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Herzschrittmachertherapie & Elektrophysiologie

C Butter, S Fehrendt, V Möller, M Seifert
There are still several limitations in delivering cardiac resynchronisation therapy (CRT). After 6 months, 20-40% of patients fail to have clinical benefit due to various reasons. Endocardial stimulation rather than conventional epicardial pacing has been shown to be more physiological, improves electrical stimulation of the left ventricle (LV), has less dispersion of electrical activity and results in better resynchronisation. The WiSE™ CRT System ("Wireless stimulation endocardial system"; EBR Systems, Sunnyvale, CA, USA) provides an option for wireless, LV endocardial pacing triggered by a conventional right ventricular pacing spike from a co-implant...
November 8, 2018: Herzschrittmachertherapie & Elektrophysiologie
F V Y Tjong, B E Koop
Cardiac implantable electronic devices have been successfully treating patients with brady- and tachyarrhythmias for decades. However, there are still significant complications related to this therapy modality, many related to the transvenous lead. Paradigm-shifting technologies, such as the subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless cardiac pacemakers (LCP), have emerged to address these complications. The novel modular cardiac rhythm management (mCRM) system, consisting of a communicating antitachycardia pacing-enabled LCP and S‑ICD, is the first system to integrate wireless intrabody communication between devices to allow for coordination of leadless pacing and defibrillator therapy delivery...
October 31, 2018: Herzschrittmachertherapie & Elektrophysiologie
J Kuschyk, B Rudic, V Liebe, E Tülümen, M Borggrefe, I Akin
The worldwide prevalence of heart failure is 1-2% with a portion of >10% in patients older than 70 years. In addition to treatment of causal determined factors and lifestyle modification, basic treatment consists of guideline-directed medical therapy with angiotensin-converting enzyme inhibitors (ACE), β‑blockers (BB), mineralocorticoid receptor antagonists (MRA), diuretics, digitalis (class IIb recommendation), angiotensin receptor blockers (ARB), Iƒ-channel blockers plus recently recommended in the guidelines angiotensin receptor neprilysin inhibitor (ARNI) to substitute the ACE inhibitor (class I b)...
October 25, 2018: Herzschrittmachertherapie & Elektrophysiologie
David Duncker, Christian Veltmann
The wearable cardioverter/defibrillator (WCD) is safe and effective in the prevention of sudden cardiac death, and has found its way into international guidelines and clinical practice. Nearly 40,000 patients with a WCD have been published in clinical registries and one randomized study has recently been presented. Especially patients with newly diagnosed cardiomyopathy with severely reduced left ventricular function show an increased risk for ventricular tachyarrhythmias and may benefit from a WCD. In these patients without an indication for an implantable cardioverter-defibrillator (ICD), the WCD offers protection from sudden cardiac death during initiation and optimization of heart failure medication...
October 24, 2018: Herzschrittmachertherapie & Elektrophysiologie
Johannes Sperzel, Christian Hamm, Andreas Hain
Nanostim™ (St. Jude Medical Inc., Saint Paul, MN, USA; now Abbott Medical Inc. Abbott Park, IL, USA) was the first self-contained intracardiac pacemaker to be implanted in a human patient. A total of 1423 Nanostim devices were implanted worldwide between 2013 and 2016 and three clinical trials were initiated. Although the device was recalled in 2016 owing to rare but serious battery failures, the concept of leadless pacing has gained widespread acceptance and is expanding beyond the initial single-chamber devices to dual-chamber systems, biventricular pacing, and combinations with defibrillators...
October 19, 2018: Herzschrittmachertherapie & Elektrophysiologie
Andreas Hain, Christian Hamm, Johannes Sperzel
The pacemaker is the treatment of choice for symptomatic bradycardic arrhythmias. However, pacemaker patients may develop further bradycardial arrhythmias, often due to a pacemaker dysfunction. The possible causes range from lead problems to complete system failure. The NanostimTM system is a leadless pacemaker. The advantages include the lead-free design and the catheter-based implantation. In 2016, all NanostimTM implantations were stopped due to a battery dysfunction.
October 12, 2018: Herzschrittmachertherapie & Elektrophysiologie
Michael Döring, Sergio Richter, Helge Knopp, Gerhard Hindricks
In addition to the telemedical follow-up at a fixed point in time, there is the possibility of a close-meshed telemetric monitoring in modern devices. By transferring device and patient-specific data, errors in the integrity of the device or electrodes and cardiac arrhythmias can be detected early, in various studies significantly reducing the number of outpatient or inpatient visits and the rate of inadequate implantable cardioverter-defibrillator (ICD) therapies. Measurement of various surrogate parameters allows better clinical assessment of heart failure patients, yet no improvement in outcome with therapy guided by telemetric data has been demonstrated...
October 10, 2018: Herzschrittmachertherapie & Elektrophysiologie
Ester Herrmann, A Ecke, S Fichtlscherer, A M Zeiher, B Assmus
BACKGROUND: Patients with advanced heart failure suffer from frequent hospitalizations. Noninvasive hemodynamic telemonitoring for assessment of pulmonary filling pressure has been shown to reduce hospitalizations. In this article, our experience with possible control intervals and the standardization of the follow-up care of hemodynamic telemonitoring is reported. METHODS: A literature search and our own experience in the follow-up care concerning the implantable pulmonary artery pressure sensor for noninvasive hemodynamic telemonitoring in patients with advanced heart failure are presented...
