Pulmonary vein isolation (PVI) is the cornerstone of interventional treatment for atrial fibrillation. Patients with persistent atrial fibrillation have relatively high recurrence rates after catheter ablation irrespective of treatment strategy. Randomized data suggest that adding substrate modification to PVI at the first ablation procedure does not improve arrhythmia-free survival. To date, real-world data from experienced centers is limited. The German Ablation registry maintained by the Institut für Herzinfarktforschung Ludwigshafen, Germany included 909 patients with persistent atrial fibrillation (AF). 645 underwent isolated PVI (PVI-only) and 264 received additional substrate modification (PVI-plus). The primary endpoint was defined as freedom from AF after 1 year documented by ECG. Mean procedure time was longer in the PVI-plus group (203 ± 75 min vs. 186 ± 68 min; p = 0.002) with no significant difference in acute procedural success (94

Measurement of the ventricular action potential (AP) via whole-cell patch clamp is an important contributor to cardiac electrophysiological research. Neonatal rat ventricular cardiomyocytes (NRVCM) are a commonly used model, in particular for stressor- or drug-related questions. High variability of APs and individual methodological settings hinder comparison both in individual studies and, to an even greater degree, between different projects. This study aims to describe sources of AP heterogeneity in NRVCM related to patch clamp measurement with a focus on resolvable causes. Therefore, AP of NRVCM were induced in whole-cell configuration and measured in current-clamp mode. The effects of varying setup temperature, electrode resistance, resting- (RMP), respectively holding membrane potential (HMP), induction approach, current pulse duration and amplitude plus total assay duration were studied and compared to systematically analyzed literature. We analyzed the impact on different output parameters, namely, maximal upstroke velocity (dV/dt), maximal AP amplitude (APA) and AP duration at different percentages (XX%) of repolarization, APDXX. In a comparative literature research, we found that mean APD90 in between 27.0 and 560.7 ms (own data 59.7 ± 5.8 ms) were described, with high variability and likely non-Gaussian distribution. In this study, APD90, APD50 and APD30, are decreased at more negative RMP (respectively HMP) values. E.g., APD90 is shortened by ∼60% after lowering HMP from −70 mV to −90 mV) while dV/dt and APA are increased at a more negative HMP. Pulse duration in induction did not affect main AP parameters itself, but induction energy levels above 1.5-fold the threshold energy level increased APA, while APD50 and APD90 were shortened. During series of APs at 1 Hz, spike duration (APD90) decreased by ∼27%, with stable AP after the third repetitive AP. Spike duration did also decreased by ∼40% after prolongated measurements for 21 min, indicating degradation of electrophysiological properties. To improve data quality in NRVCM-APs, we suggest using a constant HMP, adjustment of current pulse amplitude to the individual cells’ threshold and the use of repetitive AP-inductions. Finally, we suggest the use of nonparametric statistical methods for statistical analysis. These aspects could reduce variability and lead to more reliable and comparable data.

BACKGROUND:Although hyperthyroidism is known to increase the risk of atrial fibrillation (AF), subclinical hypothyroidism (SH) is an often-underreported condition characterized by elevated thyroid-stimulating hormone (TSH) levels and normal free triiodothyronine/free thyroxine (fT3/fT4) levels. This study aimed to clarify the association between SH and AF and to identify potential direct electrophysiological effects of TSH. METHODS:We retrospectively included 2311 patients diagnosed with SH between 2007 and 2020 who had an ECG within 7 days of diagnosis. Logistic regression analysis identified factors independently associated with AF in patients with SH. Effects of different TSH doses on ion channel mRNA and protein levels were analyzed in HL-1 and neonatal rat cardiomyocytes. Video analysis with MYOCYTER, patch-clamp, optical mapping, and computational modeling were used to study automaticity and action potential characteristics after TSH application. RESULTS:AF was documented more often with higher TSH levels (4-10 mU/L TSH: 32.1% versus >10 mU/L TSH: 44.6%; P<0.0001). Multivariable regression identified elevated TSH levels as an independent risk factor for AF. TSHR (TSH receptors) were confirmed in cardiomyocytes, and exposure to TSH led to changes in ion channel expression levels that promoted action potential prolongation. TSH also increased the beating rate in neonatal rat cardiomyocytes. We identified a TSHR-mediated cascade involving cAMP, PKA (protein kinase A), and CREB (cAMP-responsive element-binding protein) as a potential regulator of cardiomyocyte electrical remodeling leading to the proarrhythmic effects that promote the development of AF. CONCLUSIONS:Individuals with SH exhibit an increased prevalence of AF, which is likely in part due to a direct effect of TSH on ion channel expression in cardiomyocytes via the TSHR/cAMP/PKA pathway.

