Herzschrittmachertherapie & Elektrophysiologie
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Herzschrittmacherther Elektrophysiol · Mar 2012
[Sleep-disordered breathing and atrial fibrillation].
Sleep-disordered breathing is one of the most common sleep disorders. Especially obstructive sleep apnea (OSA) is an independent cardiovascular risk factor. Clinical studies have proven a significant association between OSA and atrial fibrillation, the most common cardiac arrhythmia. ⋯ However, there is a lack of randomized controlled clinical trials with defined end points on this topic. A specific sleep medicine interview as well as sleep studies with portable monitoring and cardiorespiratory polysomnography are recommended when sleep-disordered breathing is suspected. Procedures for the management of patients with atrial fibrillation are given.
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Herzschrittmacherther Elektrophysiol · Dec 2011
Comparative StudyClinical routine implantation of a dual chamber pacemaker system designed for safe use with MRI: a single center, retrospective study on lead performance of Medtronic lead 5086MRI in comparison to Medtronic leads 4592-53 and 4092-58.
We report our experience concerning lead performance and re-surgery rate of the Medtronic EnRhythm MRI SureScan pacemaker system (MRI-PM) in comparison to standard pacemaker (PM) systems and leads used at our institution. ⋯ Our study demonstrates favorable lead measurements of lead model 5086MRI in comparison to lead 4592 and 4092 in a short-term follow-up. The number of re-operations was higher in the MRI-PM group, but not statistically different in comparison with the standard dual chamber PM group.
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Herzschrittmacherther Elektrophysiol · Sep 2011
Review[Treating ICD patients at the end of their lives: attitudes, knowledge, and behavior of doctors and patients. A critical literature analysis].
The implantable cardioverter-defibrillator (ICD) is highly effective in the therapy of malign heart rhythm abnormalities. However, the ethical dilemma of harming a dying patient has received little attention. We studied the current state of knowledge and behavior of physicians and the subjective needs of ICD patients with respect to end-of-life issues. ⋯ Despite insufficient empirical data, findings point to a low willingness of ICD patients to confront the end-of-life issue and prefer decisions to be made by their physician. Substantial knowledge gaps of physicians may cause barriers in considering the option of deactivating the ICD.
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The second most frequent category of syncope is cardiac syncope. In contrast to syncope of noncardiac causes, the 1-year mortality of patients presenting with cardiac syncope without treatment is as high as 33%. Therefore, immediate diagnosis and treatment are necessary. ⋯ In many cases, an initial evaluation including history, physical examination, and electrocardiogram identifies the cause of syncope, so that specific treatment can be initiated immediately. In the remainder of cases, implantable loop recorders are useful to identify arrhythmias, while the presence or absence of structural cardiac disease is diagnosed by echocardiography. Syncope due to arrhythmias is typically treated with implantation of a pacemaker or an implantable cardioverter-defibrillator; treatment of syncope of other cardiac causes requires therapy of the underlying heart disease.