We aimed to compare patient characteristics and outcome of patients who had either undergone pulmonary vein isolation (PVI) or AV-node ablation (AVN) to control AF-related symptoms.

To determine the prevalence of sleep-related breathing disorders (SRBD) on patients who, because of malignant ventricular tachyarrhythmias associated with cardiac disease, have an implanted cardioverter-defibrillator (ICD). It was also investigated whether the frequency and circadian distribution of spontaneous ventricular tachycardia and (or) fibrillation (VTF) can be influenced by SRBD.29 consecutive ICD patients (28 men, one woman; mean age 64 +/- 8 years) were investigated by multifunction recordings. 22 patients had coronary heart disease, and seven dilated cardiomyopathy. For each patient the number of VIF episodes per month were recorded, as well as the percentage distribution of the episodes during the day per hour and after grouping into four time periods.SRBDs were recorded in 13 of the 29 patients (45%) (apnoea-hypopnea index [AHI] > 10). The other 16 patients had normal findings (AHI < or = 10). Mean frequency of the registered VTF attacks was similar in both groups (0.41/month with AHI < or = 10 vs 0.44/month with AHI > 10; difference not statistically significant). Averaged percentage distribution pattern showed a maximum frequency in both groups between 6 o'clock and 12 o'clock a.m. There was no significant increase of VTF during the night (10 o'clock p.m.-6 o'clock a.m.) in the group with SRBD (19% with AHI > 10 vs 18.2% with ATF < or = 10; difference not significant).There was a high prevalence of SRBD in the patients with ICD and underlying cardiac disease. No influence of SRBD on frequency and circadian distribution of VTF was demonstrated in patients with ICD during long-term observation.

Die medikamentöse Konversion atrialer Tachyarrhythmien in Sinusrhythmus erfährt zahlreiche Limitationen. Der Einsatz von Antiarrhythmika bei dieser Indikation kann mit einer erheblichen Anzahl von unerwünschten und z. T. gefährlichen Nebenwirkungen einhergehen. Hierbei sind die negativ inotropen Effekte der verschiedenen Substanzen zu berücksichtigen, ihre hemmenden Wirkungen auf die intrakardiale Erregungsbildung und -ausbreitung, die oft erst nach Wiederherstellung des Sinusrhythmus ernsthafte Probleme bereiten können [8], und die Möglichkeit von proarrhythmischen Effekten auf Vorhof- und Ventrikelebene [37], [58]. Elektrische Maßnahmen zur Terminierung von anhaltenden atrialen Tachyarrhythmien sind unter Verwendung optimaler Techniken [11], [26] und bei Beachtung anerkannter Indikationen und Kontraindikationen [42], [44], [67] sicher, effektiv und bei hoher Patientenakzeptanz einsetzbar. Während bei Patienten mit beständigem reinem Vorhofflattern die schnelle Vorhofstimulation mittels eines transvenös in den rechten Vorhof eingebrachten Elektrodenkatheters das elektrische Verfahren der Wahl zur Wiederherstellung des Sinusrhythmus darstellt [31], haben herkömmliche Stimulationsverfahren keine Effektivität bezüglich der Terminierung von Vorhofflimmern. Bei Patienten mit Vorhofflimmern bietet sich die externe transthorakale [44] oder intrakardiale [2], [34], [35], [48] Gleichstromkardioversion als anerkanntes Verfahren zur Elektrokonversion an.

2 Abstract: Prophylactic oral anticoagulation is indicated in patients with Atrial Fibrillation (AF) and high risk for thrombembolic events. The anticoagulant regimen is not standardized for patients with AF after coronary stenting, which requires dual antiplatelet therapy comprising aspirin and ADP -antagonists for at least four Weeks. Low Molecular Weight Heparin (LMWH) is widely used in these patients.We retrospectively compared two groups of patients with permanent AF who underwent coronary stent implantation. 47 patients in group I received 320 mg aspirin Once Daily (OD) and 250 mg ticlopidine twice daily (BID) for four weeks without additional anticoagulantion. In group II 11 patients received 320 mg aspirin OD, 250 mg ticlopidine BID and additionaly subcutaneously administered LMWH in a therapeutic dosage. Within four weeks after coronary intervention, 5 vascular or bleeding complications occured in group I (8%) and 4 in group II (36%) (p=0.035 by Fisher's exact test). One embolic event was observed in group I, whereas no embolic event occured in group II (p=0.08).The results of our study suggest that the combination of dual antiplatelet therapy in addition to anticoagulation with LMWH may significantly raise the risk of vascular and bleeding events in patients with AF after coronary stent implantation. However, as we observed one embolic event in the patients without additional anticoagulation, data from a prospective randomized trial are needed in order to clarify the optimal therapeutic approach to patients with AF undergoing coronary stent implantation.

