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INTRODUCTION: This study provides an update of survey-based data providing an overview of interventional electrophysiology over the last decade. Overall infrastructure, procedures, and training opportunities in Germany were assessed. METHODS: By analyzing mandatory quality reports, German cardiology centres performing electrophysiological studies were identified to repeat a questionnaire from 2010 and 2015. RESULTS: A complete questionnaire was returned by 192 centers performing about 75% of all ablations in Germany in 2020. In the presence of the COVID-19 pandemic, a total of 76.304 procedures including 68.407 ablations were reported representing a 38% increase compared to 2015. The median number of ablations increased from 180 in 2010 to 377 in 2020. AF was the most common arrhythmia ablated (51 vs. 35% in 2010). PVI with radiofrequency point-by-point ablation (64%) and cryo-balloon ablation (34%) were the preferred strategies. Less than 50 (75) PVI were performed by 31% (36%) of all centres. Only 25 and 24% of participating centres fulfilled EHRA and national requirements for training centre accreditation, respectively. There was a high number of EP centres with no fellows (38%). The proportion of female fellows in EP increased from 26% in 2010 to 33% in 2020. CONCLUSION: Comparing 2020, 2010 and 2015, an increasing number of EP centres and procedures were registered. In 2020, more than every second ablation was for therapy of AF. In the presence of an increasing number of procedures, training opportunities were still limited, and most centres did not fulfill recommended EHRA or national requirements for accreditation.
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Background: mRNA-based COVID-19 vaccines have been reported to rarely cause myocarditis. Although myocardial biopsy is considered gold standard in the diagnosis of myocarditis, no standardized study following COVID-19 vaccination in humans was performed so far. Since heart transplant (HTX) recipients frequently undergo routine myocardial biopsy, we here aimed to investigate effects of COVID-19 vaccination by analyzing myocardial inflammation by state-of-the-art quantitative immunohistochemistry. Method(s): Consecutive patients after HTX who underwent routine endomyocardial biopsies at a median of 167 days before and 136 days after their first COVID-19 vaccination with a mRNA vaccine were included and divided into groups with and without inflammatory response following vaccination, defined as increased number of CD3+ lymphocytes >14/mm2. Patients with histological signs of rejection (ISHLT Grade >1) or >14 CD3+ lymphocytes/mm2 at baseline were excluded. Afterward clinical characteristics of patients with inflammatory response were screened for signs of myocarditis. Result(s): The final analysis included 46 patients with a median age of 63 years and a time post-HTX of 2.4 years. Immunosuppressive therapy remained unchanged between biopsies. 36 (78%) patients remained below the cut-off of 14 CD3+ lymphocytes/mm2. However, in 10 (22%) recipients, we detected significant leucocyte infiltration by quantitative analysis of endomyocardial biopsies following vaccination (4 vs. 33.7 leucocytes/mm2, p = 0.001). Groups did not differ in age (63 vs. 57 years, p = 0.21), body mass index (25 vs. 24 kg/m2, p = 0.24), NYHA-class (>=2 in 19 vs. 10%, p = 0.4), NTProBNP levels (592 vs. 514 ng/L, p = 0.55) or myocardial CD3+ cell count (4.9 vs. 2.6 cells/mm2, p = 0.07) before vaccination. Patients with leucocyte infiltration remained clinical inapparent with stable NYHA class (>=2 in 10 vs. 20%, p = 0.99) and depicted no increased NT-ProBNP levels (514 vs. 478 ng/L, p = 0.03). No hospitalizations due to suspected myocarditis were reported. Conclusion(s): For the first time, we report subclinical myocardial leucocyte infiltration following COVID-19 mRNA vaccination in every fifth patients without clinical consequences during the short observation period.
