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Die Explantation von kardialen Devices und Extraktion von Sonden hat in den letzten Jahren enorm an Bedeutung gewonnen. Für diese Eingriffe wurde bisher kein einheitlicher Standard bezüglich der personellen, räumlichen und apparativen Voraussetzungen für Deutschland formuliert. Daher hat sich die Deutsche Gesellschaft für Kardiologie (DGK) gemeinsam mit der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) entschlossen, ein Konsensuspapier zu erarbeiten. Dieses Papier definiert fachgesellschaftsübergreifende Standards zur Durchführung dieser Eingriffe unter Berücksichtigung praktischer, klinischer und juristischer Aspekte.

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Cardiovascular implantable electronic devices can initiate and sustain pacemaker-mediated arrhythmias. Endless loop tachycardia and repetitive non-re-entrant ventriculoatrial synchrony (RNRVAS) are well-described examples of pacemaker-mediated arrhythmias. However, such arrhythmias only occur in the presence of ventriculoatrial conduction. We identified a novel pacemaker-mediated arrhythmia that closely mimics RNRVAS but in the absence of ventriculoatrial conduction. We identified these arrhythmias in 9 patients, all with a St. Jude Medical/Abbott device, recorded as inappropriate mode-switch episodes by a device algorithm that includes paced events in the atrial counter. This report describes the mechanism, discusses clinical implications, and outlines programming options to eliminate this pseudo-RNRVAS.

A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tracking. No data on the safety of this technology are yet available in a large cohort of patients.

Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes.

Recurrences of atrial fibrillation (AF) occur in up to 30 within 1 year after catheter ablation. This study evaluated the value of CHADS2, R2CHADS2, and CHA2DS2-VASc scores for the prediction of rhythm outcomes after AF catheter ablation.

Cardiac resynchronization therapy (CRT) device implantation can be challenging, time consuming, and fluoroscopy intense. To facilitate left ventricular lead placement, a novel sensor-based electromagnetic tracking system (MediGuide Technology MGT, St. Jude Medical) has been developed. We report the results of the First Human Use study evaluating the feasibility, safety, and performance of a novel CRT implantation approach using electromagnetic trackable operation equipment.

There are limited data on the predictive value of stroke risk scores for thromboembolic events (TEs) after catheter ablation of atrial fibrillation (AF). Our objectives were to report the incidence of TEs after AF ablation in a large contemporary AF ablation cohort and to investigate the impact of renal dysfunction and the value of stroke risk stratification scores (CHADS2, CHA2DS2-VASc, and R2CHADS2) for predicting TE after AF ablation.

Introduction: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with structural heart disease and at high risk for life threatening ventricular arrhythmias. Whether elderly patients benefit from device therapy in a similar way as younger patients is largely unknown.

Introduction:The randomized PRAETORIAN trial demonstrated non-inferiority of the subcutaneous implantable cardioverter-defibrillator (S-ICD) compared to the transvenous ICD (TV-ICD) with regard to inappropriate shocks and complications. Due to its extrathoracic position, the S-ICD lacks the possibility to provide antitachycardia pacing (ATP) which might result in more appropriate shock therapy. In this pre-specified secondary analysis, we aim to compare first occurrence of appropriate therapy in the S-ICD and TV-ICD.Methods:The PRAETORIAN trial is an international, multicenter, randomized trial (NCT01296022) in which 849 patients with a class I or IIa indication for ICD therapy and without the need for pacing were randomized in a 1:1 ratio to receive either an S-ICD (n = 426) or a TV-ICD (n = 423). Analyses were performed in the modified intention-to-treat population, which included patients according to the group to which they had been randomly assigned regardless of the device they received, but excluded patients who did not receive any ICD.Results:At a median follow-up of 49.1 months, 164 patients received appropriate therapy, of whom 86 in the S-ICD group and 78 in the TV-ICD group (48-month Kaplan-Meier estimated cumulative incidence 19.4% and 17.5%, respectively; hazard ratio 1.12; 95%CI, 0.83 to 1.53; p=0.45). In 83 patients (97%) in the S-ICD group the first arrhythmia was treated with a shock and in 3 patients (3%) with ATP. In 25 patients (32%) in the TV-ICD group the first arrhythmia was treated with a shock, in 31 patients (40%) solely with ATP and in 22 patients (28%) with ATP followed by a shock.Conclusions:In this secondary analysis of the PRAETORIAN trial, we found no statistical difference in first occurrence of appropriate therapy in the S-ICD group and TV-ICD group. Due to ATP, patients were less often treated with shocks in the TV-ICD group. A further analysis of all appropriate therapy in the PRAETORIAN trial could reveal the true benefit of ATP.