Search

Herzinsuffizienz ist ein Syndrom mit hoher Morbidität und Mortalität. Die neue ESC-Leitlinie stellt den aktuellen Standard der Empfehlung zur Diagnostik und Therapie der akuten und chronischen Herzinsuffizienz dar. Die wesentlichste Änderung ist die Einführung einer veränderten Erstlinientherapie der Herzinsuffizienz mit reduzierter Pumpfunktion, die mit einer Klasse-I-Empfehlung versehen ist (ACE-Hemmer bzw. Sacubitril/Valsartan, Betablocker, Mineralokortikoidrezeptor-Antagonisten und SGLT2-Inhibitoren). Es wird empfohlen, alle Substanzklassen früh zu starten und nicht mehr nacheinander nach vorheriger Titration zu maximal tolerierten Dosen zu verabreichen. Der Kommentar geht auf Neuerungen der ESC-Leitlinie und die deutsche Behandlungswirklichkeit ein.

Während die Standardschrittmachertherapie seit Jahrzehnten etabliert ist, betonen die neuen ESC-Leitlinien zur kardialen Stimulation und kardialen Resynchronisation die Korrelation von Symptomen im Zusammenhang mit dokumentierten Pausen und einer Stimulationsindikation insbesondere bei Patienten mit Synkopen. Asymptomatische Pausen rechtfertigen nur in Einzelfällen eine Stimulationsindikation. Der Wert implantierbarer Loop-Rekorder wird hervorgehoben. Darüber hinaus enthalten die neuen Leitlinien nur minimale Änderungen bei den Indikationen für die CRT, einschließlich einer Herabstufung für LSB und QRS-Komplex 130–149 ms und für ein CRT-Upgrade sowie ein Upgrade der CRT im Einklang mit dem Pace-and-ablate-Konzept. Außerdem werden zum ersten Mal Empfehlungen für die Stimulation nach TAVI vorgestellt. Neue Formen der Stimulation wie die sondenlose Stimulation und die Stimulation des Reizleitungssystems werden nun diskutiert, wobei die Empfehlungen für die sondenlose Stimulation und die His-Stimulation oder die Linksschenkelstimulation noch begrenzt sind.

Herzinsuffizienz ist ein Syndrom mit hoher Morbidität und Mortalität. Die neue ESC-Leitlinie stellt den aktuellen Standard der Empfehlung zur Diagnostik und Therapie der akuten und chronischen Herzinsuffizienz dar. Die wesentlichste Änderung ist die Einführung einer veränderten Erstlinientherapie der Herzinsuffizienz mit reduzierter Pumpfunktion, die mit einer Klasse-I-Empfehlung versehen ist (ACE-Hemmer bzw. Sacubitril/Valsartan, Betablocker, Mineralokortikoidrezeptor-Antagonisten und SGLT2-Inhibitoren). Es wird empfohlen, alle Substanzklassen früh zu starten und nicht mehr nacheinander nach vorheriger Titration zu maximal tolerierten Dosen zu verabreichen. Der Kommentar geht auf Neuerungen der ESC-Leitlinie und die deutsche Behandlungswirklichkeit ein.

Aim:This study compares the outcomes of patients who receive an implantable loop recorder (ILR) for unexplained syncope to a control group without the diagnostic device in German claims data. Methodsand materials:Patients with ILR were matched to a control group based on prior syncope events, age, gender and Charlson Comorbidity index (CCI). Survival, syncope hospitalizations, treatment and costs were compared. Results/conclusion:Four hundred and twelve ILR patients were matched with controls, mean age was 68, mean CCI was 2.7, 42% females. ILR patients lived on average 1.2 years longer than patients in the control group. Twenty-five percent of ILR patients received a therapeutic device compared with 5% in the control group. ILRs might help to diagnose and treat patients with positive impact on survival.

Methylphenidate (Ritalin®) is an increasingly used medication in the treatment of attention-deficit hyperactivity disorder (ADHD). Cardiovascular adverse effects like vasospasm or myocardial infarction are described as very rare adverse effects. We present the case of a 21-year-old man diagnosed with ADHD who recently started therapy with Ritalin®Adult 20 mg for at least 3 days. Afterwards he presented with chest pain, elevated troponin and creatine kinase, and posterolateral ST elevations. A myocarditis was initially supposed. In the coronary angiography, signs of coronary artery spasm could be found. The echocardiography showed mild left ventricular dysfunction; no acute myocarditis could be found in the cardiac MRI and myocardial biopsy. The medication with methylphenidate was stopped, and after 12 days the asymptomatic patient was discharged from hospital.

