[Troubleshooting in Patients with Implanted Pacemaker and ICD].

Because of the growing number of implanted cardiac pacemakers and defibrillators and the ever-increasing complexity of these devices a fundamental knowledge of device malfunctions is of utmost importance even for the non-cardiology physician. Apart from hardware problems such as device infection, lead fracture or dislocation, basic knowledge of the pacemaker sensing and pacing algorithms is also necessary in order to judge the stimulation behavior in different clinical settings. With this respect, there are specific problems for antibradycardia and resynchronizing pacemakers as well as implantable defibrillators.

[Practical aspects of pacemaker and ICD-lead extractions].

Special tools for lead removal enables transvenous lead extractions without cardiac exposure. The risk of fatal complications during extraction of long-term implanted leads requires detailed knowledge and trained physicians. In addition to patients’ age and gender, individual extraction risk factors are access and time since implantation, lead position, kind and number of leads.

Endocardial radiofrequency ablation for hypertrophic obstructive cardiomyopathy: acute results and 6 months' follow-up in 19 patients.

Objectives: The purpose of this study was to examine the efficacy and safety of endocardial radiofrequency ablation of septal hypertrophy (ERASH) for left ventricular outflow tract (LVOT) gradient reduction in hypertrophic obstructive cardiomyopathy (HOCM).

Background: Anatomic variability of the vessels supplying the obstructing septal bulge can limit the efficacy of transcoronary ablation of septal hypertrophy in HOCM. Previous studies showed that inducing a local contraction disorder without reducing septal mass results in effective gradient reduction.

Resynchronization therapy optimization by intracardiac impedance.

Aims: For successful cardiac resynchronization therapy (CRT), an optimization of left ventricular (LV) lead position and stimulation timing is required. The feasibility of optimizing LV lead position, atrioventricular delay (AVd), and interventricular delay (VVd) in CRT using intracardiac impedance measurement was evaluated.

Methods And Results: Heart failure patients (n = 14, NYHA 13×III, 1×II, ejection fraction: 26 ± 6%, QRS: 165 ± 30 ms) were stimulated by AAI and biventricular (DDD-BiV) pacing in turn.

Intracardiac impedance monitors stroke volume in resynchronization therapy patients.

Aims: Monitoring of haemodynamic parameters or surrogate parameters of the left ventricle is especially important for patients under cardiac resynchronization therapy (CRT). Intracardiac impedance reflects left ventricular (LV) volume changes well in animal models. Since it is unknown whether this also holds in humans with heart failure (HF), we examined the correlation of LV intracardiac impedance with haemodynamic parameters in CRT patients for different positions of the LV lead.

Predictors of complete heart block after transcoronary ablation of septal hypertrophy: results of a prospective electrophysiological investigation in 172 patients with hypertrophic obstructive cardiomyopathy.

Objectives: This study analyzed changes in intracardiac conduction during transcoronary ablation of septal hypertrophy (TASH) to identify predictors for pacemaker dependency after TASH.

Background: Transcoronary ablation of septal hypertrophy is an accepted therapeutic option in hypertrophic obstructive cardiomyopathy (HOCM). However, atrioventricular conduction disorders, requiring permanent pacemaker implantation, remain a major adverse effect.

Transcoronary ablation of septal hypertrophy does not alter ICD intervention rates in high risk patients with hypertrophic obstructive cardiomyopathy.

Introduction: Transcoronary ablation of septal hypertrophy (TASH) is safe and effectively reduces the intraventricular gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM). To analyze the potential of anti- and proarrhythmic effects of TASH, we studied the discharge rates of implanted cardioverter defibrillators (ICD) in patients with HOCM who are at a high risk for sudden cardiac death.

Methods: ICD and TASH were performed in 15 patients.