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia. To lower costs and to reduce hospitalization electrical cardioversion (CV) is frequently performed in an outpatient setting although data on safety and patient-acceptance are sparse. Aims of this study were to fill this gap by evaluating efficacy, complication rate, quality of life after CV and patient-acceptance of outpatient CV.MethodsOne-hundred and eleven consecutive patients with persistent AF were included. Patients were under continuous monitoring throughout the procedure and 3 h after. CV was done in deep sedation using rising energies (200->360 J). Quality of life (QoL), late adverse events and patient-acceptance were assessed 4 weeks after CV.ResultsAF could be terminated with a mean of 1.4 shocks in all patients. Acute adverse events could be observed in 3.6%. Late adverse events were noted in 8.2%. Seventy-four percent of the patients felt “good” or “very good” the day of CV. Eighty-nine percent of the patients would undergo a CV again and in case of a further CV 69% of the patients would prefer an outpatient setting. Patients with a lower QoL-classification had longer duration of atrial fibrillation (median 1 vs. 3 months, p<0.05). No other clinical predictor for adverse events or a low QoL-classification could be identified.ConclusionElectrical CV of persistent AF in an outpatient setting is feasible, safe and has a high patient-acceptance.

AIMS:The purpose was to determine the incidence of early recurrent atrial fibrillation (ERAF) after transthoracic cardioversion (CV) of persistent atrial fibrillation (AF) and to evaluate the efficacy of a predefined strategy for its management. METHODS AND RESULTS:Consecutive patients (n=135) underwent elective CV of AF. CV was performed according to a predefined step-up protocol with rising energy delivery (200 J to 360 J). ERAF was defined as a relapse of AF within 1 min after at least two sinus beats. For proper identification of success of CV, additional endocardial recordings were obtained by an electrode catheter positioned in the high right atrium. In case of ERAF, further CVs were attempted, first with higher energy delivery only, second after intravenous flecainide. If transthoracic CV was ineffective, an internal CV was scheduled. All patients could be converted into sinus rhythm. Sixteen patients (12%) had ERAF. ERAF could be suppressed by further shock delivery in 31% of them. In the remaining 69%, a combination of i.v. flecainide and repeated CV was effective in controlling ERAF. Clinical and echocardiographic parameters were comparable in patients with or without ERAF. CONCLUSION:(1) In the patient population studied, transthoracic CV of AF was technically highly efficacious, so that an internal CV was not necessary in any of the cases. (2) Clinical success of transthoracic cardioversion was limited by ERAF in 12% of the patients. (3) Using the described protocol, ERAF could be suppressed in all patients.

Introduction: We evaluated the influence of the peak voltage of waveforms used for internal cardioversion of atrial fibrillation on defibrillation efficacy and pain perception. A low peak voltage biphasic waveform generated by a 500‐μF capacitor with 40% tilt was compared to a standard biphasic waveform generated by a 60‐μF capacitor with 80% tilt. Methods and Results: In 19 patients with paroxysmal atrial fibrillation (79% male, age 55 ± 11 years, 21% with heart disease), the atrial defibrillation threshold (ADFT) was determined during deep sedation with midazolam for both waveforms in a randomized fashion using a step‐up protocol. Internal cardioversion with a single lead (shock vector: coronary sinus to right atrium) was successful in 18 (95%) of 19 patients. ADFT energy and peak voltage were significantly lower for the low‐voltage waveform ( 2.1 ± 2.4 J vs 3.5 ± 3.9 J, P < 0.01; 100 ± 53 V vs 290 ± 149 V, P < 0.01 ). Sedation then was reversed with flumazenil after ADFT testing. Two shocks at the ADFT (or a 3‐J shock if ADFT >3 J) were administered to the patient using each waveform in random order. Pain perception was assessed using both a visual scale and a numerical score. ADFTs were above the pain threshold in 17 (94%) of 18 patients, even though the ADFT with the 500‐μF waveform was <100 V in 63% of the patients. Pain perception was comparable for both waveforms (numerical score: 6.5 ± 2.4 vs 6.3 ± 2.6 ; visual scale: 5.4 ± 2.6 vs 5.2 ± 3.1; P = NS, 500‐μF vs 60‐μF ). The second shock was perceived as more painful in 88% of the patients, independent of the waveform used. Conclusion: Despite a 66% lower peak voltage and a 40% lower energy, the 40% tilt, 500‐μF capacitor biphasic waveform did not change the pain perceived by the patient during delivery of internal cardioversion shocks. Pain perception for internal cardioversion probably is not influenced by peak voltage alone and increases with the number of applied shocks. (J Cardiovasc Electrophysiol, Vol. 14, pp. 837‐840, August 2003)

