Autoři originálního textu: J. Steffel, R. Collins, M. Antz, P. Cornu, L. DestegheTento přeložený reprint je publikován Českou kardiologickou společností a tvořen textem vybraným a přeloženým Českou kardiologickou společností z textu původně publikovaného v angličtině v Europace 2021;23:1612–1676, https://doi:10.1093/europace/euab065 ("časopise") vydavatelstvím Oxford University Press v zastoupení Evropské kardiologické společnosti (European Society of Cardiology, ESC). EP Europace © The European Society of Cardiology 2023Všechna práva vyhrazena; žádná část publikace nesmí být reprodukována, uchovávána v systému pro uchování a vyhledávání dat či přenášena v jakékoliv formě, elektronicky, mechanicky, kopírováním, nahráváním či jiným způsobem bez předchozího písemného svolení vydavatele.Pro svolení s publikací pište prosím na e-mail: journals.permissions@oup.com.Názory vyjádřené v článku časopisu reprodukovaném jako tento reprint jsou názory autorů a přispěvatelů a nutně nemusejí odrážet názory Evropské kardiologické společnosti, redakce, redakční rady, Oxford University Press nebo společností, jichž jsou autoři členy.Zmínka o obchodních názvech, komerčních výrobcích nebo organizacích a zahrnutí inzerátů do reprintu neznamená schválení časopisem, redakcí a redakční radou, Oxford University Press ani společností, jichž jsou autoři členy. Redakce a vydavatel učinili potřebná opatření, aby ověřili názvy léčiv, dávkování, výsledky experimentální práce a klinické nálezy, které byly zveřejněny v časopise. Konečnou zodpovědnost za podání a dávkování léčiv zmíněných v tomto reprintu a interpretaci publikovaného textu nese lékař a redakce ani vydavatel nemohou přijmout zodpovědnost za škody způsobené jakoukoli chybou nebo vynecháním v časopise nebo v tomto reprintu. Prosím informujte redakci o jakýchkoli chybách.OUP, OPL ani ESC nejsou zodpovědné a v žádném případě neručí za přesnost překladu, za chyby, vynechání nebo nepřesnosti a jakékoli důsledky z toho vyplývající. Za překlad článku a tento reprint zodpovídá výhradně Česká kardiologická společnost.

Digital technology is now an integral part of medicine. Tools for detecting, screening, diagnosis, and monitoring health-related parameters have improved patient care and enabled individuals to identify issues leading to better management of their own health. Wearable technologies have integrated sensors and can measure physical activity, heart rate and rhythm, and glucose and electrolytes. For individuals at risk, wearables or other devices may be useful for early detection of atrial fibrillation or sub-clinical states of cardiovascular disease, disease management of cardiovascular diseases such as hypertension and heart failure, and lifestyle modification. Health data are available from a multitude of sources, namely clinical, laboratory and imaging data, genetic profiles, wearables, implantable devices, patient-generated measurements, and social and environmental data. Artificial intelligence is needed to efficiently extract value from this constantly increasing volume and variety of data and to help in its interpretation. Indeed, it is not the acquisition of digital information, but rather the smart handling and analysis that is challenging. There are multiple stakeholder groups involved in the development and effective implementation of digital tools. While the needs of these groups may vary, they also have many commonalities, including the following: a desire for data privacy and security; the need for understandable, trustworthy, and transparent systems; standardized processes for regulatory and reimbursement assessments; and better ways of rapidly assessing value.

The chapter is a detailed translation of the updated, 2021 European Society of Cardiology guidelines on cardiac pacing and cardiac resynchronization therapy. It presents a modified classification of bradyarrhythmias considered for cardiac pacing and highlights the importance of precision diagnosis based on the patient's symptomatology. In addition to conventional techniques, the updated version includes, as a novelty, the issue of conduction system pacing as an alternative to cardiac resynchronization therapy. A completely new subsection covers the topic of pacing in patients undergoing transcatheter aortic valve implantation. The indications are clearly specified, with preventive pacing in patients developing bundle branch block no longer recommended. Yet another new concept incorporated into the update is leadless pacing in the "real-world" setting. A section that clinicians will find most useful examines indications for pacing in specific clinical scenarios such as congenital heart disease, pregnancy, postoperative bradycardias, and so on.

