmits through the intact adjacent conduction system. For this reason, it might reasonably characterized by the term “electrical bypass” compared to the coronary artery bypass in revascularization therapy. In this review reference is made to the sequence of events that conventional right ventricular pacing may cause adverse outcomes. Furthermore, there is a reference to alternative strategies and pacing sites. Interest focuses on the modalities for which there is data from the literature, namely for the Right Ventricular (RV) septal pacing, the His Bunde pacing (HBP), and the Left Bundle Branch pacing (LBBP). A more extensive reference is about the HBP, for which there are the most updating data. We analyze the considerations that limit HBP wide application in three axes, and we also present the data for the implantation and follow-up of these patients. Then, the indications with their most important studies to date are described in detail, not only in their undoubtedly positive findings but also in their weak aspects, because of which, this pacing mode has not yet received a strong recommendation for implementation. Finally, there is a report on LBBP, focusing mainly on its points of differentiation from HBP.

Case Reports sind haufig der erste Schritt sowohl von Innovationen als auch von neuen Techniken in der Wissenschaft und bieten somit das Fundament fur einige spater etablierte Verfahren. Daruber hinaus haben sie einen grosen Fortbildungseffekt und bieten jungen Wissenschaftlern die Moglichkeit ihre ersten Erfahrungen beim Schreiben von Manuskripten zu erlangen. Wesentlich fur einen guten Case Report sind neben einem interessanten Detail (zum Beispiel einer Abbildung) eine klare Schlussfolgerung/Nachricht.

Implantable cardioverter defibrillators (ICD) represent an established treatment in preventing sudden cardiac death in patients with indications for primary or secondary prophylaxis. As for all complex surgical procedures there remains a risk for the occurrence of complications including death also for ICD implantation. The aim of the present study was to analyze the procedure-related mortality in patients after ICD implantation using the data from the obligatory quality assurance program in North-Rhine/Westphalia.Data of all 18,625 patients from the quality assurance datasets who underwent ICD implantation in the years 2010-2012 were analyzed.During the in-hospital stay 118 patients (0.6%) died after ICD implantation. Patients 80 years old had a higher mortality (1.9% vs. 0.5% in patients 80 years old, p 0.001) as well as women (0.95% vs. 0.54% in men, p = 0.004) and patients with higher New York Heart Association (NYHA) class (0.3% for NYHA II, 0.7% for NYHA III, 3.4% for NYHA IV, p 0.001 for all comparisons). The presence of diabetes mellitus (23% of the collective) did not influence the perioperative mortality, whereas renal failure requiring dialysis showed a significantly increased mortality (p 0.001 compared to patients with creatinine ≤ 1.5 mg/dl and p = 0.002 for patients with creatinine 1.5 mg/dl not requiring dialysis). Patients with indications for ICD secondary prophylaxis had a significantly higher mortality (1.2% vs. 0.4%, p 0.001), which increased from 0.6% to 3.7% (p 0.001) with the occurrence of complications.The procedure-related mortality after ICD implantation is increased in patients over 80 years of age, higher NYHA class, patients requiring dialysis, in secondary prevention indications and after the occurrence of perioperative complications.HINTERGRUND: Implantierbare Kardioverter-Defibrillatoren (ICD) sind zum Schutz vor plötzlichem Herztod bei Patienten mit primär- oder sekundärprophylaktischer Indikation etabliert. Wie bei allen komplexen operativen Verfahren verbleibt auch bei der ICD-Implantation ein Risiko für Komplikationen bis hin zum Tod. Gegenstand der vorliegenden Arbeit ist es, anhand der Datensätze zur obligaten Qualitätssicherung in Nordrhein-Westfalen die prozedurbezogene Mortalität nach ICD-Implantation zu analysieren.Aus den Datensätzen erfolgte eine Analyse der stationären Todesfälle bei allen 18.625 ICD-Implantationen der Jahre 2010 bis 2012.Während des stationären Aufenthalts verstarben 118 Patienten (0,6 %) nach ICD-Implantation. Patienten im Alter über 80 Jahre (7 %) zeigten eine höhere Mortalität (1,9 % vs. 0,5 % bei 80-jährigen Patienten, p 0,001), ebenso Frauen (0,95 % vs. 0,54 % bei Männern; p = 0,004) und Patienten mit hoher NYHA(New York Heart Association)-Klasse (0,3 % bei NYHA II, 0,7 % bei NYHA III, 3,4 % bei NYHA IV; p 0,001 für alle Vergleiche). Das Vorliegen von Diabetes mellitus (23 % des Kollektivs) beeinflusste die perioperative Letalität nicht, während eine dialysepflichtige Niereninsuffizienz eine signifikant erhöhte Mortalität aufwies (p 0,001 gegenüber Patienten mit Kreatinin ≤ 1,5 mg/dl; p = 0,002 gegenüber nicht dialysepflichtigen Patienten mit Kreatinin 1,5 mg/dl). Patienten mit sekundärprophylaktischer ICD-Indikation wiesen eine signifikant höhere Mortalität auf (1,2 % vs. 0,4 %; p 0,001), die sich beim Auftreten von Komplikationen von 0,6 % auf 3,7 % erhöhte (p 0,001).Die operationsbezogene Mortalität bei ICD-Implantation ist bei Patienten über 80 Jahre, hoher NYHA-Klasse, Dialysepflicht, sekundärprophylaktischer Indikation und nach Auftreten von Komplikationen erhöht.