STUDY OBJECTIVES:The aim of this study was to examine the influence of sleep-related breathing disorders (SBDs) on the occurrence of ventricular arrhythmias in patients with reduced left ventricular ejection fraction (LVEF), and life-threatening ventricular tachyarrhythmias treated with an implantable cardioverter-defibrillator.PATIENTS:Thirty-eight patients with LVEF of 36 +/- 13% (mean +/- SD) underwent a sleep study. When an apnea-hypopnea index (AHI) > 10/h occurred, SBD was diagnosed.MEASUREMENTS AND RESULTS:In patients with SBDs, ventricular arrhythmias (couplets, triplets, short runs) were recorded simultaneously by Holter ECG and differentiated in episodes with and without disordered breathing. An apnea-associated arrhythmia index (AI) was defined as the number of ventricular arrhythmias occurring simultaneous to disordered breathing. Accordingly, a nonapnea-associated arrhythmia index (NAI) was calculated as the number of ventricular arrhythmias during normal breathing. SBDs were diagnosed in 14 patients: Cheyne-Stokes respiration (CSR) [n = 8; AHI, 32.1 +/- 25.0/h], and obstructive sleep apnea (OSA) [n = 6; AHI, 34.1 +/- 14.6/h]. Four patients in the OSA group and four patients in the CSR group had ventricular arrhythmias during sleep, revealed by Holter ECG. In these eight patients, the AI was significantly higher than the NAI (20.9 +/- 18.8/h vs 4.9 +/- 3.3/h, respectively).CONCLUSIONS:These data show that ventricular arrhythmias occurred significantly more often in association with disordered breathing in patients at high risk for arrhythmias and reduced LVEF.

Zusammenfassung Hintergrund: Patienten mit fortgeschrittener linksventrikulärer Funktionseinschränkung haben ein erhöhtes Risiko für thromboembolische Ereignisse. In der Praxis stellt sich dem behandelnden Arzt bei diesen Patienten häufig die Frage nach einer prophylaktischen dauerhaften Antikoagulation. Datenlage: Die Inzidenz für klinisch manifeste Thromboembolien liegt bei diesen Patienten zwischen 1,5 und 3,5% pro Jahr. Patienten mit einer geringeren maximalen Sauerstoffaufnahme oder einer schlechteren systolischen linksventrikulären Funktion scheinen ein höheres Risiko aufweisen. Die Genese der Herzinsuffizienz und das klinische Stadium spielen dabei keine Rolle. Die bezüglich einer prophylaktischen Antikoagulation publizierten Studien und Metaanalysen sind uneinheitlich und zeigten zum Teil widersprüchliche Ergebnisse beim Vergleich von Patienten unter Antikoagulation und einer nicht behandelten Kontrollgruppe. Keines dieser Daten entspringt einer prospektiven, randomisierten, kontrollierten Studie, die das Thromboembolierisiko in Abhängigkeit von einer Antikoagulation untersucht. Das Blutungsrisiko unter Antikoagulation wird in der Literatur mit einer Inzidenz von 0,6–5,3% pro Jahr für lebensbedrohliche Blutungen und von 0,04–0,64% für tödliche Blutungen angeben. Schlussfolgerung: Bei sich entsprechenden Inzidenzen sowohl für das thromboembolische Ereignis als auch für das Blutungsrisiko unter Antikoagulation ist aufgrund der vorliegenden Daten keine generelle Empfehlung für eine prophylaktische Antikoagulation bei Patienten mit eingeschränkter linksventrikulärer Funktion, erhaltenem Sinusrhythmus und fehlenden Risikofaktoren möglich. Patienten mit höhergradiger myokardialer Insuffizienz (z. B. VO 2max < 14 ml/min/kg Körpergewicht oder linksventrikuläre Auswurffraktion < 20–30%) scheinen zu einem Hochrisikokollektiv zu gehören, das von einer Antikoagulation profitieren könnte. Die Indikation sollte jedoch individuell im Rahmen einer Risiko-Nutzen-Analyse geprüft werden.