BACKGROUND Pulsed field ablation (PFA) is a safe and effective technology for catheter ablation of atrial fibrillation (AF). Multiple PFA-platforms for AF ablation have been developed. However, evidence comparing the real-world implementation and performance of different PFA systems is still limited. OBJECTIVE This study compares procedural and acute outcome parameters during implementation of the PFA system employing a pentaspline PFA catheter (FARAPULSE, Boston Scientific, Marlborough, MA) and a platform using a circular PFA-catheter (PulseSelect, Medtronic, Minneapolis, MN). METHODS The first consecutive 40 patients treated with each PFA system were included. Baseline characteristics, procedural parameters, and short-term outcome regarding periprocedural safety and efficacy were evaluated. RESULTS The majority of patients showed paroxysmal AF, nearly one-third of patients in both groups suffered from persistent AF. Overall procedural complication rates were not different among subgroups (circular catheter: 12.5%; pentaspline catheter: 7.5%, P = .71), mainly minor (circular catheter: 10.0%; pentaspline catheter: 7.5%, P =1.00). There was no significant difference in median procedure duration (circular catheter: 42.0 minutes; pentaspline catheter: 43.0 minutes, P = .292), left atrial (LA) dwell time (circular catheter: 29.0 minutes; pentaspline catheter: 31.0 minutes, P = .623), and fluoroscopy duration (circular catheter: 13.2 min; pentaspline catheter: 11.9 minutes, P = .132). With the pentaspline PFA catheter, no learning curve was observed regarding procedural parameters over the course of 40 procedures. With the circular PFA catheter, there was a statistically significant decrease in LA dwell time and fluoroscopy duration comparing the first and last 10 procedures. CONCLUSION Both PFA systems could be safely and rapidly implemented into clinical practice of an experienced center. Large-scale clinical trials are needed to compare long-term outcome between different PFA systems currently introduced into clinical practice.

The sodium-glucose co-transporter-2 (SGLT2) inhibitor dapagliflozin is increasingly used in the treatment of diabetes and heart failure. Dapagliflozin has been associated with reduced incidence of atrial fibrillation (AF) in clinical trials. We hypothesized that the favorable antiarrhythmic outcome of dapagliflozin use may be caused in part by previously unrecognized effects on atrial repolarizing potassium (K+) channels. This study was designed to assess direct pharmacological effects of dapagliflozin on cloned ion channels Kv11.1, Kv1.5, Kv4.3, Kir2.1, K2P2.1, K2P3.1, and K2P17.1, contributing to IKur, Ito, IKr, IK1, and IK2P K+ currents. Human channels coded by KCNH2, KCNA5, KCND3, KCNJ2, KCNK2, KCNK3, and KCNK17 were heterologously expressed in Xenopus laevis oocytes, and currents were recorded using the voltage clamp technique. Dapagliflozin (100 µM) reduced Kv11.1 and Kv1.5 currents, whereas Kir2.1, K2P2.1, and K2P17.1 currents were enhanced. The drug did not significantly affect peak current amplitudes of Kv4.3 or K2P3.1 K+ channels. Biophysical characterization did not reveal significant effects of dapagliflozin on current–voltage relationships of study channels. In conclusion, dapagliflozin exhibits direct functional interactions with human atrial K+ channels underlying IKur, IKr, IK1, and IK2P currents. Substantial activation of K2P2.1 and K2P17.1 currents could contribute to the beneficial antiarrhythmic outcome associated with the drug. Indirect or chronic effects remain to be investigated in vivo.