Die Fortschritte der kardialen Bildgebung und bei den 3‑D-Mappingverfahren haben in der letzten Dekade zu einem signifikanten Erkenntnisgewinn hinsichtlich der Korrelation ventrikularer Extrasystolen (VES) mit anatomischen Strukturen gefuhrt. Bei allem technischen Fortschritt bleibt die Interpretation des 12-Kanal-EKGs Grundlage fur die klinische Praxis. So lasst sich mit fundiertem Grundwissen uber die kardiale Anatomie und Erregungsausbreitung – unter Berucksichtigung der Limitationen der Methode – die Herkunft ventrikularer Ektopien mit hinreichender Genauigkeit bestimmen. Zur groben Eingrenzung reichen bereits wenige Anhaltspunkte. Anhand des Lagetyps kann zwischen einem diaphragmalen Ursprung mit superiorer Achse und einem weiter superior gelegenen Ursprung mit einem nach inferior gerichteten Summationsvektor unterschieden werden. In den Brustwandableitungen kann mit hoher Wahrscheinlichkeit von einem linksventrikularen Ursprung einer Ektopie ausgegangen werden, wenn diese eine Rechtsschenkelblock-Morphologie oder positive Konkordanz zeigt. Eine Linksschenkelblock-Morphologie kann neben dem rechten Ventrikel als Ursprungsort auch das interventrikulare Septum miteinschliesen. Je spater die R/S-Transition der Brustwandableitungen erfolgt, desto weiter anterior ist der Ursprung der VES. Die sich kreuzenden Ausflusstrakte der Ventrikel erschweren eine Lokalisation von VES aus diesem Bereich. Hier gibt v. a. die Form und Hohe der R‑Zacke in V1–V3 einen Aufschluss uber den moglichen Ursprungsort. Unscharfen in der EKG-Lokalisation bestehen insbesondere bei semimobilen Strukturen wie den Papillarmuskeln und dem Moderatorband, mit variablem Verlauf innerhalb der Ventrikel. Auf Basis der so gewonnenen Informationen kann in der Folge eine fundierte Einschatzung uber die Prognose und den zu erwartenden Erfolg einer medikamentosen oder invasiven Therapie getroffen werden.

ZusammenfassungDas EKG stellt eine der wichtigsten nicht invasiven Untersuchungsmethoden dar. Im klinischen Alltag bietet es einen hohen Informationsgehalt bei sehr geringen Kosten. Nichtsdestotrotz ist die EKG-Interpretation für viele Ärzte herausfordernd. Selbst bei einem normalen EKG bedarf es ausreichender Sorgfalt, um die einzelnen Zeitintervalle ordentlich zu vermessen. Deutlich schwieriger wird die Interpretation beim Auftreten von Herzrhythmusstörungen. Hier müssen dann (wie z. B. beim Vorhofflimmern) mehrere Messungen durchgeführt und berücksichtigt werden, um das QT-Intervall korrekt zu beurteilen. Weitere EKG-Veränderungen können die Messung und Interpretation der QT-Zeit weiter beeinflussen. So kommt insbesondere bei Frequenzvariabilität (Tachykardien/Bradykardien) und beim Auftreten von Schenkelblockierungen die Anwendung diverser Formeln zum Tragen. Erst nach Berücksichtigung all dieser Aspekte kann eine ordentliche Messung und Interpretation der QTc-Zeit erfolgen.

