Single catheter approach for treatment of premature ventricular contractions.

BACKGROUND: Catheter ablation has become one of the main treatment strategies in patients with premature ventricular complexes (PVC). The successful mapping and ablation can be performed with an ablation catheter without additional diagnostic catheters. HYPOTHESIS: We hypothesize that using a single catheter for PVC ablation may decrease complications, procedure time, and fluoroscopy exposure while maintaining comparable success rates. METHODS: Sixty-nine consecutive patients with PVC were treated with a single catheter approach compared to a historical cohort, in which a conventional setup was used. Propensity score matching was conducted with a 1:1 ratio. Outcome parameters included acute procedural success with elimination of all premature ventricular contractions after catheter ablation, procedural data as well as complication rates. RESULTS: Patients treated with a single catheter approach had shorter total procedure (60 minutes [IQR: 47,5-69,0 minutes] vs. 90 minutes [IQR 60-120 minutes]; p = 0.001) and fluoroscopy times (218 seconds [IQR: 110,5-446 seconds] vs. 310 seconds [IQR 190-640 seconds]; p = 0.012), which consecutively leads to a reduction of radiation exposure signified by a lower dose area product (155 cGycm² [IQR 74.4-334.5 cGycm²] vs. 368.4 cGycm² [IQR: 126-905.4 cGycm²]; p value 0.009). Acute procedural success rates were comparable in both groups (54 [84.3%] in the single catheter approach group and 58 [90.6%] in the conventional group; p: 0.287). CONCLUSION: A single catheter approach for the treatment of PVC is associated with a reduction of procedure- and fluoroscopy time, as well as a lesser radiation exposure, while maintaining equivalent acute success and complication rates compared with a conventionally used catheter setup.

Heart rhythm in vitro: measuring stem cell-derived pacemaker cells on microelectrode arrays.

Background: Cardiac arrhythmias have markedly increased in recent decades, highlighting the urgent need for appropriate test systems to evaluate the efficacy and safety of new pharmaceuticals and the potential side effects of established drugs. Methods: The Microelectrode Array (MEA) system may be a suitable option, as it provides both real-time and non-invasive monitoring of cellular networks of spontaneously active cells. However, there is currently no commercially available cell source to apply this technology in the context of the cardiac conduction system (CCS). In response to this problem, our group has previously developed a protocol for the generation of pure functional cardiac pacemaker cells from mouse embryonic stem cells (ESCs). In addition, we compared the hanging drop method, which was previously utilized, with spherical plate-derived embryoid bodies (EBs) and the pacemaker cells that are differentiated from these. Results: We described the application of these pacemaker cells on the MEA platform, which required a number of crucial optimization steps in terms of coating, dissociation, and cell density. As a result, we were able to generate a monolayer of pure pacemaker cells on an MEA surface that is viable and electromechanically active for weeks. Furthermore, we introduced spherical plates as a convenient and scalable method to be applied for the production of induced sinoatrial bodies. Conclusion: We provide a tool to transfer modeling and analysis of cardiac rhythm diseases to the cell culture dish. Our system allows answering CCS-related queries within a cellular network, both under baseline conditions and post-drug exposure in a reliable and affordable manner. Ultimately, our approach may provide valuable guidance not only for cardiac pacemaker cells but also for the generation of an MEA test platform using other sensitive non-proliferating cell types.

Catheter ablation for atrial fibrillation: impact on mortality, morbidity, quality of life, and implications for the future.

Despite the advances in technologies and techniques in the field of catheter ablation for cardiac arrhythmias, it is estimated that the prevalence of atrial fibrillation (AF) will further increase in the nearest future. The latest trials have proven the beneficial effect on mortality after pulmonary vein isolation in patients with impaired left ventricular function, while no such effect has been seen in patients without left ventricular dysfunction. This raises the question of whether catheter ablation for AF is still suited for the latter patient cohort or whether the endpoint of mortality is not adequate enough. Not only does pulmonary vein isolation reduce the burden of atrial fibrillation, but it also somehow alters the patients' perception of it in the case of recurrence. Independent of the presence of ventricular dysfunction, patients experience a relief of AF-related symptoms, which is accompanied by an increase in quality of life based on the available patient-reported outcome measures, despite AF recurrence. Trials that are currently recruiting patients seek to unveil the accountable circumstances for these remaining uncertainties and help expand our understanding of a procedure that has been routinely performed for two decades.

[Prevention of sudden cardiac death]. / Prävention des plötzlichen Herztods.

Sudden cardiac death is a major as yet unsolved public health problem. Prevention of sudden cardiac death is subdivided into two main categories, on the one hand primary prevention (prevention of a first event of sudden cardiac death) and on the other hand secondary prevention (prevention of reoccurring events in survivors of cardiac arrest). This review article summarizes the current state of knowledge on primary and secondary prevention of sudden cardiac death in various clinical settings.