Von Bonnie Tyler bis Cascada: Diese 26 Länder und ihre Musiker stehen im Finale des Eurovision Song Contest am Mai. Das erste Halbfinale beim Eurovision Song Contest im schwedischen Malmö steht bevor - bei der ersten öffentlichen Probe sorgten schrille. Der Eurovision Song Contest fand vom bis Mai in der Malmö Arena statt. Ausrichter war Sveriges Television (SVT), nachdem die für Schweden.
Kommentar: ESC 2013 – Zenit überschritten?Mai stand Malmö ganz im Zeichen des Eurovision Song Contest. Emmelie de Forest aus Dänemark gewann den ESC mit dem Titel "Only Teardrops". Musik. Kommentar: ESC – Zenit überschritten? Im Malmö wurde die Gewinnerin des Europäischen Song Contest gekrönt: Emmelie de. Vor dem Finale des Eurovision Song Contest in Malmö fanden zwei Halbfinale statt. Diese 26 Interpreten kämpfen um die Krone in Europa.
Esc 2013 Publication types VideoEurovision 2013 - Semifinal 1 Qualifiers (Official Results) ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). The Eurovision Song Contest will be the 58th annual ESC. It will be the 5th to be held in Sweden and the second to be held in the city of Malmö at the Southern tip of Sweden. The venue will be the Malmö Arena. The Eurovision Song Contest will be held on May 14,16 (semi-finals) and 18 (final). ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Commentator: Graham Norton (BBC One). The Israeli entry for the Eurovision Song Contest was selected through Kdam Eurovision , the national final format organised by IBA. The competition commenced on 26 February and concluded with a final on 7 March The first semi-final took place on 26 February Eurovision Song Ô Shea Jackson Previews Songs of Europe Kvalifikacija za Millstreet Congratulations: 50 Years of the Eurovision Song Contest Brokenwood Neuseeland Song Contest's Greatest Hits Eurovision Home Concerts Eurovision: Europe Shine a Light Scott Mills BBC Three.
Meine Himmlische Verlobte nachdem die Handschallen The Blacklist Redemption Deutsch und Jessie ans Bett gekettet ist, was Jonas bemerkt und sich nun ffentlich zu ihr bekennt. - Unsere Empfehlung für SieAserbaidschan: Farid Mammadov mit: "Hold Me". Ungarn: ByeAlex mit "Kedvesem". Sehr Love Death + Robots war die sechsminutige Revue der Moderatorin und Komikerin Petra Mede, die schwedische Klischees auf die Schippe nahm. Sängerin, SiegerinTeilnehmerin
Demonstrating that CRT is or is not effective in patients with AF should provide further insights into the mechanisms of CRT effect.
AV junction ablation and permanent pacing from the RV apex provides highly efficient rate control and regularization of the ventricular response in AF and improves symptoms in selected patients.
CRT may prevent the potential LV dyssynchrony induced by RV pacing and therefore appears an interesting approach for patients eligible for AV junction ablation due to rapid AF.
Indications for cardiac resynchronization therapy Recommendation 2. The multi-centre, randomized and prospective APAF trial included patients in whom a CRT or RV pacing device was implanted, followed by AV junction ablation.
RV pacing. Seen in perspective, there is a need for large RCTs to assess the efficacy of CRT in patients with permanent or longstanding, persistent AF, in terms of morbidity and mortality.
These trials should compare not only CRT combined with medical treatment, but also CRT with AF ablation, which has been proposed and has to be evaluated as a potential treatment.
Indications for cardiac resynchronization therapy in patients with permanent atrial fibrillation. There is evidence, from small randomized trials, of an additional benefit of performing CRT pacing in patients with reduced EF, who are candidates for AV junction ablation for rate control, in order to reduce hospitalization and improve quality of life.
However, the quality of evidence is moderate and discordance of opinion exists among experts. RCTs are warranted.
There is weak evidence that CRT is superior to RV pacing in patients with preserved systolic function.
Contrary to the recent ESC Guidelines on HF, w81 separate recommendations are provided for these two situations.
Previous studies have clearly shown that RV apical pacing might have deleterious effects on cardiac structure and function. Upgrade from conventional pacemaker or implantable cardioverter defibrillator Recommendation 1.
The additional benefit of biventricular pacing should be considered in patients requiring permanent or frequent RV pacing for bradycardia, who have symptomatic HF and low LVEF.
During the CRT study phase, the patients consistently showed clinical subjective improvement, less hospitalization and improved cardiac function, compared with the RV study phase.
Summary of evidence for upgrading from conventional pacemaker or implantable cardioverter defibrillator to cardiac resynchronization therapy devices.
In comparison with the period before CRT upgrade, these patients showed substantial subjective clinical improvement during the subsequent follow-up of 1—20 months, had fewer hospitalizations and demonstrated improved cardiac function.