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It was reported that mRNA-based Covid-19 vaccines rarely cause myocarditis. Although endomyocardial biopsy (EMB) is considered the gold standard for diagnosing myocarditis, no standardized study has been performed after Covid-19 vaccination in humans. Because routine EMB is frequently performed in heart transplant recipients (HTX), we aimed here to investigate effects of Covid-19 vaccination by analyzing myocardial inflammation with state-of-the-art quantitative immunohistochemistry. Consecutive patients after HTX who underwent routine EMB at a median of 167 days before and 136 days after the first Covid 19 vaccination with an mRNA vaccine were included and divided into groups with and without postvaccination inflammatory response, defined as increased CD3+ lymphocyte count >14/ mm2. Patients with evidence of rejection (ISHLT grade >1) or >14 CD3+ lymphocytes/mm2 at baseline were excluded. The final analysis included 46 patients with a mean age of 63 years and a time after HTX of 2.4 years. Thirty-six (78%) patients remained below the threshold of 14 CD3+ lymphocytes/mm2. However, in 10 (22%) recipients, we detected significant leukocyte infiltration by quantitative analysis of EMB after vaccination (4 vs. 33.7 leukocytes/ mm2, p=0.001). The groups did not differ with respect to age (63 vs. 57 years, p=0.21), body mass index (25 vs. 24 kg/m2, p=0.24), NYHA class (≥2 at 19 vs. 10%, p=0.4), NT-ProBNP levels (592 vs. 514 ng/l, p=0.55) or myocardial CD3+ cell count (4.9 vs. 2.6 cells/mm2, p=0.07) before vaccination. Patients with leukocyte infiltration remained clinically inapparent with stable NYHA class (≥2 in 10 vs. 20%, p=0.99) and did not have increased NT-ProBNP levels (514 vs. 478 ng/l, p=0.03). No hospitalizations for suspected myocarditis were reported. For the first time, we report subclinical myocardial leukocyte infiltration after Covid-19 mRNA vaccination in one in five patients without clinical sequelae during the short observation period. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Immunosuppression after Heart transplantation (HTx) carries a life-long risk for infection and reactivation of herpesviridae. Especially changes in the immunosuppressive therapy regime can promote viral reactivation. Infections with SARS-CoV-2 can also alter the immune response. However, potential effects on herpesviridae reactivation still needs to be examined in this context. Since emerge of the COVID-19 pandemic in the early 2020, n=61 of our HTx or heart and kidney transplant (HKTx) patients had positive polymerase chain reaction (PCR) for SARS-CoV-2. Relevant patient data including results for potential concomitant herpes simplex virus (HSV-1, HSV-2), cytomegalovirus (CMV), Epstein-Barr-virus (EBV), varicella zoster virus (CZV) and human herpesvirus-8 (HHV-8) DNAemia were retrospectively reviewed in September 2022 to evaluate its clinical impact. Most patients have received at least one and up to six doses of COVID-19 vaccine before contracting SARS-CoV-2. In general, HTx and HKTx patients developed symptomatic but mild COVID-19, which was most likely caused by any kind of omicron subvariant. SARS-CoV-2 positive HTx and HKTx patients were pharmacologically treated for COVID-19. DNAemia of herpesviridae was examined in about one third of the patients (n=20). HSV-1 DNAemia was confirmed in 6.25% of tested patients with a maximum viral load of 1,130,000 HSV-1-DNA copies/µg-DNA. In not a single patient HSV-2, VZV and HHV-8 DNA was found. In contrast, CMV was observed in 20% of tested patients with a maximum of 195 CMV-DNA copies/µg-DNA and EBV in 23.5% (maximum 1230 EBV-DNA copies/µg-DNA). In one patient simultaneous CMV- and EBV-DNAemia and in another patient EBV- and HSV-1-DNAemia were found. Nevertheless, none of these patients developed clinically relevant infection or reactivation of herpesviridae and therefore no targeted treatment was initiated. Recently, SARS-CoV-2 infections are commonly observed in patients after HTx and HKTx. Fortunately, patients rarely suffer from severe COVID-19-related symptoms. Meanwhile, concomitant infections or reactivation of herpesviridae, especially CMV and EBV, are regularly observed. Although we did not overserved CMV or EBV disease, regularly testing for herpesviridae seems reasonable in these patients. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)