BACKGROUND:Promising as a treatment option for life-threatening ventricular arrhythmias, cardiac stereotactic body radiotherapy (cSBRT) has demonstrated early antiarrhythmic effects within days of treatment. The mechanisms underlying the immediate and short-term antiarrhythmic effects are poorly understood. OBJECTIVE:We hypothesize that cSBRT has a direct antiarrhythmic effect on cellular electrophysiology through reprogramming of ion channel and gap junction protein expression. METHODS:After exposure to 20 Gy of x-rays in a single fraction, neonatal rat ventricular cardiomyocytes were analyzed 24 and 96 hours postradiation to determine changes in conduction velocity, beating frequency, calcium transients, and action potential duration in both monolayers and single cells. In addition, the expression of gap junction proteins, ion channels, and calcium handling proteins was evaluated at protein and messenger RNA levels. RESULTS:After irradiation with 20 Gy, neonatal rat ventricular cardiomyocytes exhibited increased beat rate and conduction velocity 24 and 96 hours after treatment. Messenger RNA and protein levels of ion channels were altered, with the most significant changes observed at the 96-hour mark. Upregulation of Cacna1c (Cav1.2), Kcnd3 (Kv4.3), Kcnh2 (Kv11.1), Kcnq1 (Kv7.1), Kcnk2 (K2P2.1), Kcnj2 (Kir2.1), and Gja1 (Cx43) was noted, along with improved gap junctional coupling. Calcium handling was affected, with increased Ryr2 ryanodin-rezeptor 2 and Slc8a1 Na+/Ca2+ exchanger expression and altered properties 96 hours posttreatment. Fibroblast and myofibroblast levels remained unchanged. CONCLUSION:cSBRT modulates the expression of various ion channels, calcium handling proteins, and gap junction proteins. The described alterations in cellular electrophysiology may be the underlying cause of the immediate antiarrhythmic effects observed after cSBRT.

Background Due to suspected pro-arrhythmic effects and increased mortality associated with class-IC antiarrhythmic drugs (AADs) in previous trials, AAD therapy in structural heart disease (SHD) is mainly restricted to amiodarone. In the presence of diagnostic and therapeutic advancements in cardiovascular medicine, it remains unclear if previous studies adequately reflect contemporary patients. In clinical practice, class-IC-AADs are occasionally used in individual cases, particularly in patients with an implantable cardioverter defibrillator (ICD). Methods This study retrospectively investigated outcome in ICD-carriers with SHD in whom class-IC-AADs were used as an individualized therapy due to failure, side effects, or unacceptable risk of alternative therapeutic options. Results Fifty patients from four tertiary centers were included (median age 48.5 years; 52% female). The most common underlying SHD were dilated (42%) or ischemic cardiomyopathy (26%) (median LVEF = 45%). Indications for AAD were sustained ventricular arrhythmias (VA) (58%), symptomatic premature ventricular contractions (26%), or atrial arrhythmias (16%). Median follow-up was 27.8 months. Freedom from sustained VA was 72%, and freedom from ICD therapy was 80%. In 19 patients (38%), AAD therapy was terminated. The most common reason was insufficient efficacy ( n = 8). Pro-arrhythmia was suspected in three patients. Five patients died during follow-up (10.0%), two of cardiovascular cause (4.0%). Conclusion In a multicenter cohort of ICD-carriers with SHD, class-IC-AADs were associated with a low rate of pro-arrhythmic effects or cardiovascular mortality. The majority of patients remained free from sustained VA during a follow-up of > 2 years. Further efforts should be made to evaluate the safety of class-IC-AADs in SHD patients receiving contemporary cardiovascular therapy. Graphical abstract