a I. interní klinika – kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc b Klinika kardiologie, Institut klinické a experimentální medicíny, Praha c Kardiologická klinika, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha d I. interní kardioangiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně, Brno e Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, Brno f II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha g Kardiovaskulární centrum, Krajská nemocnice Liberec, a. s., Liberec h Kardiologická klinika, Fakulta zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajská zdravotní, a.s., a Masarykova nemocnice v Ústí nad Labem, o. z., Ústí nad Labem ch Interní a kardiologická klinika, Lékařská fakulta Ostravské univerzity a Fakultní nemocnice Ostrava, Ostrava i Kardiologické oddělení, Krajská nemocnice Tomáše Bati ve Zlíně, Zlín j Kardiologické oddělení, Nemocnice České Budějovice, a.s., České Budějovice a Zdravotně sociální fakulta Jihočeské univerzity v Českých Budějovicích, České Budějovice k Kardiologická klinika, Lékařská fakulta Plzeň, Univerzita Karlova a Fakultní nemocnice Plzeň, Plzeň l I. interní kardioangiologická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové, Hradec Králové m Kardiologické oddělení, Interní klinika, 1. lékařská fakulta Univerzity Karlovy a Ústřední vojenská nemocnice, Praha

Implantable cardioverter-defibrillators (ICD) reduce mortality of patients with risk of sudden cardiac death in primary and secondary prevention. Patients with implanted ICD can receive appropriate and inappropriate therapies with different incidence in both indication groups. There are some factors which can predict the incidence of ICD therapies. In some cases higher incidence of ICD therapies could negatively impact quality of patients lives. As predictive factors for higher incidence of appropriate therapies are discussed: reduced left venctricular ejection fraction, body mass index, chronic renal failure and frequent hospitalization for acute decompensation of chronic heart failure. As predictive factors for higher incidence of inappropriate therapies are discussed supraventricular tachycardia in patients history and single-chamber implantable kardioverter- defibrillator. The article summarizes indication criteria, incidence, predictive factors and treatment of appropriate and inappropriate therapies.

With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.

Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.

Autoři originalniho textu EHRA:Carina Blomstrom-Lundqvist, Vassil TraykovKardiostimulatory, implantabilni kardiovertery-defibrilatory a přistroje pro srdecni resynchronizacni terapii jsou potencialně život zachraňujici lecbou u řady srdecnich onemocněni, ale nejsou bez rizika. Nejvice znepokojujici je riziko infekce srdecnich implantabilnich elektronických zařizeni (CIED), ktera je spojena s významnou morbiditou, zvýsenou nutnosti hospitalizace, zkracenim přežiti a zvýsenými naklady na zdravotni peci. Doporucene preventivni postupy, jako je podavani intravenoznich antibiotik před implantaci, jsou dobře znamy. Zůstavaji nejasnosti ohledně ulohy různých preventivnich, diagnostických a lecebných opatřeni, jako jsou kožni antiseptika, aplikace antibiotik do kapsy přistroje, antibakterialni obalky, prodloužene podavani antibiotik po implantaci a dalsi. Doporuceni týkajici se použiti nových alternativ implantabilnich zařizeni, u nichž se ocekava, že budou meně nachylne k infekcim, a nových peroralnich antikoagulancii jsou rovněž omezena, stejně jako definice minimalnich požadavků na kvalitu pece implantacnich center, erudice operaterů a poctu výkonů. Navic chybi dokument o mezinarodnim konsenzu ohledně lecby infekci CIED. Rozpoznani těchto temat, siřeni výsledků důležitých randomizovaných studii zaměřených na prevenci infekce CIED a pozorovane rozdily v řeseni infekci souvisejicich s implantabilnimi přistroji, ktere byly zjistěny v celosvětovem průzkumu European Heart Rhythm Association, poskytlo silnou motivaci k vytvořeni mezinarodniho konsenzualniho dokumentu s použitim nejmodernějsich poznatků vědy z roku 2019 týkajicich se posuzovani rizik, prevence, diagnostiky a lecby infekci CIED. © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.

Abstract Background With the increasing number of implanted cardiac pacemakers, ICDs and CRTs, the number of serious infectious complications of these procedures increases significantly, especially in the longer term from the primary implantation. The systematic solution is in most cases endovasal extraction of these systems. Methods In a multicenter, prospective, randomized, controlled trial evaluating the benefit of CIEDS infection management in 277 patients, a conventional approach using blood cultures, microbiological examinations and TEE versus innovative management of these patients using PET-CT was compared. PET-CT examination is able to differentiate very well the infection of the implant pocket (Figure A) against bacterial endocarditis (Figure B). Thanks to this, it is possible to individualize the management of the patient and to shorten the dates of hospitalization, resp. time to re-implantation of the new system in patients without the presence of bacterial endocarditis. Results The results of the multicentre study are summarized in Table 1. Conclusions A comprehensive examination of patients with CDRIE using PET-CT significantly shortens hospital stay, time of antibiotic therapy and, as a consequence, leads to a lower incidence of serious complications of extraction procedures. PET-CT in CDRIE patients Funding Acknowledgement Type of funding source: None