Background The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. Methods and results We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. Conclusion 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm. Graphic abstract

Silent cerebral microembolic events (SCE) after duty-cycled ablation of atrial fibrillation using PVAC have been detected by cerebral magnet resonance imaging (MRI) in a substantial number of patients. The purpose of this study was to investigate if uninterrupted oral anticoagulation with non-vitamin K antagonists (NOACs) compared with vitamin K antagonists (VKA) affects the incidence of SCE after pulmonary vein isolation (PVI) using PVAC Gold. Eighty-four consecutive patients (62 ± 15 years, 58% male) undergoing a first PVI were prospectively enrolled. Of these, 42 were on VKA and 42 on uninterrupted NOAC treatment. An activated clotting time (ACT) ≥ 350 s was targeted for ablation. Cerebral MRI the day after PVI revealed acute diffusion-weighted positive lesions in 11/42 (26%) VKA compared with 14/42 (33%) in NOAC patients (p = 0.634). No differences were found for lesion size, number of lesions/patient, and number of lesions indicating cerebral infarction (2.4% for VKA and 4.8% for NOAC patients). Seventy-five percent of NOAC patients with sporadic ACT levels < 300 s during PVI developed SCE compared with 22% of corresponding VKA patients (p = 0.030). VKA and NOAC subgroups with ACT ≥ 350 s had no reduced incidence of SCE compared with ACT 300–350 s. A significant, but comparable, number of patients under uninterrupted anticoagulation with VKA or NOACs still experience SCE after PVAC Gold PVI. NOAC patients with sporadic subtherapeutic ACT levels during PVI are at the highest risk for SCE while permanent ACT levels ≥ 350 s did not further reduce the incidence of SCE in both groups.

Background The right bundle branch block (RBBB) and the bifascicular blocks affect QRS duration in the right precordial leads, which are usually used for QT interval determination. Up to now, there is no clear recommendation how to determine QT interval in patients with RBBB or bifascicular block. Hypothesis The hypothesis of the present study was to evaluate the feasibility of a simple formula for RBBB and bifascicular block correction, thereby making it easier to determine the QTc interval. Methods In patients with intrinsic QRS duration

We sought to establish the technical feasibility of VT-mapping with high-density catheters in patients with Mitraclips, requiring a hemodynamic support. A 73-year-old man with ischemic cardiomyopathy and reduced left ventricular ejection fraction (LVEF ~ 20%) was presented due to syncope and adequate shock of his ICD. Due to severe mitral valve regurgitation (MR), two Mitraclips were implanted earlier. The decision for catheter ablation was made in line with current guidelines. Given the increased PAAINESD score, the use of hemodynamic support was required. To employ an Impella pump via the retrograde transaortic approach, LV-mapping and VT-ablation were necessary to be performed via the transseptal approach, which was challenging due to the presence of Mitraclips. The MV passage with the steerable sheath was guided by a quadripolar catheter and 3D transoesophageal echo (TEE). After the 12F steerable sheath had passed the MV, the quadripolar catheter was exchanged by a high-density (HD) Grid® catheter. Hereafter, the Impella pump was placed retrogradely in the LV, and voltage-mapping of the LV and ablation was performed. At the end of the procedure, the Impella pump could be removed in stable hemodynamic conditions. The follow-up after 3, 6, and 12 months showed no new VT episodes. This case demonstrates the feasibility of the transseptal approach of VT mapping used HD Grid catheter and retrograde hemodynamic support with Impella Pump for VT treatment in patients after Mitraclips implantation. To avoid a damage of the MV and Mitraclips, 3D-TEE is advisable.

Background: Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implantable cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation (undertaken before ICD implantation to prevent ICD shocks for VT) and deferred ablation after 3 ICD shocks for VT. Methods: The BERLIN VT study (Preventive Ablation of Ventricular Tachycardia in Patients With Myocardial Infarction) was a prospective, open, parallel, randomized trial performed at 26 centers. Patients with stable ischemic cardiomyopathy, a left ventricular ejection fraction between 30% and 50%, and documented VT were randomly assigned 1:1 to a preventive or deferred ablation strategy. The primary outcome was a composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure. Secondary outcomes included sustained ventricular tachyarrhythmia and appropriate ICD therapy. We hypothesized that preventive ablation strategy would be superior to deferred ablation strategy in the intention-to-treat population. Results: During a mean follow-up of 396±284 days, the primary end point occurred in 25 (32.9%) of 76 patients in the preventive ablation group and 23 (27.7%) of 83 patients in the deferred ablation group (hazard ratio, 1.09 [95% CI, 0.62–1.92]; P =0.77). On the basis of prespecified criteria for interim analyses, the study was terminated early for futility. In the preventive versus deferred ablation group, 6 versus 2 patients died (7.9% versus 2.4%; P =0.18), 8 versus 2 patients were admitted for worsening heart failure (10.4% versus 2.3%; P =0.062), and 15 versus 21 patients were hospitalized for symptomatic ventricular arrhythmia (19.5% versus 25.3%; P =0.27). Among secondary outcomes, the proportions of patients with sustained ventricular tachyarrhythmia (39.7% versus 48.2%; P =0.050) and appropriate ICD therapy (34.2% versus 47.0%; P =0.020) were numerically reduced in the preventive ablation group. Conclusions: Preventive VT ablation before ICD implantation did not reduce mortality or hospitalization for arrhythmia or worsening heart failure during 1 year of follow-up compared with the deferred ablation strategy. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02501005.

