Herzschrittmachertherapie & Elektrophysiologie
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Herzschrittmacherther Elektrophysiol · Jun 2014
Epicardial ablation as a bailout in electrical storm?
Electrical storm (ES) is one of the most challenging clinical scenarios facing electrophysiologists, and in certain settings emergency ablation should be performed. The majority of ES occurs in patients with structural heart disease, predominantly coronary heart disease and nonischemic heart disease like right ventricular arrhythmogenic dysplasia and previous myocarditis as well as other cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) are the first-line therapy in patients with ventricular tachycardia (VT) and structural heart disease. ⋯ In some patients, an epicardial approach should be warranted first together with an endocardial approach or after failure of enodocardial ablation. Currently, the success rates of endocardial ablation in the acute setting are acceptable, but in the long term they are still not well defined. The purpose of this article is to highlight the importance of epicardial ablation as an alternative approach in controlling ES and to confirm the need for highly qualified centers to manage such challenging cases.
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Herzschrittmacherther Elektrophysiol · Mar 2016
[Acute kidney injury and renal replacement therapy in victims from out-of-hospital cardiac arrest with administration of contrast agent].
Early coronary angiography and computed tomography are recommended in survivors of out-of-hospital cardiac arrest (OHCA). However, both techniques require iodinated contrast agent although the effects on incident acute kidney injury are unknown. The aim of this study was to explore the incidence of acute kidney injuries (AKI) and need for renal replacement therapy (RRT) in patients after nontraumatic OHCA with special regard to the administration of contrast agent during the early in-hospital diagnostic workup. ⋯ AKI is common in survivors of OHCA, and RRT following OHCA is needed more frequently than in other cardiac disease. Despite elevated serum creatinine levels at admission, we could not show an association between early contrast administration in survivors of OHCA and AKI incidence.
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Herzschrittmacherther Elektrophysiol · Mar 2013
[Surgical closure of the left atrial appendage in patients with atrial fibrillation. Indications, techniques and results].
Cardiac embolisation in patients with atrial fibrillation accounts for the most serious complication of cerebral infarction. The left atrial appendage resembles the origin of these cardiac emboli in the majority of cases, although other anatomical areas of the left atrium might also be prerequisites for thrombus formation. Surgical closure of the left atrial appendage during an ablation therapy incorporates the theoretical possibility of reducing the rate of cardiac cerebral infarction. ⋯ Due to the good results of left atrial appendage excision, this surgical therapy at the moment presents the surgical gold standard, as this therapy is recommended in the updated ESC guidelines for the management of atrial fibrillation. If excision of the left atrial appendage will reduce the risk of cardiac embolisation needs to be examined in large prospective-randomized trials with a controlled systemic follow-up. So far, excision of the left atrial appendage as an alternative to oral anticoagulation, especially in patients with atrial fibrillation, is not recommended.
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Since the first studies on cardiac resynchronization therapy (CRT), the evidence for the benefit of this electrical therapy in heart failure has continuously grown. Thus, CRT has been firmly implemented in current therapy guidelines for heart failure. ⋯ This article aims to give an overview of the current guidelines for CRT and also discusses some of the differences between the different guidelines. It also provides an outlook for potential candidates for CRT in the future where current guidelines do not yet define a clear indication for implantation of such a device.
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Herzschrittmacherther Elektrophysiol · Mar 2002
[Pathophysiology of pacing in patients with atrial fibrillation].
The limited efficacy of and side effects associated with antiarrhythmic drug therapy have led to renewed interest in non-pharmacologic treatment options for paroxysmal atrial fibrillation. In addition to catheter ablation of the initiating ectopic atrial beats, electrical stimulation of the atrium is a new and promising method to reduce the frequency of arrhythmia recurrences. Recent studies have confirmed the importance of both the initiating triggers and the electrophysiologic substrate for the recurrence and perpetuation, respectively, of atrial fibrillation. ⋯ Finally, attempts are being made to terminate recurrences of atrial tachycardia or atrial flutter with antitachycardia pacing algorithms in order to avoid progression into atrial fibrillation. Based on experimental and clinical evidence, the initial phase of the majority of atrial tachyarrhythmia recurrences is not 'leading circle reentry'. Most episodes start relatively regular and seem to have an excitable gap, allowing capture and pace termination.