BACKGROUND:Approximately 30% of patients do not respond to implantation of Cardiac Resynchronization Therapy - Defibrillators (CRT-D). The aim of this study was to investigate the potential for cardiac strain speckle tracking to optimize the performance of CRT-D in non-responding patients. METHODS:30 patients not responding to Cardiac Resynchronization Therapy-Defibrillators after 3 months were randomly divided into control and intervention groups. Atrioventricular interval was adjusted so that E and A waves did not overlap, the interventricular interval was subsequently optimized to yield maximum improvement of the sum of longitudinal+radial+circumferential strains. The left ventricular ejection fraction (LVEF) and NYHA improvement 3 months after optimization were evaluated and use of other strain combinations assessed. RESULTS:A significant correlation between the (combined) strain change and LVEF improvement was detected (p<0.01). 75% of patients with non-ischemic etiology of heart failure who did not respond to the original CRT-D reacted favorably with significant LVEF and NYHA improvement. The area strain was the best predictor of LVEF/NYHA improvement in those patients. No significant improvement was recorded in patients with ischemic etiology. CONCLUSIONS:AV and VV optimization based on speckle tracking is a very promising method potentially leading to a significant improvement of the outcome of CRT-D, especially in patients with non-ischemic etiology of heart failure.

Background A small proportion of patients undergoing primary prophylactic implantation of implantable cardioverter defibrillators (ICDs) experiences malignant arrhythmias. We postulated that periodic repolarisation dynamics, a novel marker of sympathetic-activity-associated repolarisation instability, could be used to identify electrically vulnerable patients who would benefit from prophylactic implantation of ICDs by way of a reduction in mortality. Methods We did a prespecified substudy of EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD), a prospective, investigator-initiated, non-randomised, controlled cohort study done at 44 centres in 15 EU countries. Patients aged 18 years or older with ischaemic or non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (<= 35%) were eligible for inclusion if they met guideline-based criteria for primary prophylactic implantation of ICDs. Periodic repolarisation dynamics from 24-h Holter recordings were assessed blindly in patients the day before ICD implantation or on the day of study enrolment in patients who were conservatively managed. The primary endpoint was all-cause mortality. Propensity scoring and multivariable models were used to assess the interaction between periodic repolarisation dynamics and the treatment effect of ICDs on mortality. Findings Between May 12, 2014, and Sept 7, 2018, 1371 patients were enrolled in our study. 968 of these patients underwent ICD implantation, and 403 were treated conservatively. During follow-up (median 2.7 years [IQR 2.0-3.3] in the ICD group and 1.2 years [0.8-2.7] in the control group), 138 (14%) patients died in the ICD group and 64 (16%) patients died in the control group. We noted a 43% reduction in mortality in the ICD group compared with the control group (adjusted hazard ratio [HR] 0.57 [95% CI 0.41-0.79]; p=0.0008). Periodic repolarisation dynamics significantly predicted the treatment effect of ICDs on mortality (adjusted p=0.0307). The mortality benefits associated with ICD implantation were greater in patients with periodic repolarisation dynamics of 7.5 deg or higher (n=199; adjusted HR 0.25 [95% CI 0.13-0.47] for the ICD group vs the control group; p<0.0001) than in those with periodic repolarisation dynamics less than 7.5 deg (n=1166; adjusted HR 0.69 [95% CI 0.47-1.00]; p=0.0492; P-interaction=0.0056). The number needed to treat was 18.3 (95% CI 10.6-4895.3) in patients with periodic repolarisation dynamics less than 7.5 deg and 3.1 (2.6-4.8) in those with periodic repolarisation dynamics of 7.5 deg or higher. Interpretation Periodic repolarisation dynamics predict mortality reductions associated with prophylactic implantation of ICDs in contemporarily treated patients with ischaemic or non-ischaemic cardiomyopathy. Periodic repolarisation dynamics could help to guide treatment decisions about prophylactic ICD implantation. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

OBJECTIVES: The aim of this study was to evaluate the correlation between the change in heart strains and the success rate of Cardiac Resynchronization Therapy (CRT) optimization.We further explored the benefi t of speckle tracking for CRT.METHODS: In this prospective cohort study, CRT-Ds were implanted to 60 patients.3 months later, the response was evaluated.In the non-responders, optimization based on speckle tracking was performed.The AV interval was optimized with respect to the quality of left ventricle fi lling and the VV interval was optimized with respect to heart strains.After a further three months, the optimization success was evaluated.RESULTS: Thirty-nine patients responded well to the initial CRT.The response was independent of etiology; the subsequent optimization was however more successful in dilated cardiomyopathy (DCM) (8 out of 9) than in ischemic heart disease (IHD) patients (3 out of 10 responded).The ejection fraction increase and area strain were the best predictors of NYHA improvement.CONCLUSION: AV and VV optimization in patients who do not respond well to initial CRT seems to have better results in patients suffering from DCM. Speckle tracking (specifi cally A-strain) may be used to guide CRT optimization (Tab.2, Fig. 3, Ref. 22).

