Herzschrittmachertherapie und Elektrophysiologie最新文献

{"title":"Cardioinhibitory reflex syncope : Cardioneuroablation as a therapeutic alternative.","authors":"Amelie Beblo, Robert Hättasch, Nikolaos Dagres, Felix Hohendanner, Gerhard Hindricks, Sergio Richter, Verena Tscholl","doi":"10.1007/s00399-025-01103-8","DOIUrl":"https://doi.org/10.1007/s00399-025-01103-8","url":null,"abstract":"<p><p>The case of a 36-year-old female patient with recurrent reflex syncope characterized by predominant cardioinhibition and episodes of asystole lasting up to 9 s, as documented by an implantable loop recorder, is reported. Given her young age and symptomatic burden, cardioneuroablation (CNA) was performed without complications as an alternative to pacemaker implantation, in accordance with European Heart Rhythm Association (EHRA) recommendations. In this case, CNA has shown to be an effective and safe treatment option for managing recurrent cardioinhibitory reflex syncope. CNA should particularly be considered and offered in specialised centres for symptomatic patients under 40 years of age, in which treatment options beyond conservative measures remain limited.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of suture closure systems in interventional electrophysiology : Impact on workflows, resource utilization, reimbursement, and patient safety in hospitals in the STYLE AF study].","authors":"Sorin Ștefan Popescu, Christian Elsner, Noemi Kucharz, Valerie Zu Rhein, Clarissa Engewald, Kai Pardey, Roland Richard Tilz","doi":"10.1007/s00399-025-01095-5","DOIUrl":"https://doi.org/10.1007/s00399-025-01095-5","url":null,"abstract":"<p><strong>Background and objectives: </strong>Catheter ablation of cardiac arrhythmias is typically performed via femoral venous access. To reduce bleeding complications and shorten hospital stays, venous closure devices are gaining importance. This study aimed to quantitatively evaluate the impact of closure devices, \"tagesstationär\" (2 day-case stay with night leave) billing, and early recovery room (post-anesthesia care unit, PACU) discharge on economic indicators, patient-related outcomes, and staffing requirements.</p><p><strong>Methods: </strong>Based on data from the STYLE-AF study-including PACU length of stay, groin bleeding rates, and additional outcome parameters-supplemented by expert interviews and literature review, we conducted a simulation study and real-world implementation to analyze various scenarios: use of closure devices, \"tagesstationär\" discharge billing, early PACU discharge, and combinations thereof. Primary endpoints were time savings in the PACU, changes in groin bleeding probability, and gains in patient comfort quantified by quality-adjusted life years (QALYs).</p><p><strong>Results: </strong>The exclusive use of closure devices led to a 6.5% increase in case throughput and a gain of 0.0034 QALYs per patient. When combined with same-day discharge billing, the contribution margin increased by € 415 per case. Switching to same-day discharge billing without closure devices yielded a € 388.80 higher revenue per case but did not result in QALY gains or staff workload reductions. The most substantial effects were observed with the combined implementation of all measures: a 25% increase in case volume, € 661.27 higher contribution margin per patient, up to 24% relative reduction in PACU staff workload, and a QALY gain of 0.0034.</p><p><strong>Conclusion: </strong>Closure devices, particularly when integrated with process optimizations and \"tagesstationär\" discharge billing, provide significant multidimensional benefits across economic performance (contribution margin), resource efficiency (PACU time), and patient outcomes (QALYs through reduced groin bleeding)-contingent on institutional context and consistent implementation.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rhythm therapy for congenital heart defects with implantable electronic devices].","authors":"Peter A Zartner","doi":"10.1007/s00399-025-01080-y","DOIUrl":"10.1007/s00399-025-01080-y","url":null,"abstract":"<p><p>Patients with congenital heart defects have an increased indication rate for pacemaker systems and implantable cardioverter defibrillators (ICD), which however are not designed for children. Therefore, the combination of selected materials is essential for long-term and safe therapy. Epimyocardial systems are the best option for neonates and infants, as well as patients with Fontan circulation who do not have systemic venous access to the heart. For most other patients, transvenous systems are advantageous because the leads and batteries last longer and are easier to adjust as the patient grows. To avoid vascular complications, only the thinnest leads should be used and broken leads should be explanted. Telemetric monitoring is urgently indicated for these patients in order to detect rhythm or system disturbances at an early stage.