[Diagnostics and treatment of syncope].

The 2018 guidelines of the European Society of Cardiology (ESC) provide improved algorithms for the diagnostics and treatment of syncope. New guidelines on ventricular tachycardia, on the prevention of sudden cardiac death and on cardiomyopathies and pacemakers have refined the recommendations. The detailed medical history and examination are crucial for differentiating between cardiac and noncardiac causes and determining the appropriate treatment.

[Development of catheter ablation of supraventricular tachycardias with special consideration of contributions from German engineers and electrophysiologists].

The development and clinical implementation of catheter ablation of supraventricular tachycardia is one of the outstanding achievements of modern cardiovascular treatment. Over a period of less than 40 years, a curative and safe treatment strategy for almost all forms of atrial arrhythmias has been developed and implemented. German electrophysiologists and engineers have made a significant contribution to this truly outstanding success story in modern medicine.

Incidence and patterns of atrial fibrillation after catheter ablation of typical atrial flutter-the FLUTFIB study.

Aims: In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation (AF) may occur during follow-up. The presented FLUTFIB study was designed to identify the exact incidence, duration, timely occurrence, and associated symptoms of AF after CTI ablation using continuous cardiac monitoring via implantable loop recorders.

Methods And Results: One hundred patients with AFL without prior AF diagnosis were included after CTI ablation (mean age 69.

Diagnostic yield of an insertable cardiac monitor in a large patient population.

Background: Insertable cardiac monitors (ICMs) are increasingly used for cardiac rhythm diagnosis with expanding indications. Little has been reported about their use and efficacy.

Objective: The study sought to evaluate the clinical utility of a novel ICM (Biotronik BIOMONITOR III) including the time to diagnosis in unselected patients with different ICM indications.

Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis.

Aims: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures.

P-wave detection performance of the BioMonitor III, Confirm Rx and Reveal Linq implantable loop recorders.

Introduction: Rhythm interpretation of EGMs recorded by implantable loop recorders (ILRs) is facilitated in cases when p-waves are visible. The three most commonly used ILRs (BioMonitor III, Confirm RX and Reveal Linq) vary in size, electrode placement and filter algorithms. Therefore, p-wave visibility and amplitude on EGM may vary according to the implanted device.

Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry.

Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.

Cardiac arrhythmias in patients with COVID-19: Lessons from 2300 telemetric monitoring days on the intensive care unit.

Background: Patients with COVID-19 seem to be prone to the development of arrhythmias. The objective of this trial was to determine the characteristics, clinical significance and therapeutic consequences of these arrhythmias in COVID-19 patients requiring intensive care unit (ICU) treatment.

Methods And Results: A total of 113 consecutive patients (mean age 64.

Benefit of a wearable cardioverter defibrillator for detection and therapy of arrhythmias in patients with myocarditis.

Aims: Myocarditis may lead to malignant arrhythmias and sudden cardiac death. As of today, there are no reliable predictors to identify individuals at risk for these catastrophic events. The aim of this study was to evaluate if a wearable cardioverter defibrillator (WCD) may detect and treat such arrhythmias adequately in the peracute setting of myocarditis.

The use of a high-power (50 W), ablation index-guided protocol for ablation of the cavotricuspid isthmus.

Background: High-power (HP) ablation protocols are increasingly used for ablation procedures to shorten procedural times and improve short- and long-term success. The ablation index (AI) combines contact force, power settings, and ablation time. It can be used in combination with HP protocols to guide operators toward standardized lesions.

Reduction of mapping time in pulmonary vein isolation using atrial pacing during left atrial voltage map acquisition.

Introduction: 3D mapping systems are used during radiofrequency (RF) pulmonary vein isolation (PVI) to facilitate catheter navigation and to provide additional electroanatomical information as a surrogate marker for the presence and location of fibrotic atrial myocardium. Electric voltage information can only be measured when the myocardium is depolarized. Low heart rates or frequent premature atrial beats can significantly prolong creation of detailed left atrial voltage maps.

[Update on radiation exposure in catheter ablation of atrial fibrillation].

