RESUMO
The specification of standard operating procedures (SOPs) is a basic requirement for a successful implementation of telemonitoring with implanted cardiac devices and with external measuring devices in patients with heart failure, cardiac arrhytmia or increased risk of sudden cardiac death. The following article summarizes the possibilities of telemonitoring from a technical and organizational point of view and descibes basic requirements on SOPs. these basic requirements should be further specified and anchored in the organizational structure of the individual telemonitoring concept. Moreover, they should de understood as a basic guideline fpr the actions of telemonitoring center (TMC) employees.
Assuntos
Arritmias Cardíacas , Insuficiência Cardíaca , Telemedicina , Morte Súbita Cardíaca , HumanosRESUMO
The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e.â¯V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.
Assuntos
Cardiologia , Insuficiência Cardíaca , Telemedicina , Arritmias Cardíacas , Doença Crônica , HumanosRESUMO
Heart failure is one of the most common diseases. It is associated with high morbidity and mortality. Since heart failure is age-associated, the number of patients with heart failure is constantly increasing. At the same time, the imbalance between the need for treatment and the provision of care is growing. Telemonitoring/telemedicine offers patients in rural or remote areas access to high-quality health care and enables fast access to specialists. The working group 33 Telemonitoring of the German Cardiac Society describes the characteristics and possible applications of telemonitoring/telemedicine in the treatment of patients with heart failure. Furthermore, quality criteria for cardiological telemedicine centres are defined. In addition to the personnel structure of a telemedicine centre and the competencies of employees, requirements for the technical infrastructure and the management of incoming data and alarms are described.
Assuntos
Insuficiência Cardíaca , Telemedicina , Arritmias Cardíacas , Morte Súbita Cardíaca , HumanosRESUMO
A growing body of evidence indicates that sudden cardiac death constitutes a major cause of mortality in pulmonary hypertension (PH). As validated method to evaluate cardiac autonomic system dysfunction, alterations in heart rate variability (HRV) are predictive of arrhythmic events, particularly in left ventricular disease. Here, we sought to determine the clinical value of HRV assessment in PH. Sixty-four patients were allocated to different PH-subgroups in this prospectively conducted trial: 25 patients with pulmonary arterial hypertension (PAH), 11 patients with chronic thromboembolic PH (CTEPH), and 28 patients with COPD-induced PH. All patients underwent 24-h Holter electrocardiogram for HRV assessment by time- and frequency-domain analysis. Arrhythmic burden was evaluated by manual analysis and complementary automatic measurement of premature atrial and ventricular contractions. The results were compared to 31 healthy controls. The PAH patients offered a significantly higher mean heart rate (78.6 ± 10.4 bpm vs. 70.1 ± 10.3 bpm, p = 0.04), a higher burden of premature ventricular contractions (p < 0.01), and decreases in HRV (SDNN: p < 0.01; SDANN: p < 0.01; very low frequency: p < 0.01; low frequency/high frequency ratio: p < 0.01; total power: p = 0.02). In CTEPH patients, only the amount of premature ventricular contractions differed from controls (p < 0.01), whereas in COPD both premature atrial contraction count and frequency-domain-based HRV manifested significant differences. In conclusion, PAH appears to be primarily affected by HRV alterations and ventricular arrhythmic burden, indicating a high risk for malignant arrhythmic events.
Assuntos
Arritmias Cardíacas/fisiopatologia , Frequência Cardíaca/fisiologia , Hipertensão Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
PURPOSE: To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. MATERIALS AND METHODS: 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6â±â12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. RESULTS: The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8â%. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590â±â0.248 vs. 0.909â±â0.141; pâ<â0.001 und HU [LAA/LA] 0.689â±â0.366 vs. 1.082â±â0.228; pâ<â0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5â%, a specificity of 96.9â%, a PPV of 87.5â% and a NPV of 95.2â%. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8â%, the sensitivity to 77.8â%, the PPV to 72.4â%, and the NPV to 94.9â%. CONCLUSION: Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1â% and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT. KEY POINTS: â¢âMD-CT can reliably exclude atrial appendage thrombi/thrombogenic milieu. â¢âMD-CT is an alternative method in patients with contraindications to TEE. â¢âCalculation of relative HU ratios does not improve the diagnostic value of MD-CT.