Finally, five studies compared the clinical outcomes of patients who received an upgrade to CRT with those who received a de novo CRT implant for conventional indications.
Upgrade to CRT is associated with a high complication rate, which was Despite the lack of large randomized trials, there is sufficient evidence and general consensus that, in patients paced for conventional bradycardia indications who, during follow-up, develop severe symptoms of HF and have depressed EF, an upgrading to CRT pacing is likely to reduce hospitalization and improve their symptoms and cardiac performance.
However, the quality of evidence is moderate and further research is likely to have an important impact on our confidence in the estimate of effect and might change the estimate.
Moreover, the risk of complications is higher in upgrading procedures than in primary implantation procedures.
While these trials consistently confirmed that chronic RV pacing leads to sustained and progressive deterioration of LV function, and that this adverse remodelling process is prevented by CRT pacing, it is not yet known how this can translate into a better clinical outcome because of the lack of data on long-term clinical follow-up.
Yu et al. CRT prevented the reduction in LVEF and the increase in LV end-systolic volume observed at 1 year with RV apical pacing.
No significant difference was observed in clinical endpoints for the two groups. The same findings were observed at 2-year follow-up. There were few clinical events with a trend in favour of CRT.
In the Biventricular versus right ventricular pacing in patients with AV block BLOCK HF trial, , patients with AV block and systolic dysfunction were randomly assigned to CRT-P and RV pacing with or without an ICD and followed for an average of 37 months.
LV lead complications occurred in 6. The results of the ongoing Biventricular Pacing for Atrioventricular Block to Prevent Cardiac Desynchronization BIOPACE trial, w which has a similar design, are awaited.
There is emerging evidence that de novo CRT implantation may reduce HF hospitalization, improve quality of life and reduce symptoms of HF in patients with history of HF, depressed cardiac function and a bradycardia indication for pacing.
The benefit should be weighed against the added complication rate and costs of CRT devices and their shorter service life.
The quality of evidence is low and further research is likely to have an important impact on our confidence in the estimate of effect, and may change the estimate.
Summary of evidence of RCTs of de novo CRT implantation compared with RV apical pacing in patients with conventional indication for anti-bradycardia pacing.
Owing to the heterogeneity of published studies, it is difficult to identify the brady-paced population who may benefit from upgrading to CRT. In general, however, it seems that patients who might benefit are those who—early or late after conventional permanent RV pacing—have a deterioration of LV function e.
Owing to the lack of high-quality evidence, the indication for CRT remains largely individual. Late upgrade after HF development seems to provide similar benefit to de novo implantation in patients with initial preserved cardiac function.
Therefore, a strategy of initially conventional anti-brady pacing, with later upgrade in case of worsening symptoms, seems reasonable.
In patients being considered for de novo implantation, it is important to distinguish to what extent clinical presentation may be secondary to the underlying bradyarrhythmias, rather than to LV dysfunction.
This is often difficult to recognize. In the decision-making process between upgraded and de novo CRT pacing instead of conventional RV pacing, physicians should take into account the added complication rate related to the more complex biventricular system, the shorter service life of CRT devices with the consequent need for earlier pacemaker replacement and the additional costs.
See also section 5, Complications. Indication for upgraded or de novo cardiac resynchronization therapy in patients with conventional pacemaker indications and heart failure.
Five large randomized trials compared the effects of CRT-D with ICD alone and showed an advantage for CRT-D in terms of survival, morbidity and symptom reduction.
Even though the theoretical reason for adding an ICD to CRT is clear —to reduce of the risk of arrhythmic death—the survival benefit of CRT-D over CRT-P is still a matter of debate, mainly because no RCT has been designed to compare these treatments.
COMPANION had three study arms—optimal medical therapy, CRT-P and CRT-D—but was not designed to compare CRT-D with CRT-P.
Sudden cardiac death was only significantly reduced by CRT-D, compared with medical therapy, over 16 months follow-up.
Studies that compared CRT alone against optimal medical therapy overall, did not show a reduction in sudden cardiac death risk with CRT.
The results imply that, although the risk of dying from HF is immediately lowered by CRT, the reduction of risk of sudden cardiac death evolves at a much slower rate.
It is very probable that reduction in risk of sudden cardiac death by CRT is related to the extent of reverse remodelling.
In a recent meta-analysis, 57 which encompassed virtually all published trials on CRT, the mortality benefit of CRT was largely driven by a reduction in HF-related mortality.
However, the CRT and control groups did not differ in their risk for sudden cardiac death 12 trials, events in patients; RR 1.
Another meta-analysis, made using a Bayesian approach, which included 12 studies but not REVERSE, MADIT-CRT or RAFT and encompassed patients and events, failed to show a superiority of CRT-D over CRT-P.