Cíl: Monitorovat zastoupení pacientů indikovaných k implantaci ICD s diagnózou arytmogenní dysplazie pravé komory (ARVD)

Background. Ankle brachial index (ABI) is the principal screening method for peripheral arterial disease (PAD). In this study, we compare various types of Doppler-derived and oscillometric ABIs with results obtained through duplex ultrasonography. Methods. 62 patients were enrolled in the study. For each limb, blood pressures for both ankle arteries and the arm were measured using Doppler and an automated oscillometric device. Duplex ultrasound was performed for all limbs and occlusions >50% were considered PAD-positive. ABI was calculated using both higher (HABP) and lower (LABP) arterial blood pressure on the individual limbs and the ability to predict duplex-detected stenoses was evaluated. Results. LABP calculation provided results superior to the guideline-recommended HABP. Considering patients with ABI >1.4 or measurement failure as PAD-positive further enhanced the test parameters. The higher ABI cut-off of 1.0 resulted in somewhat better sensitivities (max 92%) and negative predictive values (max 87%) at the expense of a substantial increase in the number of false positives. Oscillometric method yielded poor sensitivities but very good specificities (max 94%) and positive predictive values (max 90%). Conclusions. Doppler-based LABP provides better results than the guideline-recommended HABP in diabetic patients, nevertheless even this method is not perfect. Increasing the cut-off value to 1.0 in these patients does not bring a substantial improvement of the test performance. Patients with high ABI should be automatically considered PAD-positive and referred for further investigation using imaging techniques.

OBJECTIVES:In diabetic patients, there is a discrepancy in guidelines for ankle-brachial index (ABI) screening for peripheral arterial disease (PAD). While diabetes organizations suggest the value of upper limit of normal ABI to be 1.3, cardiologists recommend 1.4. Also, guidelines recommend using the higher value of ankle pressure (HAP) but multiple recent studies propose the opposite (LAP).METHODS:In this prospective study, we performed ABI measurements in 62 diabetic patients. Results were calculated by comparing higher and lower values of ankle pressure to those of duplex ultrasound (stenosis ≥ 50 % was considered PAD). Special attention was paid to patients with high and non-measurable ABI.RESULTS:LAP ABI appears to be a preferable method for PAD screening in diabetics. The upper cut-off value of 1.4 yielded better results with sensitivity of 93 % and negative predictive value of 91 %. No limbs with ABI between 1.3 and 1.4 with significant stenosis were found. However, using HAP for the upper cut-off captured additional PAD patients. PAD was abundant among patients with high or non-measurable ABI.CONCLUSIONS:LAP should be used for assessing low ABI (cut-off 0.9) while HAP for detecting the abnormally high ABI. The preferable high ABI cut-off is 1.4. Condition with abnormally high or non-measurable ABI should be considered as PAD (Tab. 3, Ref. 22).

Cíl: Monitorovat zastoupení pacientů indikovaných k implantaci kardiostimulátorů (KS) s perzistující levostrannou horní dutou žílou

BACKGROUND Several studies have shown that unnecessary right ventricular pacing has detrimental effects.OBJECTIVE To evaluate whether minimization of ventricular pacing as compared with standard dual-chamber pacing (DDD) improves clinical outcomes in patients referred for pacemaker or implantable cardioverter-defibrillator (ICD) replacement.METHODS In an international single-blind, multicenter, randomized controlled trial, we compared DDD with managed ventricular pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no cardiac resynchronization therapy upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete atrioventricular block. Follow-up was for 2 years. The primary end point was cardiovascular hospitalization. The intention-to-treat analysis was performed by using Kaplan-Meier method and the log-rank test.RESULTS We randomized 605 patients (556 referred for pacemaker and 49 referred for ICD replacement; mean age 75 +/- 11 years; 365 [60%] men, at 7.7 +/- 3.3 years from first device implantation) to MVP (n = 299) or DDD (n = 306). We found no significant differences in the primary end point cardiovascular hospitalization (MVP: 16.3% vs DDD: 14.5 /0; P =.72) and the secondary end point persistent AF (MVP: 15.4% vs DDD: 11.2 /a; P =.08), permanent AF (MVP: 4.1% vs DDD: 3.1%; P =.44), and composite of death and cardiovascular hospitalization (MVP: 23.9% vs DDD: 20.2%; P =.48). MVP reduced right ventricular pacing (median 5% vs 86%; Wilcoxon, P <.0001) as compared with DOD.CONCLUSIONS In patients referred for pacemaker and ICD replacement with clinically well-tolerated long-term exposure to >40% ventricular pacing in the ventricle, a strategy to minimize ventricular pacing is not superior to standard DDD in reducing incidence of cardiovascular hospitalizations.