Assuntos
Apêndice Atrial/patologia , Meios de Contraste , Ecocardiografia Transesofagiana/métodos , Aumento da Imagem , Trombose/diagnóstico , Adulto , Idoso , Ecocardiografia/métodos , Feminino , Hemodinâmica/fisiologia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
A 65-year-old man with severe coronary artery disease and coronary artery bypass graft presented with an acute posterior ST-elevation myocardial infarction. Immediate percutaneous coronary intervention resulted in successful revascularisation of the culprit lesion (RCx) with several remaining coronary stenoses. Despite the reduced left ventricular ejection fraction, no primary prevention indication for an implantable cardioverter/defibrillator early after myocardial infarction existed. Due to the complex coronary anatomy with several remaining stenotic vessels we regarded the patient to be at a particularly high risk for lethal ventricular arrhythmias and provided him with a wearable cardioverter defibrillator (WCD). Twenty-six days later, he experienced spontaneous ventricular tachycardia and fibrillation which was successfully treated with high voltage therapy by the WCD. Subsequently, we decided to implant him an ICD following secondary prevention indication. Besides established indications for primary prevention ICD therapy, some patients early after myocardial infarction may be at a particularly high risk for sudden cardiac death. Temporary protection with a WCD in carefully selected patients can offer a safe opportunity for later reevaluation of permanent ICD implantation depending on the course of left ventricular ejection fraction and the occurrence of arrhythmia.
Assuntos
Desfibriladores Implantáveis , Infarto do Miocárdio/terapia , Taquicardia Ventricular/prevenção & controle , Fibrilação Ventricular/prevenção & controle , Idoso , Humanos , Masculino , Infarto do Miocárdio/complicações , Taquicardia Ventricular/etiologia , Resultado do Tratamento , Fibrilação Ventricular/etiologiaRESUMO
While the implantable cardioverter-defibrillator (ICD) has been proven to be the best choice for patients with long-term risk for sudden cardiac arrest/sudden cardiac death (SCA/SCD), the question is how to manage patients with only temporary risk, e.g., during the guidelines-recommended waiting period until the decision for an ICD can be made. These patient groups should be monitored around the clock to guarantee a lifesaving shock within a few minutes, if necessary.These conditions can be accomplished by the wearable cardioverter-defibrillator (WCD) in the outpatient sector. The WCD is worn on the skin and consists of four nonadhesive ECG electrodes as well as three defibrillation electrodes-two at the back and one at the front-embedded in a garment. The defibrillation unit is connected via a cord and can be worn over the shoulder or on a belt. Cardiac events can be recorded and retrospectively analyzed by the treating physician.The WCD is a safe and effective measure to terminate potentially lethal ventricular tachycardia and ventricular fibrillation. It may be used early after myocardial infarction with reduced left ventricular ejection fraction (LVEF), as well as for patients with acute heart failure in nonischemic cardiomyopathy with uncertain cause and prognosis. In addition, it may be used for patients waiting for heart transplantation, for patients who cannot be implanted an ICD due to comorbidities, and for patients after explantation of their ICD, e.g., because of infection until reimplantation.One may expect that risk stratification of patients with the WCD will lead to even better selection for ICD use.
Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores , Cardioversão Elétrica/instrumentação , Eletrocardiografia Ambulatorial/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Medicina Baseada em Evidências , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: The possibilities of telemonitoring (TM) of patients with implantable cardioverter-defibrillators (ICD) have been rapidly improving over the last few years. Numerous studies have examined the effects of this development on the follow-up care of ICD patients. OBJECTIVES: Technical implementation and safety of ICD telemonitoring. Effects on the treatment of cardiac arrhythmias, the management of cardiac insufficiency patients and morbidity as well as mortality. Illustration of patient acceptance and cost-benefit assessment. MATERIALS AND METHODS: The current research situation regarding TM of ICDs is analyzed and the available evidence for the postulated advantages in the follow-up care of ICD patients are discussed. The current treatment guidelines and recommendations for implementation of TM in daily clinical praxis are presented. RESULTS AND CONCLUSIONS: TM offers the possibility of faster reaction times to arrhythmias, cardiac decompensation and ICD malfunctions. At the same time, the outpatient follow-ups can be reduced without negatively affecting safety, quality of life or patient acceptance. TM has the potential to cost-neutrally improve the safety of ICD therapy and could lead to optimized management of heart insufficiency patients, while reducing morbidity and mortality. Following the evidence of these benefits as shown in numerous studies, TM has already been included in the current therapy guidelines.