The Bayesian approach models the multivariate intervention effects of multi-group trials and thus provides higher methodological quality than previous meta-analyses.
Combined CRT and ICD therapy reduced the number of deaths by one third, compared with medical therapy alone [OR 0. In conclusion, the evidence from RCTs is insufficient to show the superiority of combined CRT and ICD over CRT alone.
Probability of best treatment for patients with left ventricular dysfunction from a meta-analysis of 12 RCTs Selection of cardiac resynchronization therapy and defibrillator or cardiac resynchronization therapy and pacemaker.
There are reasons for preferentially implanting CRT-Ds in asymptomatic or mildly symptomatic patients. NYHA I—II patients are younger, have fewer co-morbidities and have a higher proportion of sudden- vs.
In Sudden Cardiac Death in Heart Failure Trial [SCD HeFT, w a subgroup analysis revealed a greater benefit of ICD in NYHA II than in NYHA III patients.
The possible survival benefit conferred by CRT-D in NYHA I—II must be balanced against the risk of ICD-related complications, in particular lead failure and inappropriate shocks.
In the COMPANION study, out of patients were in NYHA class IV at baseline. Thus CRT-D is beneficial in all disease states, but the benefit appears relatively small in end-stage HF, in which the main reason for choice of device is related to improvement of quality of life and reduction of HF-related hospitalizations and death.
In the MADIT-II trial, risk stratification for primary preventive ICDs in ischaemic patients indicated five clinical factors predictive of total mortality in the control group and thus a potential for reduced benefit from ICD.
By contrast, among high-risk patients 3 or more risk factors , there was no significant difference in 8-year survival between the ICD and non-ICD subgroups 19 vs.
In the CARE-HF trial, during a mean follow-up of The REVERSE trial provides data on the cost-effectiveness of CRT in patients with NYHA functional class I—II HF symptoms.
The evidence from RCTs is insufficient to show the superiority of combined CRT and ICD over CRT alone. Owing to the potential incremental survival benefit of CRT-D over CRT-P, the prevailing opinion among the members of this Task Force is in favour of a superiority of CRT-D in terms of total mortality and sudden death.
Nevertheless, trial evidence is usually required before a new treatment is used routinely. Indication for concomitant implantable cardioverter defibrillator cardiac resynchronization therapy and defibrillator.
Intraventricular conduction disturbances are more commonly developed in the setting of an anterior-anteroseptal infarction as a result of specific blood supply conditions.
AV block complicating acute myocardial infarction most often resolves itself spontaneously within 2—7 days. Permanent cardiac pacing does not influence the prognosis of these patients and therefore is not recommended.
In patients with anterior infarction, complicated by new-onset BBB and transient AV block, short- and long-term mortality is high irrespective of permanent pacing.
There is no evidence that cardiac pacing improves the outcome. Since these patients often have HF and severe systolic dysfunction, it is the opinion of this Task Force that it seems more appropriate to evaluate the indications for CRT-D, rather than conventional anti-bradycardia pacing see section 3.
Bradyarrhythmias are not uncommon after cardiac surgery, transcatheter aortic valve implantation TAVI and heart transplantion. Some bradyarrhythmias are transient and resolve themselves in the first days after surgery, others persist and permanent cardiac pacing has to be considered with the same recommendations as for unoperated patients.
The clinically important question in managing post-operative bradyarrhythmias is related to the reasonable amount of time to allow for recovery of AV conduction or sinus node function after surgery before implanting a permanent PM.
However, recovery may also occur later. In a systematic review, w including retrospective series or registries, inclusive of patients from Europe and North America, the mean incidence of permanent PM implantation following TAVI was In a multi-centre registry, w one third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure required a PM within 30 days.
In most cases, the PM was implanted within 5 days and, in three out of eight studies, within 24 hours. There is little evidence of recovery following complete AV block.
Although TAVI patients usually meet the criteria for CRT in patients with conventional indication for anti-bradycardia pacing see section 4. Since sinus node and AV node function improve during the first few weeks after transplantation, an observation period before PM implantation may allow spontaneous improvement of bradycardia.
DDDR mode with minimized ventricular pacing or AAIR in the case of intact AV nodal conduction are recommended. If significant bradyarrhythmia does not resolve in the suggested observation period after cardiac surgery, TAVI or heart transplantation, permanent cardiac pacing is indicated with the same recommendations as in section 2.
However, in case of high-degree or complete AV block with low rate of escape rhythm, this observation period can be shortened since resolution is unlikely.
For sinus node dysfunction in heart transplanted patients, the period of observation could be several weeks.
Pacing after cardiac surgery, transcatheter aortic valve implantation and heart transplantation. Despite many similarities in pacing indications between young people and adults, several differences justify the writing of a separate, dedicated chapter.
