Herzschrittmachertherapie & Elektrophysiologie
-
Herzschrittmacherther Elektrophysiol · Mar 2021
Review[Artificial intelligence in cardiology : Relevance, current applications, and future developments].
Big data and applications of artificial intelligence (AI), such as machine learning or deep learning, will enrich healthcare in the future and become increasingly important. Among other things, they have the potential to avoid unnecessary examinations as well as diagnostic and therapeutic errors. They could enable improved, early and accelerated decision-making. ⋯ The examples describe innovative solutions for risk assessment, diagnosis and therapy support up to patient self-management. Big data and AI serve as a basis for efficient, predictive, preventive and personalised medicine. However, the examples also show that research is needed to further develop the solutions for the benefit of the patient and the medical profession, to demonstrate the effectiveness and benefits in health care and to establish legal and ethical standards.
-
Herzschrittmacherther Elektrophysiol · Jun 2019
Review[Cardiac implantable electronic devices : Electromagnetic interference from electrocauterization, lithotripsy and physiotherapy].
The management of patients with a cardiac implantable electronic device (CIED) poses a particular challenge in the peri-interventional and perioperative medical environment due to the many forms of possible electromagnetic interference. Although the devices encountered nowadays are of increasing complexity, the vast majority of procedures can be safely performed in patients. The existing position statements and recommendations, however, have a low level of evidence and are often contradictory. ⋯ Although electromagnetic interference is possible, clinical observations with modern devices show that the procedure can generally be safely applied in CIED patients. Physiotherapy often utilizes a variety of electromechanical devices, which can be a relevant source of electromagnetic interference. Although some of these therapies can be safely used, coordination with the responsible CIED unit is recommended.
-
Herzschrittmacherther Elektrophysiol · Dec 2018
ReviewThe modular cardiac rhythm management system: the EMPOWER leadless pacemaker and the EMBLEM subcutaneous ICD.
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. ⋯ 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. In this review, the design and concept of the mCRM system are presented and available evidence is summarized.
-
Herzschrittmacherther Elektrophysiol · Sep 2016
ReviewDiagnosis of myocardial infarction and ischemia in the setting of bundle branch block and cardiac pacing.
The diagnosis of myocardial infarction (MI) in the presence of left bundle branch block (LBBB) or during ventricular pacing (VP) is challenging because of inherent changes in the sequence of ventricular depolarization and repolarization associated with both conditions. Although LBBB and right ventricular (RV) pacing may both produce abnormalities in the ECG, it is often possible to diagnose an acute MI (AMI) or an old MI based on selected morphologic changes. Primary ST-segment changes scoring 3 points or greater according to the Sgarbossa criteria are highly predictive of an AMI in patients with LBBB or RV pacing. ⋯ Diagnosing AMI in the setting of biventricular (BiV) pacing is challenging. To date there is minimal evidence suggesting that the traditional electrocardiographic criteria for diagnosis of AMI in bundle branch block may be applicable to patients with BiV pacing and positive QRS complexes on their ECG in lead V1. This report is a careful review of the electrocardiographic criteria facilitating the diagnosis of acute and remote MI in patients with LBBB and/or VP.
-
Herzschrittmacherther Elektrophysiol · Mar 2016
Review[New guidelines on resuscitation in adults : What has changed?]
In October 2015, new guidelines for cardiopulmonary resuscitation (CPR) were published, which represent a revision of the guidelines 2010. The new recommendations are based on an update of knowledge on resuscitation, which was evaluated for the first time by GRADE (Grading of Recommendations Assessment, Development and Evaluation). The key messages of the guidelines 2010 were retained in 2015. ⋯ In postresuscitation care, mild hypothermia (body temperature 32-34 °C) has been replaced by targeted temperature management in unconscious patients. Now, the guidelines recommend a constant body temperature between 32-36 °C for at least 24 h. Fever should be prevented or treated.