October 10, 2018: Herzschrittmachertherapie & Elektrophysiologie
Philipp Niehues, Gerrit Frommeyer, Florian Reinke, Lars Eckardt
The use of transvenous implantable cardioverter-defibrillators (ICD) for the prevention of sudden cardiac death has been proven in numerous randomized trials. By using a totally subcutaneous ICD (S-ICD) system, it is expected to ensure appropriate protection while avoiding long-term complications associated with transvenous leads, such as systemic infection and electrode dysfunction. Meanwhile, the safety and effectiveness of the S‑ICD has been substantiated by results of large registry studies. Based on the missing option for ventricular stimulation, corresponding recommendations have been integrated into current guidelines for certain patient populations...
October 10, 2018: Herzschrittmachertherapie & Elektrophysiologie
Christoph Stellbrink, Bert Hansky, Philipp Baumann, Dennis Lawin
Sleep-related breathing disorders can be classified as either obstructive (OSA) or central sleep apnea (CSA). Whereas there is substantial knowledge about the pathophysiology and sound recommendations for the diagnosis and treatment of OSA, the origin of CSA is still incompletely understood, patient identification is difficult and the necessity for specific treatment is under debate. CSA often accompanies heart failure and is associated with an adverse prognosis. Optimized heart failure treatment reduces CSA and is thus the cornerstone of CSA treatment...
October 10, 2018: Herzschrittmachertherapie & Elektrophysiologie
Miriam Schnur, Severin Wannagat, Lena Loehr, Sebastian Lask, Andreas Mügge, Alexander Wutzler
BACKGROUND: Radiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether a reduction of radiation exposure with the use of "near-zero fluoroscopy" protocols is possible when applied by less experienced operators. METHODS: Consecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used...
August 28, 2018: Herzschrittmachertherapie & Elektrophysiologie
Felix Bourier, Pierre Jais
No abstract text is available yet for this article.
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Reinhard Höltgen, Philipp Sommer
No abstract text is available yet for this article.
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Isabel Deisenhofer
The three-dimensional (3D) mapping of cardiac arrhythmias has evolved in recent years to an important and extremely useful tool, providing important insights into arrhythmia mechanisms and thus improving ablation success rates, especially in complex arrhythmias. In atrial fibrillation (AF), the most common but also one of the most complex cardiac arrhythmias, progress in mapping technology has been focusing on several aspects according to the type of AF.In paroxysmal AF, important progress in the exact anatomic reconstruction of the main ablation target, i...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Dennis Lawin, Bert Hansky, Philipp Baumann, Christoph Stellbrink
This case highlights the difficulties in pacing lead implantation for transvenous phrenic nerve stimulation to treat central sleep apnea in heart failure. Cannulation of the left pericardiacophrenic vein (PPV) initially failed due to vessel tortuosity. On the basis of sound knowledge of collateral vessels, the inferior phrenic vein (IPV), which drains into the inferior vena cava, was intubated using a guide catheter. A guidewire could be retrogradely advanced via the IPV to the left PPV and brachiocephalic vein...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Kay Weipert, Malte Kuniss, Thomas Neumann
BACKGROUND: CardioInsight™ is a noninvasive three-dimensional mapping system technology which offers a unique method for arrhythmia characterization and localization. With a 252-lead ECG vest on the patient's torso and a noncontrast CT scan, epicardial potentials are detected and by means of reconstruction algorithms activation and phase maps are created, offering a deeper understanding of localization and mechanisms of arrhythmias including atrial fibrillation without the need for an endocardial catheter...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Thomas Gaspar
Cardiac resynchronization therapy (CRT) is an established pillar of treatment for patients with chronic heart failure. However, 30% of patients do not respond adequately to this type of therapy. One possible reason for this is a nonoptimal left ventricular stimulation site. This review focuses on possibilities of visualization of the coronary vein anatomy and its role in the determination of the electrical and mechanical dyssynchrony to optimize the therapeutic success of the resynchronization therapy. In addition, the clinical implication and the perspectives of a dedicated mapping of the coronary vein are discussed...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Stefan Georg Spitzer, László Károlyi, Carola Rämmler, Frank Scharfe, Mirko Zieschank, Anke Langbein
Catheter ablation has become the most common therapy in patients with atrial fibrillation (AF). However, despite significant advances in technology and operators' experience, ablation outcomes remain suboptimal, especially in patients with persistent AF. Focal impulse and rotor modulation (FIRM) represents a new technology for mapping and ablation of patient-specific AF sources. This approach is based on the concept of localized sources, which can be understood as organized rotational waves or focal impulses driving disorganized AF...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
Livio Bertagnolli, Federica Torri, Sergio Richter, Borislav Dinov, Andreas Müssigbrodt, Arash Arya, Philipp Sommer, Andreas Bollmann, Gerhard Hindricks, Sebastian Hilbert
The precise target location for radiofrequency energy delivery was initially determined through electrophysiological signals and with the help of fluoroscopy. The introduction of the 3D mapping system CARTO® (Biosense Webster Inc., Diamond Bar, CA, USA) in recent years for radiofrequency ablation of arrhythmias has provided new therapeutic options. These improvements have led to reduced procedural and fluoroscopic times. The introduction of new software and technology has also improved clinical outcome and helped to understand the substrate of complex arrhythmias...
September 2018: Herzschrittmachertherapie & Elektrophysiologie
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