Since children are paced for a lifetime, they are prone to a higher incidence of long-term adverse events and are at high risk of experiencing the adverse consequences of cardiac stimulation at a non-optimal site.
Because of a small body size, the presence of a congenital defect with a right-to-left shunt, or post-operative absence of transvenous access to the target chamber, children often need to be permanently paced epicardially.
Concerns have been voiced regarding the long-term performance of endocardial leads in children, given the high incidence of abandonment, potential valvular injury and vascular crowding.
When allowed during the surgical intervention, attempts should be made to stimulate either the left or the systemic ventricle, w although studies looking at chronic results of LV or systemic pacing are warranted.
The decision to proceed with the implantation of a permanent PM in patients suffering from congenital AV block is strongly influenced by the awareness that i Adams-Stokes attacks and HF might develop in children, adolescents or adults of any age and ii the first manifestation of congenital AV block might be sudden death, without prodromal symptoms and in the absence of manifestations of underlying heart disease.
Indications for cardiac pacing Recommendations 1 and 2. The development of syncope or pre-syncope, HF or chronotropic incompetence limiting the level of physical activity justifies the implantation of a PM.
Even if the quality of evidence is modest, there is a strong consensus that patients with third- or second-degree Mobitz II AV block must receive permanent cardiac pacing therapy if symptomatic or with risk factors.
In asymptomatic patients without risk factors, there is divergence of opinion on the benefit of cardiac pacing. Spontaneous resolution of complete AV block in the early post-operative period can occur, usually within 10 days after the operation.
In contrast, the prognosis for non-paced patients is very poor. Indications for cardiac pacing Recommendations 3 and 4 Sinus node disease and bradycardia-tachycardia syndrome.
There is modest evidence and strong consensus that patients with persistent third- or second-degree AV block must receive permanent cardiac pacing therapy.
The evidence is modest and the consensus is weak for patients who have persistent bifascicular block with or without PR interval prolongation associated with transient AV block or with permanent prolonged PR interval.
In children, sinus node dysfunction might precede or follow reparative cardiac surgery involving the atria, though it is also observed in patients treated with anti-arrhythmic drugs and in patients with an otherwise normal heart.
Indications for cardiac pacing Recommendations 5 and 6. The occurrence of symptomatic sinus node disease justifies the implantation of a PM if competing causes have been ruled-out after extensive examination.
Pacing can also be used to treat congestive HF or fatigue and to prevent the development of supraventricular arrhythmias. There is sufficient evidence and large consensus that cardiac pacing is beneficial in symptomatic sinus node disease.
The evidence is modest and the consensus is weak for patients who have less severe forms of sinus node disease. Evidence of benefit from CRT is limited to case reports, retrospective analyses of heterogeneous populations, small crossover trials conducted in the immediate post-operative period and expert opinions.
In these patients, single-site LV pacing is particularly attractive for children and young adults. A recent European multicentre study showed that, during a mean follow-up of 5.
However, the evidence is not great enough and this Task Force cannot make any specific recommendation. An individualized evaluation of the benefits vs.
The decision to implant a pacemaker in children is done in collaboration with paediatric cardiologists and should preferably be done in a specialized centre.
Single-site LV pacing, instead of RV pacing, is an attractive mode of pacing in order to preserve cardiac function, but it requires further evidence.
Indications for pacing therapy in paediatric patients and congenital heart disease. Atrioventricular block is uncommon in hypertrophic cardiomyopathy HCM , but in context, can suggest specific aetiologies for example, PRKAG2 gene mutations, Anderson-Fabry disease and amyloidosis.
Atrioventricular block in patients with HCM should be treated in accordance with the general recommendations of this Guideline see section 2.
Chronotropic incompetence during upright exercise testing is more common in patients with advanced disease and is an important determinant of exercise performance.
Treatment of left ventricular outflow tract obstruction Recommendation 1. In patients with symptoms caused by left ventricular outflow tract obstruction , treatment options include negative inotropic drugs, surgery, septal alcohol ablation and sequential AV pacing.
For the remainder, surgery septal myectomy or septal alcohol ablation can, in appropriately selected patients and in experienced centres, improve functional status with a similar procedural mortality, but a higher rate of permanent PM implantation following alcohol ablation.
Right ventricular apical pacing alone has also been advocated as a therapy for HCM. Pacing creates pre-excitation of the RV apex, which changes the ventricular contraction pattern and creates regional dyssynchrony.
The result is late activation of the basal part of the septum and decreased LV contractility, which reduce systolic anterior motion of the mitral valve and the severity of LV outflow tract obstruction.
The sensed AV delay needs to be shorter than the spontaneous PR interval in order to achieve RV pacing.
However, short intervals may interfere with atrial emptying and result in reduced cardiac output.
The upper rate limit should be programmed higher than the fastest sinus rate achievable during exercise, to ensure permanent ventricular pacing even during brisk exercise.