Community-based interventions may promote awareness and adherence to atrial fibrillation (AF)-related therapies, potentially reducing adverse events. The ARENA project investigated the health status, therapies and events in AF patients in the Rhein–Neckar Region, Germany. The subproject “ARENA intervention” studied the effect of community-based interventions on AF-associated outcomes. From 2016 onward, patients with diagnosed AF were recruited for the observational ARENA registry. In 2018, an intervention period was initiated involving population-based information campaigns on AF diagnosis and therapies. The “control group” was recruited prior to initiation, and the “intervention group” afterward. Patients underwent standardized follow-up > 1 year after recruitment. Clinical outcomes, therapy and quality of life were compared between the two groups. A total of 2769 patients were included. This real-world cohort showed high adherence to oral anticoagulation therapy (OAC) and an increased use of NOACs over vitamin K antagonists over time. In the intervention group (n = 1362), more patients continued OAC at follow-up (87.1

Objective: Atrial fibrillation (AF) is associated with impaired health-related quality of life (HRQoL), an increased risk of morbidity, and mortality. Traditional AF-related outcomes (e.g., AF recurrence) primarily demonstrate the physiological benefits of AF management but do not focus on the benefits experienced subjectively by the patient (i.e., patient-reported outcomes), which have been suggested as optimal endpoints in AF intervention studies. The aim of this study is to identify medical and psychological factors associated with impaired HRQoL at 1-year follow-up. Methods: Using data from the prospective observational multicenter ARENA study in patients with AF, we analyzed associations between medical factors, anxiety, and HRQoL at 1-year follow-up assessed using 5-level EuroQoL-5D. Results: In 1353 AF patients (mean age 71.4 +/- 10.3 years, 33.8% female), none of the medical predictors (e.g., heart disease) or history of cardioversion were associated with HRQoL at the 1-year follow-up. Higher generalized anxiety (beta = -0.114, p < .001) but not cardiac anxiety (beta = -0.006, p = .809) at baseline predicted decreased HRQoL, independent of confounding variables and patients' medical status. Furthermore, the worsening of patients' generalized anxiety was associated with decreased HRQoL (beta =-0.091, p < .001). In contrast, the improvement of generalized anxiety over time predicted higher HRQoL (beta = 0.097, p < .001). Finally, the worsening of patients' cardiac anxiety over time was associated with decreased HRQoL (beta =-0.081, p < .001). Conclusion: Our results highlight the importance of anxiety as a predictor of future HRQoL in patients with AF. Additional studies to examine the impact of anxiety treatment on HRQoL in this population are needed.

BackgroundHeart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) often coincide. Female sex is associated with both increased prevalence of HFpEF and reduced therapeutic efficacy of catheter ablation of AF. This sub-analysis of the previously published AFFECT-study evaluates outcome after cryoballoon-ablation in women with and without HFpEF.MethodsOne-hundred-and-two patients (LVEF ≥ 50%) scheduled for cryoballoon-ablation of AF were prospectively enrolled. Forty-two were female. Comprehensive baseline assessment included echocardiography, stress echocardiography, six-minute-walk-test, biomarker- and quality-of-life-assessment (QoL, SF-36), and was repeated at follow-up ≥12 months after AF-ablation. Baseline parameters, procedural characteristics and outcome after AF-ablation were compared between women with and without HFpEF.ResultsWomen with HFpEF (n = 20) were characterized by higher median left atrial volume index (35.8 ml/m2 vs. 25.8 ml/m2, P < 0.001), left ventricular hypertrophy (median left ventricular mass index: 92.0 g/m2 vs. 83.0 g/m2, P = 0.027), reduced distance in the 6-min-walk-test (median: 453 m vs. 527 m, P = 0.008) and higher left atrial pressures (median: 14.0 mmHg vs.9.5 mmHg, P = 0.008) compared to women without HFpEF (n = 21). During follow-up, HFpEF-patients more often experienced AF-related re-hospitalization (36.8% vs. 9.1%, P = 0.039) and numerically higher AF-recurrence-rates (57.9% vs. 31.1%, P = 0.109). There was no significant improvement of heart failure-related symptoms, echocardiographic parameters and cardiac biomarkers levels. QoL showed no significant improvement in both subgroups. Women with HFpEF still exhibited a lower SF-36 Physical Component Summary Score vs. women without HFpEF (median: 41.2 vs. 52.1, P < 0.001).ConclusionWomen with HFpEF constitute a distinct subgroup with high rates of AF-related events after AF-ablation, and persistence of both symptoms and functional hallmarks of HFpEF. Consideration of sex-specific cardiac co-morbidities is crucial for personalization and optimization of AF-therapy.Clinical Trial RegistrationClinicalTrials.gov Identifier NCT05603611.