Assuntos
Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/prevenção & controle , Desfibriladores Implantáveis/estatística & dados numéricos , Telemetria/estatística & dados numéricos , Arritmias Cardíacas/diagnóstico , Medicina Baseada em Evidências , Humanos , Satisfação do Paciente , Prevalência , Medição de Risco , Taxa de Sobrevida , Telemedicina/estatística & dados numéricos , Resultado do TratamentoAssuntos
Algoritmos , Desfibriladores Implantáveis , Software , Taquicardia Ventricular/terapia , Terapia Assistida por Computador , Fibrilação Ventricular/terapia , Ensaios Clínicos como Assunto , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Prognóstico , Processamento de Sinais Assistido por Computador , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/terapia , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnósticoRESUMO
BACKGROUND: Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent. OBJECTIVES: The primary objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness of remote monitoring. METHODS: The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system at participating centres in five European countries. Patients will be randomised to remote monitoring or in-clinic follow-up. The In-Clinic group will visit the outpatient clinic every 3-6 months, according to standard practice. The Remote Monitoring group only visits the outpatient clinic at 12 and 24 months post-implantation, other check-ups are performed remotely. Patients are asked to complete questionnaires at five time points during the 2-year follow-up. CONCLUSION: The REMOTE-CIED study will provide insight into the patient perspective on remote monitoring in ICD patients, which could help to support patient-centred care in the future.
RESUMO
HISTORY AND ADMISSION FINDINGS: Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering. INVESTIGATIONS: Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI). TREATMENT AND COURSE: The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit. CONCLUSION: TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected.
Assuntos
Lesão Pulmonar Aguda/diagnóstico , Cateterismo Cardíaco/efeitos adversos , Reestenose Coronária/terapia , Stents Farmacológicos , Transfusão de Eritrócitos/efeitos adversos , Hematoma/etiologia , Hematoma/terapia , Infarto do Miocárdio/terapia , Revascularização Miocárdica , Edema Pulmonar/etiologia , Insuficiência Respiratória/etiologia , Espaço Retroperitoneal , Lesão Pulmonar Aguda/terapia , Catecolaminas/administração & dosagem , Terapia Combinada , Ecocardiografia , Feminino , Humanos , Instituições para Cuidados Intermediários , Intubação Intratraqueal , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico , Edema Pulmonar/terapia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X , Desmame do RespiradorRESUMO
BACKGROUND AND AIMS: Patients with congestive heart failure represent a significant amount of the total annual cost of the health care system. Because of a lack of studies on the economic health cost of the related health care, including all cost generating factors, we analysed in detail characteristics of these patients and the costs created by their care. METHOD: Data were retrieved from the German Bureau of Health Statistics for the year 2002 relating to congestive heart failure (Code I50) including other factors (e. g. co-morbidities, ambulatory and hospital care and choice of the doctor). The data were from more than 2 million patients, from 350 insurance companies, the Federal Employees Insurance and the German Institute for Medical Informatics and Documentation. A total of 86 193 patients with congestive heart failure had been recorded. RESULTS: More women than men were recorded as having congestive heart failure (66 vs. 34 %). The various health insurance companies paid 2.3 times more for patients with than without congestive heart failure. Nearly three quarters of the cost for these patients (72 %) resulted from in-patient care. Moreover, costs for drugs were three times higher (1073 Euro vs. 366 Euro). CONCLUSIONS: This analysis clearly demonstrates the increased costs incurred for patients with congestive heart failure. It should serve as a reference base for better assessing future innovations, such as telemedicine, for their effects in different sectors of health care.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/economia , Programas Nacionais de Saúde/economia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Comorbidade , Custos e Análise de Custo , Estudos Transversais , Bases de Dados Factuais , Custos de Medicamentos/estatística & dados numéricos , Feminino , Alemanha , Insuficiência Cardíaca/mortalidade , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/economia , Fatores Sexuais , Adulto JovemRESUMO
The changes in the demographic structure, the increasing multi-morbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of health care services with its discontinuous processes and redundancies will increase the economic burdens in the health care system. The latest developments and appropriate logistic premises nowadays offer a realistic basis for implementing telemonitoring as a central service and information tool as well as an instrument controlling the information- and data-flow between patient, hospital and medical practitioner.
Assuntos
Cardiologia/métodos , Cardiologia/tendências , Telemedicina , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Desfibriladores Implantáveis/normas , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Monitorização Ambulatorial/métodos , Monitorização Ambulatorial/normas , Marca-Passo Artificial/normas , Telemedicina/normas , Telemedicina/tendências , Telemetria/métodos , Telemetria/normasRESUMO
OBJECTIVE: Since the publication of MADIT II and SCD-HeFT, an implantable cardioverter defibrillator (ICD) for primary prevention represents an established, guideline-implemented therapeutic strategy. Facing such an enormous amount of potential ICD recipients, the identification of an effective risk stratification remains crucial. METHODS: This article reviews the tools of noninvasive risk stratification which are currently used and defines an optimal test configuration. This analysis focuses on the capacity of the tests regarding to the negative predictive value to reduce unneeded devices. RESULTS: Presently, no marker exists in terms of risk stratification which qualifies itself as gold standard. However, encouraging results can be stated for microvolt T-wave alternans (mTWA) providing a high negative predictive value. An increased QT variability (QTv) and an impaired deceleration capacity are associated with an excellent positive predictive value. Currently, only mTWA and QTv seem to be suitable in ischemic and non-ischemic disease, but available data, especially in non-ischemic patients, are too small to provide clear recommendations. CONCLUSION: The most hopeful tools at hand in modern noninvasive risk evaluation of sudden cardiac death in primary prevention seem to be mTWA and QTv. These noninvasive methods provide the best negative predictive or positive predictive value of all known parameters, while a higher rate of complete coronary revascularizations in acute coronary syndromes might also reduce the number of fatal arrhythmic events and therefore complicate the invention of an ideal risk marker.