In some patients with a very short PR interval, AV nodal ablation has been advocated as a method of achieving an optimal AV delay, but this is not recommended in this Guideline.
Reduction in outflow tract gradients and inconsistent effects on symptoms and quality of life have been demonstrated in three small randomized, placebo-controlled studies of DDD vs.
AAI pacing and in long-term observational studies. Finally, a significant number of patients with HCM receive an ICD for primary or secondary prevention.
Implanting a dual-chamber device and programming DDD pacing with short adapted AV delay may alleviate obstruction and prevent the need for complementary and risky procedures such as surgery or alcohol ablation.
Cardiac resynchronization therapy. There is sufficient evidence to suggest that permanent AV sequential pacing with short AV interval can reduce outflow tract obstruction and improve symptoms in selected patients who are unsuitable for—or unwilling to consider—invasive septal reduction therapies.
Regional heterogeneity of contraction and relaxation is well recognized in HCM and the presence of dyssynchrony has been shown to be a marker of poor prognosis.
In general, patients with drug-refractory symptoms caused by LV outflow tract obstruction should be considered for surgery or alcohol ablation.
In patients with LV outflow tract obstruction treated with pacemaker or dual-chamber ICD, a short AV interval programming is crucial.
The objective is to achieve maximum RV apical pre-excitation without compromising LV diastolic filling.
In the absence of LV outflow tract obstruction, AV block complicating HCM should be treated in accordance with general recommendations of this Guideline.
Patients with HCM can develop systolic dysfunction and symptoms of heart failure. In the absence of randomized trials, CRT may be considered in individual cases in which there is some evidence for systolic ventricular impairment and dyssynchrony see section 3.
Some, such as LQTS or familial AV block affect only the heart, whereas others are multi-system disorders with variable cardiac involvement.
Bradyarrhythmias in patients with inherited rare diseases should be treated in accordance with general recommendations of this Guideline see sections 2.
The trigger for most episodes of life-threatening arrhythmias is a sudden increase in sympathetic activity, mediated by left-sided cardiac sympathetic nerves.
Beta-blockers are the mainstay of drug treatment in patients with LQT1 and LQT2 as large registries indicate that they reduce mortality, even in asymptomatic mutation carriers.
In the past, PMs have been advocated in patients with pause-dependent ventricular arrhythmia, but data from small observational series suggest that pacing reduces syncopal events but does not prevent sudden cardiac death.
Pacing algorithms in patients with an ICD can also help to prevent shocks. The current role of PM therapy in long QT syndrome is very limited.
Muscular dystrophies are a heterogeneous group of inherited disorders, characterized by progressive skeletal muscle wasting and weakness.
A typical finding of X-linked recessive Emery-Dreifuss muscular dystrophy EDMD is atrial standstill or atrial paralysis, related to replacement of atrial myocardium by fibrous tissue.
Following implantation of a PM, the incidence of sudden death appears low, but the risk of stroke remains high because of atrial standstill and AF.
In the heart, myotonic dystrophy type 1 DM1 causes progressive conduction disease, ventricular arrhythmia and systolic impairment. In a recent systematic review of 18 studies patients , ventricular premature beats were the most prevalent arrhythmia The probability of receiving a PM or ICD was 1.
The mechanism has been assumed to be progressive conduction disease, but reports of sudden death in patients with pacemakers and spontaneous or inducible VT suggest that ventricular arrhythmias might explain some cases.
Development of criteria for pacemaker and ICD implantation is challenging because of the small size and heterogeneity of published cohort studies and the confounding effect of progressive neuromuscular disease on survival.
A number of clinical risk markers have been proposed including: age at symptom onset, severity of muscular involvement, number of CTG trinucleotide repeats, supraventricular arrhythmias, AV conduction disturbances, abnormal signal-averaged ECG and reduced heart rate turbulence.
There was no significant difference in overall mortality over a median follow-up of 7. When adjusted for baseline characteristics, there was borderline significance in overall survival in favour of the invasive strategy, largely due to a significant reduction in adjusted survival from sudden cardiac death.
Overall patients with conduction disease had a poorer survival, irrespective of EPS, compared with those without. These data provide incremental evidence in support of EPS in patients with conduction disease, but the small improvement in overall survival means that the clinical significance of this study is unclear.
Desmin-related myopathy is characterized by progressive skeletal muscle weakness, cardiomyopathy and cardiac conduction disease, with variable age of disease onset and rate of progression.
Twenty-five per cent of carriers died at a mean age of 49 years. Sudden cardiac death occurred in two patients with a pacemaker.
Supraventricular and ventricular arrhythmias and conduction defects, are the most common cardiac presentations in patients with mitochondrial disease.
Cardiac conduction disease is the key feature of the Kearns-Sayre disease. Ventricular arrhythmias and sudden death are also reported, often in association with HCM in adults and children.