Cardiac stereotactic body radiation therapy (cSBRT) is an innovative and promising noninvasive treatment option for recurrent, therapy-refractory ventricular tachycardia (VT). Although long term efficacy and safety is still under evaluation in multicenter studies, it is associated with a significant short-term reduction of VT burden and ICD shocks.1–3 To date cSBRT is neither a first line treatment strategy for VT ablation nor for premature ventricular contractions (PVC) but encouraging results have been reported.

BackgroundThe novel multielectrode radiofrequency (RF) balloon catheter (HELIOSTAR™. Biosense Webster) is a new technology for pulmonary vein isolation (PVI) in atrial fibrillation (AF), combining RF-ablation and 3D-mapping visualization with the concept of a “single-shot”-ablation device. This study evaluates the operator learning curve und procedural outcome during implementation of the multielectrode RF-balloon at a high-volume center.MethodsThe first 40 patients undergoing PVI by multielectrode RF-balloon catheter at Heidelberg University Hospital were included in this prospective study. Procedural outcome was analyzed over the course of increasing experience with the device.Results157/157 pulmonary veins (PVs) were successfully isolated with the RF-balloon catheter, in 73.2% by a single RF-application. Median time to isolation (TTI) was 11.0 s (Q1 = 8.0 s; Q3 = 13.8 s). Median procedure time was 62.5 min (Q1 = 50.0 min; Q3 = 70.5 min). LA-dwell time was 28.5 min (Q1 = 23.3 min; Q3 = 36.5 min). Median fluoroscopy duration was 11.6 min (Q1 = 10.1 min; Q3 = 13.7 min). No serious procedure-related complications were observed, apart from one case of unclear, post-procedural acute-on-chronic kidney injury. With increasing operator experience, an additional reduction in procedure duration was observed.ConclusionRapid implementation of a “single shot”-ablation device combining RF-ablation and 3D-mapping can be achieved with high acute procedural efficacy and safety at a high-volume center. Previous experience with “single-shot” ablation devices may be advantageous for time-efficient introduction of the novel RF-balloon catheter into clinical practice.Clinical trial registrationhttps://clinicaltrials.gov, identifier NCT05603611.

Cardiac Kv4.3 channels contribute to the transient outward K+ current, Ito, during early repolarization of the cardiac action potential. Two different isoforms of Kv4.3 are present in the human ventricle and exhibit differential remodeling in heart failure (HF). Cardioselective betablockers are a cornerstone of HF with reduced ejection fraction therapy as well as ventricular arrhythmia treatment. In this study we examined pharmacological effects of betablockers on both Kv4.3 isoforms to explore their potential for isoform-specific therapy. Kv4.3 isoforms were expressed in Xenopus laevis oocytes and incubated with the respective betablockers. Dose-dependency and biophysical characteristics were examined. HEK 293T-cells were transfected with the two Kv4.3 isoforms and analyzed with Western blots. Carvedilol (100 µM) blocked Kv4.3 L by 77 ± 2% and Kv4.3 S by 67 ± 6%, respectively. Metoprolol (100 µM) was less effective with inhibition of 37 ± 3% (Kv4.3 L) and 35 ± 4% (Kv4.3 S). Bisoprolol showed no inhibitory effect. Current reduction was not caused by changes in Kv4.3 protein expression. Carvedilol inhibited Kv4.3 channels at physiologically relevant concentrations, affecting both isoforms. Metoprolol showed a weaker blocking effect and bisoprolol did not exert an effect on Kv4.3. Blockade of repolarizing Kv4.3 channels by carvedilol and metoprolol extend their pharmacological mechanism of action, potentially contributing beneficial antiarrhythmic effects in normal and failing hearts.

