Moderne Herzschrittmacher sind mit zahlreichen Algorithmen ausgestattet, die sie zu bemerkenswerten therapeutischen und diagnostischen Werkzeugen machen. Die zunehmende Komplexität bringt jedoch unbeabsichtigt neue Herausforderungen mit sich. In dieser Arbeit beschreiben wir eine neue Herzschrittmacher-Induzierte Arrhythmie die oft zum Vorhofflimmern führt.:1. Introduction................................................................................................ 3 1.1. A flashback to the beginning of cardiac pacemakers ............................. 3 1.2. Early pacemakers and significant advances .......................................... 5 1.3. Fast-forward to modern pacemakers ...................................................... 6 1.4. Current challenges .................................................................................. 8 1.5. Identification of a new pacemaker induced arrhythmia .......................... 10 1.6. Methods and results ............................................................................... 11 1.7. Patient characteristics ............................................................................ 13

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Untersuchung von MPO sowie anti-inflammatorischer HDL Funktionalität bei Patienten mit Vorhofflimmern

Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke (n=86) had a larger overall oriented bounding box (OBB) volume (p=0.003) and a higher number of brain lesion components (p=0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p<0.001), age (OR 2.13, 95%CI 1.52–3.06, p<0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p=0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.

The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients (n = 454) undergoing CV. Cox regression models were performed to estimate AF recurrence comparing patients with and without statins. In addition, we performed a propensity score matched analysis with a 1:1 ratio. Statins were prescribed to 183 (40.3%) patients. After a median follow-up period of 373 (207–805) days, recurrence of AF was present in 150 (33.0%) patients. Patients receiving statins had a significantly lower rate of AF recurrence (log-rank p < 0.001). In univariate analysis, statin therapy was associated with a significantly reduced rate of AF recurrence (HR 0.333 (95% CI 0.225–0.493), p = 0.001), which remained significant after adjustment (HR 0.238 (95% CI 0.151–0.375), p < 0.001). After propensity score matching treatment with statins resulted in an absolute risk reduction of 27.5% for recurrent AF (21 (18.1%) vs. 53 (45.7%); p < 0.001). Statin therapy was associated with a reduced risk of long-term AF recurrence after successful cardioversion.

Atrial fibrillation (AF) is our society's most common cardiac arrhythmic disease, leading to increased morbidity and mortality. Predicting AF episodes during sinus rhythm based on electrocardiograms (ECGs) allows timely interventions. It is known, that changes in selected ECG morphology features are a predictor for the onset of AF, but no systematic investigation of different ECG features' temporal changes has been performed so far. We split sinus rhythm episodes of 60 minutes preceding AF from the MIT-BIH AF database into segments of 5 minutes with 50% overlap (n=644) and calculated 155 features of different domains per segment. Logistic regression analyses between the segments preceding AF and others revealed the most significant effects for segments ending 5 minutes before AF onset, with PQ interval slope (p < 0.01), PQ interval correlation (p < 0.05), and median RR time (p < 0.05) being the most relevant features. A decision tree ensemble, trained with all features, achieved an accuracy of 0.87 when distinguishing 8 segment clusters. Our results confirm expected changes in ECG features (e.g., PQ interval) before AF episodes, indicating impaired atrial excitation, and show that the combination of interpretable features is sufficient to discriminate at different points in time before AF onset. For advanced analyses, more extensive databases should be included.

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