Background: Patients with heart failure have an increased risk for thromboembolic events. In clinical practice the physician is often en confronted with the decision to establish a prophylactic anticoagulation.Data: The incidence for clinical embolization is 1.5 to 3.5% per ye;ir. It seems that patients with a lower peak oxygen uptake and with a lower ejection fraction are at higher risk for embolic events. There is no evidence for a correlation of such events with the clinical classification (NYHA) or with the genesis of heart failure. Concerning a prophylactic anticoagulation, the results of the published studies and meta-analyses are inhomogenous with a benefit in some, no difference in others and a significant disadvantage for the patients with and coagulation in a part of them compared to a non-treated control group. None of these data is established by a prospective, randomized, controlled study with the primary endpoint thromboembolic event in patients with or without anticoagulation. The incidence for a hemorrhage under anticoagulation is 0.6-5.3% per year for life-threatening and 0.04-0.64% for fatal bleeding.Conclusion:Because of similar incidences for thromboembolic events and for the bleeding complication of anticoagulation, there is no evidence for a general indication for anticoagulation of patients with heart failure, persistent sinus rhythm and lack of risk factors; In patients with high-grade heart failure (e.g. VO2max < 14 ml/min/kg body weight or left ventricular ejection fraction < 20-30%), who belong to a high-risk population, anticoagulation should be considered and may be acceptable in individual cases.

BACKGROUND:Patients with heart failure have an increased risk for thromboembolic events. In clinical practice the physician is often confronted with the decision to establish a prophylactic anticoagulation.DATA:The incidence for clinical embolization is 1.5 to 3.5% per year. It seems that patients with a lower peak oxygen uptake and with a lower ejection fraction are at higher risk for embolic events. There is no evidence for a correlation of such events with the clinical classification (NYHA) or with the genesis of heart failure. Concerning a prophylactic anticoagulation, the results of the published studies and meta-analyses are inhomogenous with a benefit in some, no difference in others and a significant disadvantage for the patients with anticoagulation in a part of them compared to a non-treated control group. None of these data is established by a prospective, randomized, controlled study with the primary endpoint thromboembolic event in patients with or without anticoagulation. The incidence for a hemorrhage under anticoagulation is 0.6-5.3% per year for life-threatening and 0.04-0.64% for fatal bleeding.CONCLUSION:Because of similar incidences for thromboembolic events and for the bleeding complication of anticoagulation, there is no evidence for a general indication for anticoagulation of patients with heart failure, persistent sinus rhythm and lack of risk factors. In patients with high-grade heart failure (e.g. VO2max < 14 ml/min/kg body weight or left ventricular ejection fraction < 20-30%), who belong to a high-risk population, anticoagulation should be considered and may be acceptable in individual cases.

Die günstigen Ergebnisse mit der internen, niederenergetischen atrialen Kardioversion haben die Entwicklung eines implantierbaren atrialen Defibrillators angeregt. Erste klinische Studien mit dem Metrix™-System bei einer hoch selektierten Patientengruppe mit refrektärem Vorhofflimmern haben gezeigt, dass unter Verwendung eines ausschließlich atrialen Defibrillators Vorhofflimmern effektiv und sicher terminiert werden kann. Weitere Studien müssen durchgeführt werden, um den klinischen Stellenwert dieses neuen Therapieverfahrens, insbesondere im Vergleich zu anderen neuen nicht medikamentösen Behandlungsformen des Vorhofflimmerns, zu evaluieren. Zahlreiche Untersuchungen haben gezeigt, dass Vorhofflimmern mit niedrigen Energien unter Verwendung einer Elektrodenkonfiguration, die primär zur Ventrikeldefibrillation konzipiert wurde, terminiert werden kann. Da Vorhofflimmern häufig ein relevantes klinische Problem bei Patienten mit einem ventrikulären Defibrillator darstellt, wurde kürzlich ein Zweikammerdefibrillator entwickelt (Jewel-AF™-System). Erste klinische Erfahrungen mit diesem System, das sowohl im Vorhof als auch im Ventrikel die Wahrnehmung und Therapie von Tachyarrhythmien ermöglicht, weisen daraufhin, dass mit einem Zweikammerdefibrillator eine vielversprechende therapeutische Option bei Patienten mit supraventrikulären und ventrikulären Arrhythmien gegeben ist.