Abstract Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Sex is a major determinant of the incidence and clinical presentation in arrhythmia syndromes such as Brugada syndrome (BrS). We generated a novel SCN5A-G1408R/+ knock-in mouse model mimicking key features of human BrS regarding male predominance and susceptibility to ventricular tachycardias.

BACKGROUND:Telemonitoring is used to monitor implantable cardioverter defibrillators (ICDs). Despite the scientifically proven effectiveness and safety of telemetric care, studies show that the offer is not used and accepted by all patients. OBJECTIVES:The aim of this study is to investigate the attitudes of ICD patients towards telemonitoring, including which aspects influence attitudes and decision-making. METHODS:Data were collected using semi-structured, guideline-based individual interviews. A total of 14 patients with a subcutaneous ICD (sICD) and both primary and secondary prophylactic indications were recruited. Data analysis followed a content-structuring qualitative approach. RESULTS:Patients with telemonitoring perceived a high benefit with low concerns about digital technology, while the opposite was observed for patients without telemonitoring. The patients' previous medical experience has a crucial impact on the acceptance of telemonitoring. All age groups reported the technical implementation and practical handling of telemonitoring to be simple and uncomplicated. CONCLUSION:The results suggest that the primary and secondary prophylactic indication for ICD implantation have an influence on the attitude towards telemonitoring and, thus, on acceptance. Further qualitative research regarding user acceptance of telemonitoring of other ICD systems is needed.

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) are well established therapies in heart failure. Therapeutic and technological advancements led to increasing numbers of younger patients receiving these devices. Distinguishing patient characteristics among this younger patient cohort, especially gender-specific differences, are important to optimize patient care. Methods Between 2007-2014 the German DEVICE registry enrolled patients from 50 German centers undergoing ICD/CRT-D implantation. Patient characteristics, data on procedural outcome and adverse events during index hospitalization and 1-year follow-up were recorded. All patients under the age of 45 years were identified, separated into two groups according to their gender and analyzed. Results Out of 4181 patients enrolled, 236 patients (5.6%) were under the age of 45 years, of which 162 patients (68.6%) were male and 72 patients were female (31.4%). Male patients were older (39.5 [35.0; 42.0] vs. 34.0 [28.0; 40.0] years, p<0.001) and were more likely to suffer from cardiac disease (77.2 vs. 59.5%, p=0.005) and non-cardiac comorbidities (24.1 vs. 12.2%, p=0.035). The prevalence of Long-QT syndrome was markedly increased in female patients (1.9 vs. 10.8%, p=0.002). Male patients had lower mean left-ventricular ejection fraction (39.8±18.5 vs. 49.5±16.7%, p=0.003), were less likely to be in NYHA functional class I (44.0 vs. 61.4%, p=0.047) and received more betablockers (80,2% vs. 64,9%; p=0,011), ACE-inhibitors (56,2% vs. 46,5%; p=0,005) and statins (27,5% vs. 10,8%, p=0,005). Dual-chamber ICD were more common in female patients (13.0 vs. 27.8%, p=0.006) with a trend towards higher prevalence of pathological AV-conduction in female patients (6.2% vs. 13.5%, p=0.06). There were no differences in the number of implanted CRT-D devices between groups (9.3 vs. 6.9%, p=0.56). There was no detectable difference in overall post-operative complications (1.9 vs. 5.4%, p=0.21) with no cases of in-hospital mortality in both groups. However, there were more pneumothoraces requiring a chest tube insertion in female patients (0.0% vs. 4,1%, p=0.03). Median follow-up time was 514 [398; 669] days. There were no differences in neither device-associated complications requiring revision (15.0 vs. 19.1%, p=0.52), nor in all-cause mortality (3.7 vs. 1.9%, p=0.52; HR 0.5, 95%CI: 0.06-4.27) after 1-year of follow-up, but female patients had a higher mean number of rehospitalizations (1.6±1.5 vs. 2.1±1.3; p=0.026). Conclusion In young patients under 45 years, there were no differences in overall device complications and overall mortality between male and female patients after implantation and after 1-year follow-up. Even though female patients had less cardiac and non-cardiac (co-)morbidities, the number of rehospitalizations after 1-year follow up were higher.