ObjectiveIncreasing utilization rates of implantable cardioverter-defi brillators (ICDs) tend to overburden follow-up resources at the implanting electrophysiological centres (ECs). Remote monitoring technology allows physicians from diff erent institutions to simultaneously review ICD data of shared patients. We studied if an integrated follow-up care involving ECs and general cardiologists (GCs) may reduce the frequency of in-offi ce follow-ups at ECs by using remote monitoring data to identify routine checks that may be conducted at GCs.Methods and resultsThe analysis included 109 patients (aged 63 ± 11 years, 84.4% male) followed for a cumulative study duration of 155 patient-years. The patients underwent 436 in-offi ce controls after hospital discharge: 143 (33%) at two ECs and 293 (67%) at two GCs (each cooperating with one EC). The mean duration of in-offi ce follow-up sessions was 13.7 min (EC) and 10.3 min (GC). The average distance between patients’ homes and follow-up sites was 31.6 km (EC) vs. 16.2 km (GC). Investigators considered a follow-up to be of ‘high or medium’ importance in 78% (EC) vs. 45% (GC) of all in-offi ce follow-ups. At one EC, the integrated follow-up care concept appeared highly successful, with 97% of follow-ups transferred to the corresponding GC and, on average, 103.8 km shorter patient trips per follow-up.ConclusionsIntegrated follow-up care guided by remote monitoring allows to direct the more signifi cant follow-ups towards ECs and routine follow-ups towards GCs. This concept may contribute to the needed adaptations of the health-care system to the rising numbers of patients with implanted devices.

Abstract

We report the history of a 60-year-old patient with a multiple myeloma and staphylococcus aureus associated sepsis to whom adenosine in a dose of 6 mg was administered, when a regular, narrow QRS complex tachycardia at a heart rate of 120 beats/minute started. Adenosine led to a complete AV-block and revealed atrial flutter. Atrial flutter waves persisted for about 15 seconds and were followed by atrial and ventricular asystole for about 20 seconds. Repeated nonsustained polymorphic ventricular tachycardias followed and after about 90 seconds sinus rhythm was restored.

Background:P‐wave signal averaged ECG has been used to detect atrial late potentials that were found in paroxysmal atrial fibrillation. Ischemia is supposed to trigger ventricular late potentials, which indicate an elevated risk for ventricular tachycardia. Preexistent ventricular late potentials measured by ventricular signal averaged ECG is supposed to be eliminated by successful PTCA.

Objective— The aim of this study was to evaluate if administration of adenosine during sinus rhythm to patients with PSVT of unknown mechanism is capable to detect dual AV nodal conduction and furthermore to evaluate this diagnostic parameter as a controlling test after slow pathway ablation in AVNRT.Methods and results— Before electrophysiological study 35 consecutive patients with PSVT were given adenosine during sinus rhythm. After radiofrequency ablation the adenosine test was repeated in a subset of 19 patients. The electrophysiological study revealed 19 patients (54%) with typical AVNRT (study group), 10 (29%) with atrioventricular reentry tachycardia (AVRT), 4 (11%) with ectopic atrial tachycardia (EAT) and 2 patients (6%) with inducible atrial flutter (AF) (control group). We observed a sudden increment of the PQ interval of more than 50 msec between two consecutive beats in 15 of 19 patients (79%) in the study group (75 ± 35 msec) and in 2 patients (1 with EAT, AF) of the control group (19 ± 12 msec) (p<0.001). After slow pathway radiofrequency ablation the sudden increment of PQ interval persisted in 4 of 12 patients (33%) of the study group. Three of these 4 patients had a relapse of AVNRT during a follow-up of 3 months.Conclusion— The administration of adenosine during sinus rhythm is an excellent noninvasive diagnostic test for identifying dual AV nodal conduction and additionally for verifying radiofrequency ablation results in patients with AVNRT.