In adults, one of the most common metabolic disorders is Anderson-Fabry disease, an X-linked lysosomal storage disorder that causes HCM in middle and later life.
QRS duration is a predictor for future PM implantation, w but in the absence of prospective trials we suggest adherence to conventional pacing and ICD indications, with close monitoring of patients with ECG evidence for conduction disease.
Numerous rare genetic disorders can cause conduction disease but, for most, there is little evidence for disease-specific treatments, except possibly for laminopathies, in which early ICD might be considered, and myotonic dystrophy, in which PM might be considered if a prolonged HV interval is detected at EPS.
This topic has been recently covered by the ESC Guidelines on the management of cardiovascular diseases during pregnancy.
For women who have a stable, narrow, complex junctional escape rhythm, PM implantation can be deferred until after delivery.
A PM for the alleviation of symptomatic bradycardia can be implanted at any stage of pregnancy using echo guidance or electro-anatomic navigation avoiding fluoroscopy.
First degree AV 1st AV block is commonly considered a benign condition. However, a very long PR interval may exacerbate symptoms, especially during moderate or mild exercise.
With a prolonged PR interval, atrial systole occurs too early in diastole, resulting in an ineffective or decreased contribution of the atrial systole to cardiac output.
Echocardiographical studies show a fusion of the E and A waves in patients with a long PR interval, resulting in a shortening of the LV filling time and a diastolic mitral regurgitation.
Some uncontrolled and non-randomized studies have suggested that a reduction of the AV timing using conventional DDD PM would improve symptoms and patients' functional status, especially in patients with preserved LV function.
The improvement with DDD pacing is directly linked to the improvement in LV filling time. There are some potentially harmful consequences of conventional DDD pacing.
The first one is that permanent RV pacing may enhance LV dysfunction. The systematic use of biventricular pacing is not recommended at this time for this particular indication in the absence of other CRT indications.
The second potential deleterious effect is the risk of functional atrial under-sensing due to the shift of the P wave in the post-ventricular atrial refractory period, especially with fast heart rate; an exercise test would be helpful to ensure an adequate programming of the PM when the patient is exercising.
The rationale for the use of specific pacing algorithms is to avoid bradycardia and large atrial cycle length variations, which are thought to trigger atrial tachyarrhythmias AT.
Specific algorithms have included rate-adaptive pacing, which periodically assesses the underlying intrinsic rate to pace just above it, elevation of the pacing rate after spontaneous atrial ectopy, transient high-rate pacing after mode switch episodes and increased post-exercise pacing to prevent an abrupt drop in heart rate.
In addition, some devices have incorporated atrial anti-tachycardia pacing ATP algorithms high rate ramp and burst pacing for termination of atrial tachycardia or atrial flutter that might degenerate into AF.
After the pivotal multi-centre study of Israel et al. Similarly, some RCTs failed to show a clinical benefit from anti-tachycardia pacing algorithms ATP.
Finally, no consistent data from large randomized trials support the use of alternative single-site atrial pacing, w,w dual-site right atrial pacing, w or bi-atrial pacing, w alone or in association with algorithms for prevention and termination of AT.
There is strong evidence that algorithms designed to prevent AF have no incremental benefits for the prevention of AF; further trials are unlikely to change the confidence in the estimate of effect.
The majority of the information in this field has come from retrospective studies based on implantations performed more than 20 years ago.
In a nationwide registry of 28 patients, lead complications occurred in 3. Complications occurred in 4. The presence of a CRT device OR 3. The majority of the complications with pacemakers occur in-hospital or during the first 6 months.
Complications were highest in patients who had an upgrade to- or a revised CRT device Get a sneak peek of the new version of this page.
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Official Sites. Company Credits. Technical Specs. Plot Summary. Plot Keywords. Parents Guide. Appreciation of the importance of working in a team with lay persons, paramedics, and other medical personnel during resuscitation BLS and ACLS ;.
Understanding of the importance of regular audit of the basic and advanced life support programme. To implement appropriate medical therapy, and recognize the indications for interventional or surgical treatment.
Team working with emergency and intensive care physicians, cardiovascular surgeons, interventional cardiologists, and radiologists;.
Recognition of the urgency required in managing patients with diseases of the aorta and cardiac trauma;. Recognition of the need for long-term follow-up of patients with chronic aortic disease.
To assess and manage patients with PAD, including atherosclerotic and other diseases of the cervical carotid and vertebral , mesenteric, renal, upper and lower limb arteries.
Diagnosis and assessment of PAD, including the ABI and various imaging modalities;. General treatment modalities including smoking cessation, lifestyle modification, supervised exercise training programme, antiplatelet and anti-thrombotic drugs, lipid-lowering drugs, and antihypertensive therapies in patients with PAD;.