The electrical storm (ES) defined as ≥3 sustained episodes of ventricular tachycardia within a 24 h period comprises a wide spectrum of clinical entities. Mostly patients suffer from severe heart insufficiency and comorbidities making an immediate transfer into a heart center with multidisciplinary expertise in the treatment of ES mandatory. As these patients are often traumatized by ongoing tachycardia despite multiple cardioversions, early deep sedation and β‑blockade to break the vicious circle of sympathico-adrenergic hyperactivation is very effective. Multiple ICD discharges suggesting the diagnosis of ES are inadequate in one third of cases. Pharmacological suppression, frequency control or ablation of supraventricular tachycardias (SVT) help in most cases. In some cases "oversensing" demands optimization of ICD programming. Even so not all adequate ICD discharges, however, are necessary. Since every ICD discharge worsens the patient's prognosis, any kind of ICD discharge should be prevented as far as hemodynamically feasible. After clinical stabilization of the patient with simultaneous acquisition of ECG and testing for reversible causes of ES, ES should be terminated by external or internal cardioversion followed by urgent but elective therapy. Some cases of ES, however, may require immediate escalation of therapy with emergency ablation or revascularization sometimes with circulatory support systems. If ES still persists, a further step in escalation may be taken by cardiac sympathetic denervation. Due to the poor prognosis of patients after ES, close monitoring of the patient, preferably with telemedicine, is indicated.

With an estimated incidence of approximated 36 per 100,000 persons per year, paroxysmal supraventricular tachycardias form a relevant clinical set of problems. They occur based on different substrates with varied symptoms and electrocardiographic items. The 12-channel ECG depicts the background to determine the underlying pathomechanism. The sinus node and all components of the conduction system such as atrial myocardium can be involved. Vagal maneuvers, several pharmacological strategies and various ablation technology are available for acute therapy.

Seit dem 6. Weltsymposium wird eine pulmonale Hypertonie (PH) als eine Erhohung des mittleren pulmonalarteriellen Drucks >20 mmHg und eines pulmonalvaskularen Widerstands ≥3 Wood-Einheiten definiert. Herzrhythmusstorungen sind ein zunehmendes Problem bei Patienten mit einer pulmonalen Hypertonie. Pathophysiologisch liegen eine durch die rechtsatriale Druckerhohung und Dilatation bedingte atriale Fibrose und durch den erhohten sympathischen Tonus bedingte Verlangerung des Aktionspotenzials sowie verzogerte Depolarisationen zugrunde, die zu Herzrhythmusstorungen fuhren. Die Behandlung umfasst eine medikamentose Therapie mit einer Praferenz fur Amiodaron und elektrophysiologische Masnahmen, wie elektrische Kardioversionen und Ablationen, welche bei PH-Patienten technisch sicher durchfuhrbar sind.

