Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6-128/100,000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. ⋯ Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification.
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Comparative Study Clinical Trial
Lack of interference of electromagnetic navigation bronchoscopy to implanted cardioverter-defibrillator: in-vivo study.
Electromagnetic navigation bronchoscopy (ENB) (Superdimension) is a diagnostic and therapeutic tool in patients with lung lesions. Very small data are available about potential interference of ENB magnetic field to implanted cardioverter-defibrillators (ICDs) and any documentation of ICD behaviour if a ventricular tachyarrhythmia occurs during ENB is lacking. We tested a number of selected ICDs to assess if any interference occurs by ENB magnetic field on detection of clinical ventricular fibrillation and shock delivery. ⋯ All tested ICDs correctly operated and rescued the patients from induced ventricular fibrillation during ENB. Electromagnetic navigation bronchoscopy appears to be safe in heart patients with an ICD; however, close cardiac monitoring of these patients during ENB must be ensured as correct behaviour of all existing ICDs can only be presumed from compliance of the manufacturer to International Standards which establish procedures for electromagnetic interference checking on implantable devices on different ranges of frequency.
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Clinical Trial
Effect of beta-blockers on QT dynamics in the long QT syndrome: measuring the benefit.
Beta-blockers are the standard of care for the treatment of long QT syndrome (LQTS), and have been shown to reduce recurrent syncope and mortality in patients with type 1 LQTS (LQT1). Although beta-blockers have minimal effect on the resting corrected QT interval, their effect on the dynamics of the non-corrected QT interval is unknown, and may provide insight into their protective effects. ⋯ Beta-blockers have heart-rate-dependent effects on the QT and QTc intervals in LQTS. They appear to increase the QT and QTc intervals at slower heart rates and shorten them at faster heart rates during exercise.
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Recent guidelines for implantable cardioverter-defibrillator (ICD) use in patients with early ventricular arrhythmia (VA) after acute myocardial infarction (MI) are based on systolic function and revascularization status, yet decision to implant an ICD remains highly subjective. We aimed to determine characteristics, utilization of ICDs, and long-term outcomes of survivors of early VA (<48 h) after acute MI. ⋯ Early VA survivors after MI receiving ICD due to suspected non-reversible arrhythmogenic substrate have high rates of appropriate ICD therapy and mortality. Our ICD implantation practice corresponds well with the AUC. Sustained monomorphic VT and non-ST-elevation MI at presentation predict increased risk for death. Larger prospective studies are necessary to confirm our findings, such as to provide evidence for future ICD guidelines.