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Herzschrittmachertherapie & Elektrophysiologie

Martin Grett, Martin Christ, Hans-Joachim Trappe
BACKGROUND: Little is known about the incidence and risk factors for progression to pacemaker dependency or the need for cardiac resynchronization in typical patients with an implanted defibrillator with regard to an alternative implantation of a subcutaneous ICD (S-ICD). STUDY DESIGN AND METHODS: After retrospective analysis of 291 patients with first implantation of a transvenous single chamber ICD (VVI-ICD) from 2010-2016 and excluding those with an indication for pacemaker or lack of follow-up data, 121 patients were included and investigated with regard to the following endpoints: need for pacemaker stimulation, upgrade for cardiac resynchronization (CRT), and secondary occurrence and effectiveness of antitachycardia pacing (ATP)...
October 13, 2016: Herzschrittmachertherapie & Elektrophysiologie
Claudia Schaarschmidt, Christof Kolb
The subcutaneous implantable defibrillator (S-ICD) has become an established tool for the prevention of sudden cardiac death. Based on its detection properties, the S‑ICD is essentially dependent on correct morphology discrimination of the QRS complex and avoidance of potential T‑wave sensing. We report on a patient who experienced multiple inappropriate S‑ICD shocks due to T‑wave oversensing in the setting of new onset of right bundle branch block. Strategies for the optimisation of the device programming are discussed...
October 13, 2016: Herzschrittmachertherapie & Elektrophysiologie
Johannes Sperzel
No abstract text is available yet for this article.
October 6, 2016: Herzschrittmachertherapie & Elektrophysiologie
Julia W Erath, Abdul Sami Sirat, Mate Vamos, Stefan H Hohnloser
Persistent left superior vena cava is known to be a challenging anatomic abnormality for transvenous cardiac device implantation. In the a case of a young man presenting with dilative cardiomyopathy with severely impaired left ventricular ejection fraction (LVEF) and second-degree atrioventricular block (AV block), cardiac resynchronization therapy (CRT) with defibrillator (CRT-D) implantation was indicated. A transvenous approach was attempted, but placement of the right ventricular lead was not successful due to anatomic abnormalities...
September 19, 2016: Herzschrittmachertherapie & Elektrophysiologie
Dirk Vollmann, Claudius Hansen
A 35-year-old female was referred with progressive dyspnoea and elevated heart rate. Surface electrocardiography (ECG) showed supraventricular tachycardia (SVT) with long RP interval and inverse P waves. ECG revealed left ventricular dilation and severe systolic dysfunction. An electrophysiological (EP) examination was performed due to incessant SVT despite betablocker medication. Permanent junctional reciprocating tachycardia (PJRT) was diagnosed and successfully ablated. During follow-up, the patient's symptoms abated and ECG parameters normalized...
September 7, 2016: Herzschrittmachertherapie & Elektrophysiologie
Carsten W Israel
During the CARDIOSTIM/EUROPACE meeting in Nice, France, the First World Championship of Device Electrogram (EGM) Interpretation was held and more than 120 physicians participated actively. In the first round, questions on 20 EGMs had to be answered, and the eight finalists had to solve another seven EGM questions before gold, silver, and bronze medals were distributed. This activity prepared by STIMUPRAT - an organization in which electrophysiologists, other physicians, residents, fellows, and students share their tracings and thoughts with others - demonstrates that knowledge about the way devices think and document their events is not only important so as to optimize the treatment of device patients but can also be great fun...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Mark L Brown, Charles D Swerdlow
Ensuring sensing and detection of ventricular tachycardia (VT) and ventricular fibrillation (VF) was a prerequisite for the clinical trials that established the survival benefit of implantable cardioverter defibrillators (ICDs). However, for decades, a high incidence of unnecessary shocks limited patients' and physicians' acceptance of ICD therapy. Oversensing, misclassification of supraventricular tachycardia (SVT) as VT, and self-terminating VT accounted for the vast majority of unnecessary shocks. Medtronic ICDs utilize sensitive baseline settings with minimal blanking periods to ensure accurate sensing of VF, VT, and SVT electrograms...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Carsten W Israel, Tatsiana Burmistrava
Optimal implantable cardioverter-defibrillator (ICD) programming can reduce the incidence of inappropriate shock therapy and improve prognosis in patients with an ICD. Only after results from randomized trials became available was the "safety first" feeling overcome that mandated early shock therapy, waived the use of antitachycardia pacing and forced shock therapy after a time of 30 s expired, even if tachycardia discriminators would have withheld the therapy. The strong evidence to limit ICD therapy to longer ventricular tachycardia (VT) should not result in individually dangerous ICD programming, particularly in patients with a high risk of slow VT (known monomorphic VT, post VT ablation, during treatment with amiodarone, very dilated left ventricle)...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Jan Zdarek, Carsten W Israel
Modern implantable cardioverter/defibrillator (ICD) systems offer a multitude of algorithms to optimize performance in sensing and tachycardia detection even in difficult circumstances (e. g., ventricular tachycardia during supraventricular tachycardia, fine ventricular fibrillation with intermittent undersensing), to reliably discriminate sustained ventricular tachyarrhythmia from noise, nonsustained and supraventricular tachyarrhythmia, and to limit shock therapy only to those arrhythmias that definitely need to be treated by a shock...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Norbert Zanker, Diane Schuster, James Gilkerson, Kenneth Stein