History of syncope is an independent predictor for sudden cardiac death. Programmed stimulation may be considered for risk stratification, but data remain sparse among different populations. Here, we analyzed the prognostic value of inducible ventricular arrhythmia (VA) regarding clinical outcome in patients with syncope undergoing defibrillator implantation. Among 4196 patients enrolled in the prospective, multi-center German Device Registry, patients with syncope and inducible VA (n = 285, 6.8%) vs. those with a secondary preventive indication (n = 1885, 45.2%), defined as previously documented sustained ventricular tachycardia or ventricular fibrillation, serving as a control group were studied regarding demographics, device implantation and post-procedural adverse events. Patients with syncope and inducible VA (64.9 ± 14.4 years, 81.1% male) presented less frequently with congestive heart failure (15.1% vs. 29.1%; p < 0.001) and any structural heart disease (84.9% vs. 89.3%; p = 0.030) than patients with a secondary preventive indication (65.0 ± 13.8 years, 81.0% male). Whereas dilated cardiomyopathy (16.8% vs. 23.8%; p = 0.009) was less common, hypertrophic cardiomyopathy (5.6% vs. 2.8%; p = 0.010) and Brugada syndrome (2.1% vs. 0.3%; p < 0.001) were present more often. During 1-year-follow-up, mortality (5.1% vs. 8.9%; p = 0.036) and the rate of major adverse cardiac or cerebrovascular events (5.8% vs. 10.0%; p = 0.027) were lower in patients with syncope and inducible VA. Among patients with inducible VA, post-procedural adverse events including rehospitalization (27.6% vs. 21.7%; p = 0.37) did not differ between those with vs. without syncope. Taken together, patients with syncope and inducible VA have better clinical outcomes than patients with a secondary preventive defibrillator indication, but comparable outcomes to patients without syncope, which underlines the relevance of VA inducibility, potentially irrespective of a syncope.

Zusammenfassung Hintergrund Telemonitoring dient der Überwachung von implantierbaren Kardioverter-Defibrillatoren (ICD). Trotz der wissenschaftlich nachgewiesenen Effektivität und Sicherheit der telemetrischen Versorgung zeigen Studien, dass das Angebot nicht bei allen Patienten mit der Nutzung und Akzeptanz des Telemonitorings einhergeht. Fragestellung Ziel dieses Forschungsvorhabens ist die Untersuchung der Einstellungen von ICD-Patienten zum Telemonitoring. Dabei ist von Interesse, welche Aspekte Einfluss auf die Haltung und Entscheidungsfindung nehmen. Methode Die Datenerhebung erfolgte anhand teilstrukturierter leitfadengestützter Einzelinterviews. Es wurden insgesamt 14 Patienten mit subkutanem ICD und sowohl primär als auch sekundärprophylaktischer Indikation rekrutiert. Die Datenauswertung erfolgte nach inhaltlich strukturierender qualitativer Vorgehensweise. Ergebnis Die Studie hat gezeigt, dass die Patienten mit Telemonitoring einen hohen Nutzen sehen, bei geringem Bedenken hinsichtlich der digitalen Technik. Bei Patienten ohne Telemonitoring verhält es sich umgekehrt. Die medizinischen Vorerfahrungen der Patienten haben einen wesentlichen Einfluss auf die Akzeptanz des Telemonitorings. Die technische Umsetzung und die praktische Handhabung des Telemonitorings wurden von Patienten aller Altersgruppen als einfach und unkompliziert angesehen. Diskussion Die Ergebnisse lassen darauf schließen, dass die primär- und sekundärprophylaktische Indikation für eine ICD-Implantation einen Einfluss auf die Einstellung zum Telemonitoring und somit auf dessen Akzeptanz haben. Die Ergebnisse geben Anlass zu weiterer qualitativer Forschung im Hinblick auf die Nutzerakzeptanz zum Telemonitoring anderer ICD-Systeme.