[The ECG in cardiac rehabilitation]. / Das EKG in der Rehabilitation.

The concept and the benefits of cardiac rehabilitation are well established and scientifically proven. In the context of shortened in-hospital stays and older patients receiving more complex interventions, complications of those procedures might occur during cardiac rehabilitation. This article discusses guideline-directed diagnosis and treatment of complications after transcatheter aortic valve replacement, especially delayed-onset heart block, post-operative atrial fibrillation, and acute coronary ischemia in the setting of pre-existent bundle branch block.

[A practical approach to device interrogation]. / Praktisches Vorgehen in der Schrittmachernachsorge.

For many cardiologists in training, interrogation of implantable cardiac devices is the first step into the fascinating world of electrophysiology. A growing number of patients implanted with pacemakers, implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy devices (CRTs) fuels the need for a basic understanding of those devices by every cardiologist. This article is meant to address the most important theoretical points to facilitate an easy, quick but still comprehensive device interrogation in nine steps.

Catheter ablation of atrial fibrillation in a functionally univentricular heart: a risk-adjusted interventional approach.

In adults with congenital heart disease, atrial fibrillation occurs at a lower age due to the increased atrial stress compared to structurally normal hearts. The ablation target thus results from the underlying heart defect and the specific arrhythmia: in the case of atrial fibrillation, pulmonary vein isolation with left atrial substrate modification can be performed safely and effectively taking into account the individual cardiac lesion, which is often related to difficult transseptal access. This case is a representative example of catheter ablation of atrial fibrillation in a patient with a functional univentricular heart using intracardiac echocardiography-guided double transseptal puncture.

Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort.

PURPOSE: The concern of higher radiation exposure during cryoballoon ablation (CBA) compared with radiofrequency ablation for atrial fibrillation (AF) was raised before. Previously, we compared CBA plus intracardiac echocardiography (ICE) to our former standard approach without ICE. A substantial reduction of radiation exposure without compromising safety or outcome was observed. We now investigate if at all and possibly to which amount radiation reduction can be achieved with growing experience. METHODS: We retrospectively analysed procedure time, dose area product (DAP), fluoroscopy time (FT) and contrast media (CM) use for all patients receiving CBA between 2013 and 2017 for AF. RESULTS: In 1131 procedures, procedure time decreased significantly between 2013 and 2017 (2013 111 ± 26 min, 2017 99 ± 25 min, p = 0.005). DAP halved between 2013 and 2014 without further significant decline (2013 1428 ± 1276 cGycm2, 2014 725 ± 551 cGycm2, p < 0.001). FT demonstrated a constant decrease from 2013 to 2017 (2013 11.7 ± 5.5 min, 2017 5.1 ± 3.5 min, p < 0.001). CM use did not show a significant reduction comparing 2013 to 2017 (2013 62 ± 19 ml, 2017 59 ± 18 ml, 2013/2017 p = 0.584). CONCLUSION: Given the imminent negative effects of radiation, every effort should be undertaken for its reduction. Feasible protocols can be kept simple by technical changes as reducing frame rates and basic radiation reduction strategies such as collimation, but ICE might add additional benefit. With growing experience and awareness of radioprotection, DAP and FT as low as or lower than in radiofrequency ablations seem possible.

Reduction of radiation exposure in cryoballoon ablation procedures: a single-centre study applying intracardiac echocardiography and other radioprotective measures.

AIMS: The population treated with cryoballoon (CB) ablation is relatively young, and radiation protection is of major importance. We aimed to demonstrate that radiation exposure can be markedly reduced by intracardiac echocardiography (ICE) and optimized settings of the X-ray system. METHODS AND RESULTS: We analysed 100 patients undergoing CB pulmonary vein isolation (PVI) for treatment of paroxysmal atrial fibrillation. In 50 consecutive patients (25 male, 59 ± 13 years; Group 1), we used ICE, skipped PV angiography prior to CB inflation, and avoided fluoroscopy whenever possible. Furthermore, we reduced the frame rate, minimized distance between patient and detector, and consequently applied collimation. These patients were compared with 50 similar preceding patients in Group 2 (29 male, 61 ± 12 years). Total fluoroscopy time was reduced from 18 ± 6 min in Group 2 to 12 ± 5 min in Group 1 (P < 0.001). Moreover, the dose area product was significantly lower (1555 ± 1219 vs. 4935 ± 2094 cGycm2, P < 0.001), total freezing time was significantly shortened (1855 ± 399 vs. 2121 ± 756 s, P = 0.031), and contrast media use was significantly reduced (66 ± 25 vs. 109 ± 27 mL, P < 0.001). At the same time, total procedure duration and complication rates did not differ significantly between both groups. After a 12 months follow-up, a similar percentage of patients was free from recurrences (74% in Group 1 vs. 78% in Group 2, P = 0.640). CONCLUSION: Radiation exposure in CB PVI can be markedly reduced without prolonging procedure times, affecting the outcome or complication rates. Moreover, ICE seems to shorten total freezing time.