AIM: The aim of this study was to summarize how implantable cardioverter defibrillators (ICDs) by Boston Scientific sense, detect, discriminate rhythms, and classify episodes. METHODS: Modern devices include multiple programming selections, diagnostic features, therapy options, memory functions, and device-related history features. Device operation includes logical steps from sensing, detection, discrimination, therapy delivery to history recording. The program is designed to facilitate the application of the device algorithms to the individual patient's clinical needs...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
S Serge Barold, Andreas Kucher
Some systems for cardiac resynchronization therapy (CRT) offer left ventricular sensing. This discussion with an illustrative case demonstrates that timing cycles in these devices may sometimes be difficult to understand because of left ventricular sensing. Programming of the left ventricular upper rate interval is crucial to optimize the resynchronization ability of the system. Interactions with the maximum sensor rate, the right ventricular upper rate interval, the left ventricular T wave protection algorithm, and the minimum ventricular tachycardia detection rate have to be considered...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Christof Kolb, Rolf Ocklenburg
For physicians involved in the treatment of patients with implantable cardioverter-defibrillators (ICDs) the knowledge of tachycardia detection algorithms is of paramount importance. This knowledge is essential for adequate device selection during de-novo implantation, ICD replacement, and for troubleshooting during follow-up. This review describes tachycardia detection algorithms incorporated in ICDs by Sorin/LivaNova and analyses their strengths and weaknesses.
September 2016: Herzschrittmachertherapie & Elektrophysiologie
L Eckardt, T Deneke
The 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death is an update of the former 2006 European/American guidelines. This new consensus document gives a detailed overview on prevention and therapy of ventricular arrhythmias and sudden cardiac death. This includes detailed discussion of channelopathies and various cardiomyopathies. Gaps in evidence are identified and also discussed. DNA analysis and postmortem assessment in sudden cardiac death victims is for the first time part of these new recommendations...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Thomas Maria Helms, Sigmund Silber, Andreas Schäfer, Florian Masuhr, Frederick Palm, Harald Darius, Karsten Schrör, Dietmar Bänsch, Peter Bramlage, Johannes Hankowitz, Christoph A Karle, Tom Stargardt, Joachim Weil, Johann Christoph Geller
With the introduction of edoxaban last year in Germany, four nonvitamin K antagonist oral anticoagulants are now available for stroke prevention in patients with nonvalvular atrial fibrillation. These novel oral anticoagulants (NOAC) represent an attractive new option compared to vitamin K antagonists (e.g., warfarin or phenprocoumon) due to simple use and fewer interactions with other drugs or food. Therefore, no INR monitoring and dosage adjustments are required for NOAC. The compelling clinical advantage of NOAC is the dramatic risk reduction of hemorhagic stroke and intracranial bleeding compared to current standard...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Thomas Brüggemann, Daniel Dahlke, Amin Chebbo, Ilka Neumann
Implantable cardioverter-defibrillators (ICD) have to reliably sense, detect, and treat malignant ventricular tachyarrhythmias. Inappropriate treatment of non life-threatening tachyarrhythmias should be avoided. This article outlines the functionality of ICDs developed and manufactured by BIOTRONIK. Proper sensing is achieved by an automatic sensitivity control which can be individually tailored to solve special under- and oversensing situations. The programming of detection zones for ventricular fibrillation (VF), ventricular tachycardia (VT), and zones to monitor other tachyarrhythmias is outlined...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Carsten W Israel
No abstract text is available yet for this article.
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Haran Burri
This case describes a tachycardia with a 1:1 atrioventricular relationship that was effectively terminated with antitachycardia pacing by the implantable cardioverter defibrillator. The differential diagnosis and clues that allow the reader to establish the correct diagnosis are discussed. The case also serves to analyse technical features of Boston Scientific dual-chamber defibrillators.
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Jan Steffel
In a 50-year-old patient with arrhythmogenic right ventricular cardiomyopathy (ARVC) and implantable cardioverter defibrillator (ICD) two shock discharges occurred after several ineffective attempts with antitachycardia pacing. The analysis of the stored electrograms shows a peculiarity of shocks with low energy, a problem of ICD therapy in ARVC, and the impact of committed shocks as opposed to non-committed shocks.
September 2016: Herzschrittmachertherapie & Elektrophysiologie
H Elfarra, R Moosdorf, L Rybinski, W Grimm
No abstract text is available yet for this article.
September 2016: Herzschrittmachertherapie & Elektrophysiologie
S Serge Barold, F Van Heuverswyn
A patient with a dual chamber implantable cardioverter-defibrillator developed a defective atrial lead whereupon the generated false atrial signals were repeatedly interpreted as atrial tachycardia/atrial fibrillation (AF) by the atrial upper rate algorithm coupled with rare episodes of noise reversion. This unusual response highlights the limitations of the upper atrial rate triggers of device diagnosis of supraventricular tachyarrhythmias. The converse may occur with a very fine AF or with a very sensitive sensitivity setting (e...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
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