The rising number of catheter ablations of atrial fibrillation increases radiation exposure for both patients and surgeons. Fortunately, this trend is counteracted by the development of measures to reduce total fluoroscopy time using non-fluoroscopic catheter visualization. Since even low-dose radiation can cause serious injury, all options to reduce radiation burden must be utilized (ALARA, "as low as reasonably achievable").

Early NT-proBNP and MR-proANP associated with QoL 1 year after acutely decompensated heart failure: secondary analysis from the MOLITOR trial.

Heart failure negatively impacts quality of life (QoL), which in turn contributes to an adverse long-term prognosis. We aimed at identifying biomarker trajectories after an episode of acutely decompensated heart failure (ADHF) that differ between patients showing average versus impaired QoL 1 year later, thus allowing to predict impaired QoL. Biomarkers were repeatedly measured throughout the year in 104 ADHF patients.

Correlation of P-wave properties with the size of left atrial low voltage areas in patients with atrial fibrillation.

Background: Left atrial low voltage areas (LVA) are associated with increased recurrence rates of atrial fibrillation (AF) after catheter ablation and can be a potential ablation target during the procedure. Therefore, noninvasive prediction of the presence and the distribution of LVA may help physicians to predict ablation outcomes and to guide antiarrhythmic management.

Material And Methods: Seventy-three consecutive patients with atrial fibrillation undergoing first time left atrial ablation for paroxysmal or persistent AF were enrolled.

Velocity characteristics of atrial fibrillation sources determined by electrographic flow mapping before and after catheter ablation.

Background: Electrographic-Flow-(EGF)-Mapping is a novel method to identify Atrial Fibrillation (AF) drivers. Sources of excitation during AF can be characterized and monitored.

Objective: The aim of this study was to evaluate the correlation between velocity of EGF around a respective AF source and its spatial variability (SV) and stability (SST).

A combination of rare complications 3 years after a dual-chamber pacemaker implantation.

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation.

Identification of active atrial fibrillation sources and their discrimination from passive rotors using electrographical flow mapping.

Background: The optimal ablation approach for the treatment of persistent atrial fibrillation (AF) is still under debate; however, the identification and elimination of AF sources is thought to play a key role. Currently available technologies for the identification of AF sources are not able to differentiate between active rotors or focal impulse (FI) and passive circular turbulences as generated by the interaction of a wave front with a functional obstacle such as fibrotic tissue.

Objectives: This study introduces electrographic flow (EGF) mapping as a novel technology for the identification and characterization of AF sources in humans.

Cryoballoon ablation in the elderly: one year outcome and safety of the second-generation 28mm cryoballoon in patients over 75 years old.

Aims: The efficacy of the second-generation cryoballoon (CB) ablation in patients with atrial fibrillation (AF) has been demonstrated previously. Data on the efficacy of CB ablation in elderly patients is missing. The aim of this study was to evaluate the long-term success rate of pulmonary vein isolation (PVI) in patients ≥75 years vs.

Long-term follow up of 3 T MRI-detected brain lesions after percutaneous catheter-based left atrial appendage closure.

Background: Left atrial appendage closure (LAAC) for stroke prevention is an increasingly performed intervention.

Aims: This prospective study aims to evaluate the incidence of long-term magnetic resonance imaging (MRI)-detected brain lesions as well as potential changes of neurocognitive function after percutaneous LAAC.

Methods: Brain MRI at 3 T was performed within 24 hr before and after LAAC.

Prognostic performance of serial in-hospital measurements of copeptin and multiple novel biomarkers among patients with worsening heart failure: results from the MOLITOR study.

Aims: In heart failure, various biomarkers are established for diagnosis and risk stratification; however, little is known about the relevance of serial measurements during an episode worsening heart failure (WHF). This study sought to investigate the trajectory of natriuretic peptides and multiple novel biomarkers during hospitalization for WHF and to determine the best time point to predict outcome.

Methods And Results: MOLITOR (Impact of Therapy Optimisation on the Level of Biomarkers in Patients with Acute and Decompensated Chronic Heart Failure) was an eight-centre prospective study of 164 patients hospitalized with a primary diagnosis of WHF.