Zeitschrift für Kardiologie
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Case Reports
Catheter ablation of junctional ectopic tachycardia in children, with preservation of atrioventricular conduction.
Idiopathic junctional ectopic tachycardia is a rare arrhythmia in children. Several studies have demonstrated that drug therapy is often ineffective and sometimes the only achieved effect is rate control. Early presentation and frequent recurrence are associated with adverse outcome. ⋯ Radio frequency catheter ablation of junctional ectopic tachycardia is feasible with preservation of atrioventricular conduction.
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In order to improve the quality of medical care, minimum volumes for services were set. Hospitals are only permitted to continue to provide these services and settle accounts with the health insurance companies if they are able to achieve these minimum annual volumes. This study is based on service data of the year 2002 from 88 neighboring hospitals of the hospital association Cologne, Bonn and region. ⋯ Depending on the minimum quantity, service concentrations are only expected for pacemaker implantations. Due to the increasing service concentration as a consequence of the DRG-payment system, a bureaucratic regulation of minimum volumes has become superfluous for most cardiological services. Instead of minimum volume regulations, recommendation of minimum volumes should be made in cardiological guidelines.
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We report about a 52-year old woman, who underwent a resection of a left atrial myxoma 20 years ago. Twelve years later she suffered from exertional dyspnea. Echocardiography revealed a recurrent myxoma. ⋯ Eight years later the woman suffered from disturbances of heart rhythm and from angina pectoris. The coronary arteries were normal, but a recurrent left atrial myxoma was found and operated. We conclude a long-term follow-up is inevitable in patients after the resection of a myxoma.
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Aggressive antithrombotic medical therapy may increase the rate of access-site complications after percutaneous coronary intervention. Frequently, emergency coronary interventions have to be performed in a situation when thrombolysis therapy was administered as the first-line therapeutic approach in acute myocardial infarction but failed to achieve stable conditions. We analyzed the rate of femoral bleeding complications after emergency coronary intervention in 76 consecutive patients with unsuccessful thrombolysis in acute myocardial infarction. ⋯ In three patients (3.9%) femoral hematomas without therapeutic consequences were documented; one patient (1.3%) developed a hematoma requiring blood transfusion. A pseudoaneurysm, fistula or surgical vascular intervention did not occur. Coronary interventional procedures in rescue situations can be performed with excellent safety with respect to access-site bleeding complications even under conditions of ongoing thrombolysis therapy and aggressive antithrombotic medical regimens.
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Measures of quality assurance in echocardiography can be categorized according to standard principles into measures of reviewing structure, processing, and results. This document contains 1) the description of a three level system for education and qualifying in echocardiographic examinations (quality of structure) and 2) the draft of an external quality assurance process for reviewing the results of one echocardiographic investigator or of one laboratory of echocardiography (quality of results). The document also contains a draft description of a nationwide independent institution for certification, which is needed for both projects. ⋯ The external quality assurance process should provide the possibility to certify the results and reports of a single investigator or of an echo laboratory, according to standard principles of reviewing the records. The process of certification is exclusively performed on a voluntary basis. The nationwide institution of certification should be part of the academy of education in cardiology of the German Society of Cardiology.