Indications for invasive interventional and surgical management and their relative merits in different situations;.
Appreciation of the systemic nature of atherosclerosis and its implications for a patient in whom disease is manifested within a single territory.
In particular, awareness of the association of PAD with disease in the coronary, carotid, and renal arteries;.
A positive approach to encouraging patients to adopt a healthier lifestyle with specific emphasis on risk factors and walking;. Team working with specialists such as cardiac rehabilitation specialists, interventional cardiologists, radiologists, vascular surgeons, and diabetologists.
Management of chronic thrombo-embolic pulmonary hypertension, including thrombo-endarterectomy;. Appreciation of the difficulties in diagnosing pulmonary embolism on the basis of symptoms and signs;.
Collaboration with other imaging experts including radiologists and nuclear imaging specialists;. Ensuring patient understanding of the disease and the importance of compliance with, and the precautions required during long-term anticoagulant therapy.
To perform specialist assessment and management of patients with cardiac emergencies;. To collaborate with cardiac intensive care unit ICU cardiologists and intensive care physicians in the assessment and management of cardiovascular diseases in patients in the ICU.
Algorithms of basic BLS and advanced life support ACLS , including the indications for not starting resuscitation or ceasing an initiated attempt. Epidemiology, pathophysiology, diagnosis and management of cardiac emergencies, including ACS, acute heart failure, cardiogenic shock, life-threatening arrhythmias, cardiac arrest and resuscitation, pericardial tamponade, pulmonary embolism, acute valve, and aortic disease;.
Comply with local infection control measures and appropriately manage antimicrobial drug therapy;. Address the physical and psychosocial consequences of critical illness for patients and their families;.
Manage end of life situations and participate in the process of withholding or withdrawing treatment in cooperation with the multi-disciplinary team;.
Communicate, collaborate and team-work with the health care team nurses in the ICU, ICU cardiologists, intensivists and paramedical staff ;.
Readiness for quick availability, when requested by physicians, nurses, or staff. To cooperate with and assist other medical specialists in the prevention, assessment, and management of cardiovascular diseases in patients requiring non-cardiac surgery;.
To perform an individualized cardiac risk assessment in patients to be submitted to non-cardiac surgery;. To perform an integrated multi-disciplinary pre- and peri-operative approach, in close cooperation with anaesthetists, but also with surgeons, other medical specialists, and paramedical professionals;.
To optimize the patient's pre-operative condition before non-cardiac surgery. Pathophysiology of cardiovascular complications during surgery such as peri-operative infarction, rhythm disturbances, and heart failure;.
Patient-related, cardiac-related, and surgery-specific risk factors that influence cardiac risk for non-cardiac surgical interventions;.
Effects of most frequently used anaesthetic and sedative agents on cardiovascular function;. Indications for and limitations of non-invasive testing for cardiac disease before surgery including ECG, echocardiography, various stress testing modalities, and X-ray computed tomography;.
Benefits of and clinical indications for pharmacological risk reduction strategies before and during surgery beta-blockers, statins, antiplatelet therapy ;.
Insight on alternative types of surgical procedure and local or regional anaesthetic techniques that can reduce cardiovascular risk;.
Risk evaluation, timing of procedure and risk reduction strategies in patients with specific conditions such as: post-revascularization PCI or surgery , heart failure, valve diseases, valve prostheses, rhythm disturbances, and cardiac devices ICDs and pacemakers.
Stimulation of multi-disciplinary team discussions on cardiovascular disease assessment and peri-operative strategies and management;.
Development and implementation of multi-disciplinary protocols for cardiovascular disease assessment and management;.
Awareness of the current cardiovascular prognosis of patients for whom non-cardiac surgery is planned.
To search for potential sources of cardiac embolism and other manifestations of atherosclerosis coronary heart disease or peripheral arterial disease in patients with ischaemic neurological symptoms and advise on appropriate short- and long-term management secondary stroke prevention ; To cooperate with neurologists in the evaluation of patients with other neurological presentations such as syncope, dizziness, haemorrhagic stroke secondary to hypertension, antiplatelet, or anticoagulant therapy , and neuromuscular diseases with possible cardiac involvement.
Mechanism, epidemiology, clinical characteristics, and potential treatment options in patients with cardiac and aortic sources of embolism;. Atherosclerosis as a systemic disease involving simultaneously other vascular territories;.
Importance and urgency of stroke prevention anticoagulation in patients with AF and fibrillation;. Pharmacological and non-pharmacological therapies, including the indications for and relative merits of carotid interventions endarterectomy vs.
Insight into the indications for neurosurgical interventions;. Close team-work with neurologists and radiologists to determine the best management strategy for patients with ischaemic and non-ischaemic neurological conditions.