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"119-125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Angiology in rhythmology: What should I know about vascular complications?]","authors":"Kristina Sonnenschein","doi":"10.1007/s00399-025-01067-9","DOIUrl":"10.1007/s00399-025-01067-9","url":null,"abstract":"<p><p>Both the performance of electrophysiological examinations and the implantation of cardiac devices (pacemakers, implantable cardioverter-defibrillator [ICDs], and cardiac resynchronization therapy defibrillator [CRT-D] systems) are associated with vascular punctures. This article provides an overview of possible vascular complications and their management from the perspective of angiology. The most common access site for invasive electrophysiological procedures is usually via the femoral veins and/or arteries. Puncture of the brachial vessels is a possible but rarely used alternative. For implantation of transvenous cardiac devices, access via the cephalic vein or axillary vein is used. The electrodes located in the venous vascular system represent a foreign material and increase the risk of thrombus formation in the affected vein. Punctures of the femoral vessels can lead to bleeding, thrombosis and the formation of arteriovenous fistulas or pseudoaneurysms (aneurysma spurium). Venous thromboses can occur postprocedurally. The correct puncture technique is essential to avoid complications. Ultrasound-guided puncture also significantly reduces the rate of vascular complications.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"166-170"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of His-bundle ablation after pacemaker implantation in patients with persistent or permanent atrial fibrillation.","authors":"Celine Zezyk, Andreas A Boehmer, Moritz Rothe, Fabian Bork, Bernhard M Kaess, Joachim R Ehrlich","doi":"10.1007/s00399-025-01082-w","DOIUrl":"10.1007/s00399-025-01082-w","url":null,"abstract":"<p><strong>Background: </strong>His-bundle ablation after pacemaker implantation is an effective means of rate control in patients with refractory atrial fibrillation (AF). Pacemaker insertion may be complicated by lead dislodgement, and accordingly, His-bundle ablation is commonly postponed to 4-8 weeks after pacemaker implantation. Theoretically, His-bundle ablation itself could also lead to atrial or ventricular lead dislodgement. The precise rate of lead dislodgement in this context is unknown.</p><p><strong>Objective: </strong>To determine atrial or ventricular lead dislodgements in patients with pacemaker implantation and His-bundle ablation.</p><p><strong>Methods: </strong>Consecutive patients with AF who received His-bundle ablation between 01/2017 and 12/2022 were retrospectively studied. Two groups were defined. Group 1 had de-novo pacemaker implantation and subsequent His-bundle ablation (at 4-8 weeks after implantation). A second group of patients underwent His-bundle ablation > 8 weeks after pacemakers (group 2) had been previously implanted for other indications. Pacemaker lead dislodgments were assessed as the primary endpoint prior to or immediately after His-bundle ablation and compared between the two groups.</p><p><strong>Results: </strong>Data from 177 patients were collected. Of these, 110 underwent implantation 4-8 weeks prior to ablation (group 1) and 67 were in group 2. Baseline patient and procedure characteristics were similar. Regarding the primary endpoint, no lead dislodgment was observed in either group. Any lead dislodgments observed occurred within 24 h of pacemaker implantation and were unrelated to His-bundle ablation.</p><p><strong>Conclusion: </strong>In patients with refractory persistent or permanent AF, His-bundle ablation is safe and no lead dislodgements were detected related to the ablation.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"132-137"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful pulsed field ablation of pulmonary veins in an atrial fibrillation patient with situs inversus totalis.","authors":"Endrik Wolff, Sybille Brandner, Mihai Hasmasan, Wishnu Mahardhika, Andreas Goette","doi":"10.1007/s00399-025-01077-7","DOIUrl":"10.1007/s00399-025-01077-7","url":null,"abstract":"<p><p>Situs inversus (situs transversus) is a rare congenital anomaly with an incidence of ∼0.01% in the general population. Catheter ablation of atrial fibrillation (AF) in patients with situs inversus totalis poses technical challenges. Here, the first case of successful pulsed field ablation (PFA) using the circular array catheter (PulseSelect™ PFA System; Medtronic) in an AF patient with situs inversus totalis is presented.