Assuntos
Arritmias Cardíacas/classificação , Morte Súbita Cardíaca/prevenção & controle , Sistema de Condução Cardíaco/fisiopatologia , Arritmias Cardíacas/complicações , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/efeitos adversos , Eletrocardiografia , Humanos , Valor Preditivo dos Testes , Prevenção Primária , Medição de Risco , Disfunção Ventricular Esquerda/complicaçõesRESUMO
The implantable cardioverter/defibrillator (ICD), which uses antitachycardia pacing or shock, is the only adequate therapeutic option for life threatening ventricular tachyarrhythmias. The results of prospective, randomised ICD trials show that the indications for primary and secondary prevention of sudden cardiac death have changed in a relevant manner. After the identification of a patient at risk, the implantation of an ICD reduces cardiac and total mortality significantly. A clear diagnostic procedure and the parameters needed for the identification of this risk are essential. We report on the indications for the implantation of an ICD following current guidelines in order to enable the physician to provide his patients with an adequate ICD therapy in everyday practice.
Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Taquicardia Ventricular/terapia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Humanos , Guias de Prática Clínica como Assunto , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/mortalidadeRESUMO
The origin of ventricular tachycardia lies in the ventricular tissue and includes a variety of symptoms such as monomorphic and polymorphic ventricular tachyarrhythmia (VT), ventricular flutter and ventricular fibrillation. Due to transitions of one form of VT to another, any form of VT incurs in principal the risk of cardiac failure. Apart from different electrophysiologic mechanisms such as reentry or triggered activity, any occurrence of VT has to be considered in an individual context: VT can be caused by structural heart disease such as coronary artery disease or dilative cardiomyopathy, or primary electrical disease such as long or short QT syndromes or can even occur without any detectable cause (idiopathic VT). Correct identification of the underlying cause of the arrhythmia is essential for the prognosis, differential therapy and long-term treatment of patients.
Assuntos
Taquicardia Ventricular/terapia , Ablação por Cateter , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Eletrocardiografia , Humanos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologiaRESUMO
UNLABELLED: The pharmacological and ablative hybrid therapy of atrial fibrillation (AF) consists of radiofrequency catheter ablation of antiarrhythmic drug-induced typical atrial flutter (AFl) and continuation of drug therapy. The purpose of this study was to determine the effect of this therapy on AF symptoms and quality of life (QoL). Forty-six patients were monitored after isthmus-ablation of drug-induced typical AFl and continuation of their antiarrhythmic drug treatment over a mean follow-up of 22.4+/-11.6 months. AF characteristics, symptoms and QoL before and after ablation were evaluated by the SF-36 question- naire, the Symptoms Checklist-Frequency and Severity Scale and the analysis of ECG recordings. 63% of patients demonstrated recurrences of AF. However, the frequency and duration of symptomatic episodes significantly decreased in 82.6 and 76% of patients. All categories of the SF-36 improved significantly and the AF symptomatology showed a relevant attenuation in 65.8% of the study population. CONCLUSION: The pharmacological and ablative hybrid therapy significantly reduced the mean number and the duration of symptomatic AF episodes as well as AF-correlated symptoms and was associated with significant QoL improvement.
Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Ablação por Cateter/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida , Fibrilação Atrial/diagnóstico , Terapia Combinada/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Resultado do TratamentoRESUMO
A diagnostic and therapeutic approach of supraventricular and ventricular tachyarrhythmia is always challenging. Several criteria serve to discriminate correctly between these two types of tachycardia. Cardiac arrhythmias are terminated reliably by intravenous (IV) application of antiarrhythmic drugs: adenosine for supraventricular arrhythmia, amiodarone or ajmaline for ventricular tachycardia. Furthermore, AV-nodal tachycardia, atrioventricular reciprocating tachycardia, and typical atrial flutter is treated curatively by radiofrequency ablation during an electrophysiological study. This interventional therapy is well established in patients suffering from ventricular premature contractions or tachycardia originating in the right or left ventricular outflow tract. Aside treatment with an implantable defibrillator, patients with coronary artery disease highly benefit from adjusted pharmaceutical treatment.