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Abstract Aims Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field. Methods In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. Results Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p 30 s and > 0.1 mV were found. Two ST-T segment changes

Up to 20% of patients with ischemic stroke or transient ischemic attack have a prior history of known atrial fibrillation (AF). Additionally, unknown AF can be detected by different monitoring strategies in up to 23% of patients with cryptogenic or non-cardioembolic stroke. However, most studies had substantial gaps in monitoring time, especially early after the index event. Following this, AF rates would be higher if patients underwent continuous monitoring early after stroke, avoiding any gaps in monitoring. The few existing randomized studies focused on patients with cryptogenic stroke but did not focus otherwise specifically on prevention strategies in patients at high risk for AF (patients at higher age or with high CHA2DS2-VASC scores). Besides invasive implantable loop recorders (ILRs), external loop recorders (ELRs) and mobile cardiac outpatient telemetry (MCOT) are non-invasive tools that are commonly used for long-term ECG monitoring in cryptogenic-stroke patients in the ambulatory setting. The role of MCOT and hand-held devices within ECG smart monitoring in the detection of AF for the prevention of and after cryptogenic stroke is currently unclear. This intense review provides an overview of current evidence, techniques, and gaps in knowledge and aims to advise which patients benefit most from the current available devices.

Introduction: Evidence of sex-related differences in patients with pacemakers regarding comorbidities is insufficiently investigated. The aim of this study was to determine the relationship of cardiovascular comorbidities and sex category with properties of pacemaker implantation, pacemaker follow-up, and long-term survival.Methods: This retrospective, single-center cohort study consisted of 6,362 pacemaker-patients (39.7% female) enrolled between May 2000 and April 2015. Functional pacemaker parameters were registered at regular pacemaker controls. Survival status and cause of death were analyzed in relation to comorbidities, implanted pacing devices, and echocardiography. Survival analyses were plotted for a 10-year follow-up.Results: Patients with hypertension or hyperlipidemia had higher rates of implantations due to sick sinus syndrome (28.6 vs. 25.5% without hypertension, P < 0.001; 30.7 vs. 25.7% without hyperlipidemia, P < 0.001), while endocarditis was associated with higher rates of implantations due to AV block (46.7 vs. 33.4%, P < 0.001). Patients with valvular heart disease had higher rates of pacemaker implantation due to bradycardic atrial fibrillation (24.9 vs. 21.0% without valvular heart disease, P < 0.001). Ventricular pacing threshold increased in both sexes during the follow-up and was higher in women in the final follow-up (0.94 vs. 0.91 V in men, P = 0.002). During the 10-years follow-up, 6.1% of women and 8.6% of men underwent lead replacement (P = 0.054). Device and lead replacement rates were increased if the comorbidities coronary artery disease, heart failure, hypertension, hyperlipidemia, valvular heart disease, previous stroke/TIA, atrial arrhythmias, chronic kidney disease, or endocarditis were present. Diabetes and previous CABG increase the rates of device replacement, but not the rate of lead replacement. Severe tricuspid regurgitation after implantation of pacemaker was present in more men than women (14.4 vs. 6.1%, P < 0.001). In a multivariate COX regression, the following variables were associated with independent decrease of 10-year survival: hypertension (HR 1.34, 95% CI 1.09–1.64), chronic kidney disease (HR 1.83, 95% CI 1.53–2.19), tricuspid regurgitation after pacemaker implantation (HR 1.48, 95% CI 1.26–1.74). Survival was independently increased in female sex (HR 0.83, 95% CI 0.70–0.99) and hyperlipidemia (HR 0.81, 95% CI 0.67–0.97).Conclusions: Cardiovascular comorbidities influenced significantly pacemaker implantations and long-term outcome.Trial Registration:ClinicalTrials.gov Unique identifier: NCT03388281.

Guidelines for the diagnosis and management of syncope (2009).

Внешние эксперты: Haruhiko Abe (Япония), David G. Benditt (США), Wyatt W. Decker (США), Blair P. Grubb (США), Horacio Kaufmann9 (США), Carlos Morillo (Канада), Brian Olshansky (США), Steve W. Parry (Великобритания), Robert Sheldon (Канада), Win K. Shen (США)Члены Комитета Европейского общества кардиологов по практическим рекомендациям (ESC Committee for Practice Guidelines: CPG): Alec Vahanian (Председатель) (Франция), Angelo Auricchio (Швейцария),Jeroen Bax (Нидерланды), Claudio Ceconi (Италия), Veronica Dean (Франция), Gerasimos Filippatos (Греция), Christian Funck-Brentano (Франция), Richard Hobbs (Великобритания), Peter Kearney (Ирландия), Theresa McDonagh (Великобритания), Keith McGregor (Франция), Bogdan A. Popescu (Румыния), Zeljko Reiner (Хорватия), Udo Sechtem (Германия), Per Anton Sirnes (Норвегия), Michal Tendera (Польша), Panos Vardas (Греция), Petr Widimsky (Чехия)Рецензенты: Angelo Auricchio (Координатор от CPG) (Швейцария), Esmeray Acarturk (Турция), Felicita Andreotti (Италия), Riccardo Asteggiano (Италия), Urs Bauersfeld (Швейцария), Abdelouahab Bellou4 (Франция), Athanase Benetos6 (Франция), Johan Brandt (Швеция), Mina K. Chung3 (США), Pietro Cortelli 8 (Италия), Antoine Da Costa (Франция), Fabrice Extramiana (Франция), Jose´ Ferro7 (Португалия), Bulent Gorenek (Турция), Antti Hedman (Финляндия), Rafael Hirsch (Израиль), Gabriela Kaliska (Словакия), Rose Anne Kenny6 (Ирландия), Keld Per Kjeldsen (Дания), Rachel Lampert 3 (USA), Henning Mølgard (Denmark), Rain Paju (Эстония), Aras Puodziukynas (Литва), Antonio Raviele (Италия), Pilar Roman5 (Испания), Martin Scherer (Германия), Ronald Schondorf 9 (Канада), Rosa Sicari (Италия), Peter Vanbrabant 4 (Бельгия), Christian Wolpert1 (Германия), Jose Luis Zamorano (Испания).