Die „idiopathische” Kammertachykardie ist eine Ausschlussdiagnose bei sogenannten „herzgesunden” Patienten. Die genauen Ursachen und Mechanismen der „idiopathischen” Kammertachykardien sind bisher unklar. Neueren Berichten zufolge findet man bei Patienten mit „idiopathischen” Kammertachykardien aus dem rechtsventrikulären Ausflusstrakt überzufällig häufig morphologische Veränderungen im Bereich des rechten Ventrikels, welche häufig mit dem Ursprung der Kammertachykardie korrelieren. Die bisher beschriebenen Veränderungen zeigten sich als nicht einheitlich. Hier berichten wir erstmalig über einen Patienten, der seit 10 Jahren unter symptomatischen, belastungsinduzierten, antiarrhythmikarefraktären Kammertachykardien litt und deren Ursprung sich mittels rechtsventrikulärer Angiographie, Kernspintomographie und elektrophysiologischer Untersuchung im rechtsventrikulären Ausflusstrakt im Bereich einer Verdickung des interventrikulären Septums mit muskelisointensem Signalverhalten lokalisieren und erfolgreich mittels Hochfrequenzstrom-Katheterablation kurativ therapieren ließ.

The promising results achieved with low-energy, internal atrial cardioversion have stimulated the development of an implantable atrial defibrillator. Initial clinical experience with the Metrix system in a group of highly selected patients with refractory atrial fibrillation (AF) suggests that atrial defibrillation can be performed effectively and safely by using a stand-alone device. The extension of this therapy will depend on the results of further prospective studies comparing this new therapeutic option with other new non-pharmacological methods to treat AF. Internal atrial cardioversion is feasible at low energies with current endocardial transvenous lead configurations primarily designed for ventricular defibrillation. As AF is a frequent arrhythmia in implantable cardioverter defibrillator recipients, the capability for atrial defibrillation has recently been incorporated in a newly designed dual chamber defibrillator (Jewel AF system). Initial clinical experience with this device that combines both detection and treatment in the atrium as well as in the ventricle indicates a significant improvement in the management of patients with both supraventricular and ventricular tachyarrhythmias.

In dieser Übersicht werden die Prinzipien der medikamentösen und elektrischen Therapie von Vorhofflimmern und Vorhofflattern dargestellt. Bei persistierendem Vorhofflimmern einer Dauer < 24 h ist mit einer hohen spontanen Konversionsrate zu rechnen. Eine frühe aktive Konversion dieser Arrhythmie ist auch beim nichtantikoagulierten Patienten < 48 h nach Episodenbeginn durchführbar. Je kürzer die Arrhythmiedauer ist, um so höher liegt die akute Kardioversionsrate beim Einsatz von Klasse I A, I C und III Antiarrhythmika. Die auch in tiefer Sedierung des Patienten durchführbare externe elektrische Kardioversion ist unter Verwendung verschiedener Elektrodenpositionen und bei aktiver Elektrodenkompression ein hocheffektives Verfahren zur Terminierung von Vorhofflimmern. Die relativ hohe Rate eines frühen Rezidivs nach primär erfolgreicher elektrischer Kardioversion läßt sich durch eine akute Vorbehandlung mit Antiarrythmika deutlich reduzieren. Läßt sich die Arrhythmie mittels externer Kardioversion nicht in Sinusrhythmus überführen, besteht die vielversprechende Option einer internen niederenergetischen Kardioversion. In den meisten Fällen ist zur Aufrechterhaltung des Sinusrhythmus nach Konversion von Vorhofflimmern eine Langzeittherapie mit Antiarrhythmika erforderlich. Die Auswahl des Medikamentes ist nach individuellen Patientenkriterien zu treffen. Bei einer Subgruppe ausgewählter Patienten läßt sich durch serielle Kardioversion im Langzeitverlauf der Übergang in permanentes Vorhofflimmern verhindern. Bei reinem Vorhofflattern stellt die transvenöse rechtsatriale schnelle Vorhofstimulation ein einfaches und effektives Verfahren zur Terminierung dar. Die Konversionsrate in Sinusrhythmus läßt sich durch eine akute Vorbehandlung mit Klasse I A, I C oder III Antiarrhythmika signifikant steigern.