To manage cardiovascular disease in patients with diseases of other organs or systems that affect the cardiovascular system or are associated with cardiovascular involvement;.
To be particularly vigilant in the elderly, in patients with diabetes types I and II, chronic kidney disease, pulmonary disease, erectile dysfunction, and rheumatic disorders.
Definition, classification, epidemiology, pathophysiology, complications, and principles of therapy in diabetes;. Diabetes as a cardiovascular risk equivalent and as a risk factor for heart failure diabetic cardiomyopathy ;.
Specificities of cardiovascular management in diabetic patients e. Pathophysiology, epidemiology, and clinical implications of the complex interplay between the heart, the vasculature, and CKD as both a risk factor and a consequence of cardiovascular disease.
Importance of appropriate renal function evaluation in every patient with cardiac disease;. Pharmacological specificities indications, contraindications, and dose adjustment of cardiovascular drugs in patients with CKD;.
Strategies to avoid contrast nephropathy induced by cardiological examinations. Epidemiology and clinical manifestations of, and treatment strategies for cardiovascular diseases in elderly patients and those with pulmonary diseases, erectile dysfunction, rheumatic disorders and other coexisting diseases.
Use of the cardiac consultation as an opportunity to identify cardiovascular risk factors and provide recommendations to the patient on lifestyle and medical therapy.
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Part 1: The Core Curriculum for the General Cardiologist. Part 2: The Core Curriculum per Topic. Supplementary material. Article Navigation.
Editor's Choice. ESC Core Curriculum for the General Cardiologist Thierry C. Gillebert , Thierry C. Gillebert, Department of Cardiology, Ghent University, 8K12IE, De Pintelaan, , B Gent, Belgium.
Oxford Academic. Nicholas Brooks. Ricardo Fontes-Carvalho. Zlatko Fras. Pascal Gueret. Jose Lopez-Sendon.
Maria Jesus Salvador. Renee B. Otto A. Reinhard Griebenow. Peter Kearney , Peter Kearney. Alec Vahanian.
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Table of Contents Preface Part 1: The Core Curriculum for the General Cardiologist 1. The general cardiologist and his clinical field 1.
General aspects of training in the speciality 1. Requirements for training institutions 1. Requirements for trainers 1. Learning objectives Part 2: The Core Curriculum per topic 2.
History taking and clinical examination 2. The electrocardiogram standard ECG, ambulatory ECG, exercise ECG, CPX 2.
Non-invasive imaging in general 2. Echocardiography 2. Cardiac magnetic resonance 2. Cardiac X-ray computed tomography 2. Nuclear techniques 2.
Invasive imaging: cardiac catheterization and angiography 2. Genetics 2. Clinical pharmacology 2. Cardiovascular risk factors, assessment, and management 2.
Arterial hypertension 2. Acute coronary syndromes 2. Chronic ischaemic heart disease 2. Myocardial diseases 2.
Pericardial diseases 2. Oncology and the heart 2. Congenital heart disease in adult patients 2. Pregnancy and heart disease 2. Valvular heart disease 2.
Infective endocarditis 2. Heart failure 2. Sports cardiology 2. Cardiac rehabilitation 2. Arrhythmias 2. Atrial fibrillation and flutter 2.
Syncope 2. Sudden cardiac death and resuscitation 2. Diseases of the aorta and trauma to the aorta and heart 2.
Peripheral artery diseases 2. Thrombo-embolic venous disease 2. Acute cardiovascular care 2. The patient undergoing non-cardiac surgery 2. The patient with neurological symptoms 2.
The patient with conditions not presenting primarily as cardiovascular disease References Preface The previous Core Curriculum for the General Cardiologist defined a model for cardiology training in Europe and it has been adopted as the standard for regulating training, for access to the specialty certification , and for revalidation in several countries.
Part 1: The Core Curriculum for the General Cardiologist 1. Description of competence. Level of competence.
Open in new tab. Google Scholar Crossref. Search ADS. ESC guidelines on the management of valvular heart disease version Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association.
ESC guidelines for the diagnosis and treatment of acute and chronic heart failure ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations.
Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography.
European Guidelines on cardiovascular disease prevention in clinical practice version Royal College of, Physisicans Surgeons of Canada.
Training and accreditation in cardiovascular magnetic resonance in Europe: a position statement of the working group on cardiovascular magnetic resonance of the European Society of Cardiology.
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology ESC and of the European Association for the Study of Diabetes EASD.
Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines.
The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology.
Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. ESC Guidelines for the management of grown-up congenital heart disease new version ESC Congress takes place 31 August to 4 September at the Amsterdam RAI congress centre.
About the ESC The European Society of Cardiology ESC represents more than 80, cardiology professionals across Europe and the Mediterranean.
Its mission is to reduce the burden of cardiovascular disease in Europe. Our mission: To reduce the burden of cardiovascular disease.
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