610 Medizin, Gesundheit
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About 20% of those heart failure patients receiving cardiac resynchronization therapy (CRT) are in atrial fibrillation (AF). Current guidelines apply for patients in sinus rhythm only. Recent studies have shown again, that successful resynchronization is closely linked to a pre-existent ventricular desynchronization. In those studies, the interventricular conduction delay (IVCD) was determined prior to device implantation by ultrasound in patients with sinus rhythm (SR)only. In patients with AF this method ́s use is limited.
To implement left-heart electrogram (LHE) into standard programmers and to simplify IVCD measurement in heart failure patients with AF, LHE was recorded in 11 AF patients with heart failure by Biotronik ICS3000 programmer via a15Hz Butterworth high-pass filter. Therefore, TOslim esophageal electrode (Dr. Osypka GmbH, Rheinfelden, Germany) was perorally applied and fixed in position of maximal left ventricular defection. IVCD was measured between onset of QRS in surface ECG and left ventricular defection (LV) in LHE. In addition, intra-left ventricular conduction delay (ILVCD) was measured as duration of LV in LHE.
In all of the 11 AF patients, desynchronization was quantifiable by LHE. Mean QRS of 162 ± 27ms (120-206ms) was linked with IVCD of 62ms ± 27ms (37-98ms) and ILVCD of 110 ± 20ms (80-144ms), at mean. Correlation between IVCD and QRS was 0.39 (n. s.) with IVCD/QRS ratio of 0.38 ± 0.11 (0.22-0.81).
A 15Hz high-pass filtered LHE feature of the Biotronik ICS3000 programmer is feasible to quantify ventricular dyssynchrony in heart failure patients with AF in order to clearly indicate implantation of CRT systems. As relations between QRS duration, IVCD and ILVCD considerably differ interindividually, the predictive values of IVCD, ILVCD and IVCD/QRS ratio for individual CRT response or non-response shall be identified in follow-up studies.
New frontiers of supraventricular tachycardia and atrial flutter evaluation and catheter ablation
(2012)
Radiofrequency catheter ablation (RFCA) has revolutionized treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. Although developed in the 1980s and widely applied in the 1990s, the technique is still in development. Transesophageal atrial pacing (TAP) can used for initiation and termination of supraventricular tachycardia (SVT).
Methods: The paroxysmal SVT include a wide spectrum of disorders including, in descending order of frequency, atrial flutter, atrioventricular (AV) nodal reentry, Wolff-Parkinson-White syndrome, and atrial tachycardia. While not life-threatening in most cases, they may cause important symptoms, such as palpitations, chest discomfort, breathlessness, anxiety, and syncope, which significantly impair quality of life. Medical therapy has variable efficacy, and most patients are not rendered free of symptoms. Research over the past several decades has revealed fundamental mechanisms involved in the initiation and maintenance of all of these arrhythmias. Knowledge of mechanisms has in turn led to highly effective surgical and catheter-based treatments. The supraventricular arrhythmias and their treatment are described in this report. SVT initiation was analysed with programmed TAP in 49 patients with palpitations (age 47 ± 17 years, 24 females, 25 males).
Results: In comparison to antiarrhythmic drug therapy the radiofrequency catheter ablation in patients suffering from atrial flutter, atrioventricular nodal reentry, atrioventricular reentry and atrial tachycardia is the better choice in most cases. TAP SVT initiation was possible in 23 patients before RFCA. Atrial cycle length of SVT was 320 ± 59 ms. We initiated AV nodal reentrant tachycardia (AVNRT, n=15), atrial tachycardia (AT, n=6) and AV reentrant tachycardia with Kent pathway conduction (AVRT, n=2) before RFCA.
Conclusions: Radiofrequency catheter ablation is a successful and safe method to cure most patients with paroxysmal supraventricular tachycardias. TAP allowed initiation and termination of SVT especially in outpatients.
Whiplash injury
(2012)
Das 20. Jahrhundert ist geprägt von Aufsehen erregenden medizintechnischen Durchbrüchen: Von der ersten erfolgreichen Herztransplantation über die Entdeckung des Penicillins, vom Kampf gegen Infektionskrankheiten bis hin zu ersten Röntgenaufnahmen und Computer-Scans. Die Technologie und die medizinische Forschung haben in der Welt zu umwälzenden Fortschritten geführt. Krankheiten können gelindert oder sogar geheilt werden. Die Entwicklung von künstlichen Hüftgelenken, Cochlea-Implantaten sowie Herzschrittmachern sind in unserer Zeit zu alltäglichen Errungenschaften geworden. Auch die Behandlung neurologischer Bewegungsstörungen ist in den Fokus des technisch-medizinischen Fortschritts gelangt: „Hirnschrittmachersysteme“ – symptomfrei auf Knopfdruck. Ein Eingriff in das Gehirn, um gezielt elektrische Impulse abzugeben, um die Symptome beispielsweise von pharmakoresistenter Parkinsonpatienten effektiv zu behandeln. Dieses Therapieverfahren stellt für viele Patienten die letzte Möglichkeit dar, ein mehr oder weniger beschwerdefreies Leben führen zu können. Gleichzeitig ist dieses Verfahren ethisch heftig umstritten, zumal der Eingriff in das Gehirn gleichbedeutend mit einem Eingriff in den ‚Sitz des Selbst‘, der Persönlichkeit eines Patienten, verbunden ist.
Home Automation, Smart Metering, reduction of energy consumption for climate preservation – those buzz words are flooding the daily press.The European Directive 2006/32/EC (Energy-Use Efficiency and Energy Services) commits its members to reduce their energy consumption about nine percent from 1996 to 2015, and supports smart metering and the need of new developments for encouraging energy efficiency and CO² reduction in households and commercial buildings. The European countries have started different projects to achieve this goal. Also outside Europe, smart metering gains interest, for energy savings and better distribution network control.
Cardiac resynchronisation therapy (CRT) is a promising treatment option in patients with chronic heart failure. In this article the roles of semi-invasive esophageal left-heart electrocardiography and functional cardiac nuclear imaging in the field of CRT are highlighted, as the combination of both could be a favourable diagnostic approach in special cardiac situations. Also original esophageal left heart electrogram data of exemplary CRT patients is presented.
Für den Erfolg einer kardialen Resynchronisationstherapie der Herzinsuffizienz mit biventrikulär stimulierenden Implantaten ist deren individuelle Programmierung von erfolgsbestimmender Bedeutung. Dies trifft insbesondere auf den Parameter AV-Delay zu. Dessen Optimierung durch Echo-Verfahren ist zeitaufwendig, die Suche nach einfacheren Methoden darum verständlich. Eine solche verspricht der in St. Jude Aggregate implementierte automatische QuickOpt Algorithmus. In-vitro-Untersuchungen unter Einsatz eines elektronischen Herzsimulators sagten jedoch verschiedene ungünstige Eigenschaften vorher. Die eingeschränkte Nutzbarkeit ließ sich auch mit In-vitro-Vergleichen belegen.
Das Institut für Angewandte Forschung arbeitet seit Jahren an RFID-Applikationen unter Verwendung des Protokolls nach ISO15693-Standard. Wir entwickeln in dem Zusammenhang sowohl Frontendelektronik als auch Reader, die es ermöglichen, diese Tags auszulesen. Projekte der vergangenen Jahre waren sowohl SEAGsens als auch medizintechnische Anwendungen unterschiedlichster Art.