"Idiopathic" ventricular tachycardia is an exclusion diagnosis. The underlying reasons and mechanisms of "idiopathic" ventricular tachycardias are still not completely understood. Recent investigations showed a high prevalence of morphological abnormalities in the right ventricle of patients with "idiopathic" ventricular tachycardia out of the right ventricular outflow tract, which could often be correlated with the origin of the ventricular tachycardia. These described abnormalities were not uniform. Here we report about a patient suffering from drug-refractory "idiopathic" ventricular tachycardia for 10 years. This is the first report in which the origin of an "idiopathic" ventricular tachycardia could be localized by right-ventricular angiography, magnetic resonance tomography and electrophysiological study in the area of an interventricular septal thickening of the right ventricular outflow tract and cured by radiofrequency catheter ablation.

This article reviews current pharmacological and electrical approaches to the restoration of sinus rhythm in patients who suffer from atrial fibrillation and atrial flutter. Spontaneous conversion to sinus rhythm occurs in a high proportion of atrial fibrillation of < 24 h duration. Among patients presenting with atrial fibrillation, which was clinically estimated to have lasted < 48 h, the likelihood of cardioversion-related clinical thromboembolism is low, which supports the current practice of early cardioversion without anticoagulation. Antiarrhythmic drugs effective in terminating atrial fibrillation of short duration are those which possess class IA, IC and III properties. Electrical transthoracic cardioversion by using different electrode positions and additional pressure over the electrodes during shock delivery is a highly effective and well-tolerated method in restoration of sinus rhythm even in patients under conscious sedation. Immediate spontaneous reinitiation of atrial fibrillation can occur in a significant proportion of patients undergoing electrical cardioversion and can be reduced after a pretreatment with antiarrhythmic drugs. In patients with failed external cardioversion, internal low energy cardioversion offers an effective option for restoring sinus rhythm. After cardioversion in a high proportion of patients antiarrhythmic drugs are necessary to prevent atrial fibrillation from recurring. A serial cardioversion approach can prevent the evolution of permanent atrial fibrillation in a subgroup of patients. Overdrive atrial pacing is an effective and minimally invasive procedure for termination of atrial flutter. The acute administration of class IA, IC and III antiarrhythmic drugs increases the success rate of this method in restoring sinus rhythm.

Zusammenfassung Die günstigen Ergebnisse mit der internen, niederenergetischen atrialen Kardioversion haben die Entwicklung eines implantierbaren atrialen Defibrillators angeregt. Erste klinische Studien mit dem Metrix ™ -System bei einer hoch selektierten Patientengruppe mit refrektärem Vorhofflimmern haben gezeigt, dass unter Verwendung eines ausschließlich atrialen Defibrillators Vorhofflimmern effektiv und sicher terminiert werden kann. Weitere Studien müssen durchgeführt werden, um den klinischen Stellenwert dieses neuen Therapieverfahrens, insbesondere im Vergleich zu anderen neuen nicht medikamentösen Behandlungsformen des Vorhofflimmerns, zu evaluieren. Zahlreiche Untersuchungen haben gezeigt, dass Vorhofflimmern mit niedrigen Energien unter Verwendung einer Elektrodenkonfiguration, die primär zur Ventrikeldefibrillation konzipiert wurde, terminiert werden kann. Da Vorhofflimmern häufig ein relevantes klinische Problem bei Patienten mit einem ventrikulären Defibrillator darstellt, wurde kürzlich ein Zweikammerdefibrillator entwickelt (Jewel-AF ™ -System). Erste klinische Erfahrungen mit diesem System, das sowohl im Vorhof als auch im Ventrikel die Wahrnehmung und Therapie von Tachyarrhythmien ermöglicht, weisen daraufhin, dass mit einem Zweikammerdefibrillator eine vielversprechende therapeutische Option bei Patienten mit supraventrikulären und ventrikulären Arrhythmien gegeben ist.