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"171-175"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Was können junge RhythmologInnen und HerzchirurgInnen voneinander lernen?","authors":"","doi":"10.1007/s00399-025-01085-7","DOIUrl":"https://doi.org/10.1007/s00399-025-01085-7","url":null,"abstract":"","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":"36 2","pages":"176-178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical closure of the left atrial appendage for thromboembolism prophylaxis].","authors":"Ioana Geisler, Thomas Pühler, Stephan Ensminger, Buntaro Fujita","doi":"10.1007/s00399-025-01086-6","DOIUrl":"10.1007/s00399-025-01086-6","url":null,"abstract":"<p><strong>Background: </strong>The left atrial appendage (LAA) is the origin of thrombi in patients with atrial fibrillation (AF). Various techniques are available for surgical LAA occlusion. Current guidelines recommend surgical LAA closure as concomitant procedure in patients undergoing cardiac surgery or endoscopic or hybrid ablation for AF.</p><p><strong>Objectives: </strong>This review article summarizes the current scientific evidence regarding surgical LAA closure and provides an outlook into its potential role in the future.</p><p><strong>Materials and methods: </strong>A literature review was performed for LAA closure, indications, techniques, clinical outcomes, and ongoing studies.</p><p><strong>Results: </strong>Different techniques are performed for surgical LAA closure. In a large randomizes study surgical LAA closure was associated with a reduction in thromboembolism in patients with AF. There are ongoing studies that examine the potential role of surgical LAA closure in patients with sinus rhythm and increased risk for stroke.</p><p><strong>Conclusions: </strong>Surgical closure as a concomitant procedure in patients with AF undergoing cardiac surgery is now well established. It is unclear whether these patients require anticoagulation after successful closure. Currently, a few randomized trials are ongoing to evaluate whether prophylactic surgical LAA closure in patients with sinus rhythm and increased risk for stroke effectively reduces the incidence of stroke. At present, there are no data that support surgical LAA closure in patients with sinus rhythm and low risk for stroke.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"104-110"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Implantable cardioverter-defibrillators in patients with left ventricular assist devices : Current controversies].","authors":"Barbara Linz, Thomas Pühler, Julia Vogler, Christina Paitazoglou, Roland Richard Tilz, Stephan Ensminger, Buntaro Fujita","doi":"10.1007/s00399-025-01081-x","DOIUrl":"10.1007/s00399-025-01081-x","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular assist devices (LVAD) are used to treat patients with advanced heart failure. A significant fraction of these patients simultaneously fulfill the indication for an implantable cardioverter-defibrillator (ICD).</p><p><strong>Objectives: </strong>It is currently unclear whether patients require an ICD after LVAD implantation. In addition, it remains uncertain whether patients with an LVAD are suitable candidates for a subcutaneous ICD (S-ICD).</p><p><strong>Materials and methods: </strong>The aforementioned questions were addresses using studies, case reports, and our own experience.</p><p><strong>Results: </strong>Studies have yielded varying findings on the above question. While some investigations suggest that an ICD may also be beneficial for LVAD patients, other studies highlight potential risks with limited benefit. This underscores the complexity of clinical decision-making in this specific patient cohort. S‑ICDs can suffer from significant functional impairments after LVAD implantation, making this combination controversial.</p><p><strong>Conclusions: </strong>Due to the inconclusiveness of current studies, a general recommendation regarding the role of an ICD (both conventional and S‑ICD) after LVAD implantation cannot be established at this time. Therefore, it should involve individualized and interdisciplinary decision making.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"126-131"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical perspectives of rhythm therapy].","authors":"Brigitte Osswald, Buntaro Fujita","doi":"10.1007/s00399-025-01084-8","DOIUrl":"10.1007/s00399-025-01084-8","url":null,"abstract":"","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"103"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}