The quantity of data produced and captured in medicine today is unprecedented. Technological improvements and automation have expanded the traditional statistical methods and enabled the analysis of Big Data. This has permitted the discovery of new associations with a granularity that was previously hidden to human eyes. In the first part of this review, the authors would like to provide an overview of basic Machine Learning (ML) principles and techniques in order to better understand their application in recent publications about cardiac arrhythmias. In the second part, ML-enabled advances in disease detection and diagnosis, outcome prediction, and novel disease characterization in topics like electrocardiography, atrial fibrillation, ventricular arrhythmias, and cardiac devices are presented. Finally, the limitations and challenges of applying ML in clinical practice, such as validation, replication, generalizability, and regulatory issues, are discussed. More carefully designed studies and collaborations are needed for ML to become feasible, trustworthy, accurate, and reproducible and to reach its full potential for patient-oriented precision medicine.Die Menge generierter und erfasster Daten in der Medizin war noch nie so hoch wie heute. Der technologische Fortschritt und die Automatisierung haben die traditionellen statistischen Methoden erweitert und die Analyse von Big Data ermöglicht. Dies hat die Entdeckung neuer Assoziationen mit einer Granularität ermöglicht, die dem Menschen zuvor verborgen war. Der erste Teil dieser Übersichtsarbeit bietet einen Überblick der grundlegenden Prinzipien und Techniken des maschinellen Lernens (ML), um deren Anwendung in den neuesten Veröffentlichungen über Herzrhythmusstörungen besser zu verstehen. Der zweite Teil schildert ML-gestützte Fortschritte bei der Erkennung und Diagnose von Erkrankungen, bei der Vorhersage von Ergebnissen und bei der neuartigen Charakterisierung von Erkrankungen im Zusammenhang mit Themen wie Elektrokardiographie, Vorhofflimmern, ventrikulären Arrhythmien und kardialen Geräten. Schließlich werden die Grenzen und Herausforderungen der Anwendung von ML in der klinischen Praxis diskutiert, beispielsweise in Bezug auf Validierung, Replikation, Verallgemeinerbarkeit und regulatorische Fragen. Weitere sorgfältig konzipierte Studien und Kooperationen sind erforderlich, damit ML umsetzbar, verlässlich, präzise und reproduzierbar wird und um ihr volles Potenzial für eine patientenorientierte Präzisionsmedizin ausschöpfen zu können.

In patients with high risk for sudden cardiac death the implantation of a defibrillator is an established treatment. However the benefits and risks for patients in accordance to the number of the leads are not clear. Even in the current guidelines a recommendation to this question is missing. We analyzed advantage and disadvantages of single-chamber implantable cardioverter defibrillators (VVI-ICD) versus dual-chamber implantable cardioverter defibrillators (DDD-ICD) in the prospective German Device Registry. The data of 2240 patients who underwent ICD implantation in 45 German Centers between January 2007 and March 2011 were included in a prospective device registry (VVI: n = 1629, male = 1358, EF = 34% ± 13%; DDD: n = 611, male = 491, EF = 35% ± 14%). The in-hospital complications were significantly higher in the DDD-ICD group with higher revision/device complication rates (3.0% vs. 1.2%; p = 0.003) but also higher mortality rate (1.0% vs. 0.1%; p

Purpose The cephalic vein cutdown (CVC) and the subclavian puncture (SP) is the most common access for pacemaker implantation. The purpose of this study was to compare the peri-/postoperative complications of these approaches. Methods A retrospective analysis of the quality assurance data of the state of North Rhine-Westphalia was performed to evaluate the peri-/postoperative complications of first pacemaker implantation according to the venous access. The primary endpoint was defined as the occurrence of one of the following: asystole, ventricular fibrillation, pneumothorax, hemothorax, pericardial effusion, pocket hematoma, lead dislocation, lead dysfunction, postoperative wound infection or other complication requiring intervention. Descriptive analysis was done via absolute, relative frequencies and Odds Ratio. Fisher’s exact test was used for comparison of the both study groups. Results From 139,176 pacemaker implantations from 2010 to 2014, 15,483 cases were excluded due to other/double access. The median age was 78 years and the access used was CVC for 75,251 cases (60.8%) and SP for 48,442 cases (39.2%). The implanted devices were mainly dual-chamber pacemakers (73.9% in the CVC group and 78.4% in the SP group), followed by single-chamber pacemakers VVI (24.9% and 19.9% in the CVC and SP group respectively). There were significantly fewer peri/postoperative complications in the CVC group compared to the SP group (2.49% vs. 3.64%, p = 0.0001, OR 1.47; 95% CI 1.38–1.57). Conclusions CVC as venous access for pacemaker implantation has significantly fewer peri/postoperative complications than SP and appears to be an advantageous technique.

Case reports are often the first step of innovations and new techniques in science and thus are fundamental for some later established procedures. In addition, they have a great educational effect and offer young scientists the opportunity to gain their first experiences in writing manuscripts. In addition to an interesting detail (e.g. figure), a clear message is essential for a good case report.Case Reports sind häufig der erste Schritt sowohl von Innovationen als auch von neuen Techniken in der Wissenschaft und bieten somit das Fundament für einige später etablierte Verfahren. Darüber hinaus haben sie einen großen Fortbildungseffekt und bieten jungen Wissenschaftlern die Möglichkeit ihre ersten Erfahrungen beim Schreiben von Manuskripten zu erlangen. Wesentlich für einen guten Case Report sind neben einem interessanten Detail (zum Beispiel einer Abbildung) eine klare Schlussfolgerung/Nachricht.