Arrhythmogenic Right Ventricular Cardiomyopathy and Differential Diagnosis with Diseases Mimicking Its Phenotypes

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease, which is characterized by fibro-fatty replacement of predominantly the right ventricle (RV). The disease can result in ventricular tachyarrhythmias and sudden cardiac death. Our understanding of the pathophysiology and clinical expressivity of ARVC has been continuously evolving. The diagnosis can be challenging due to its variable expressivity, incomplete penetrance and the lack of specific diagnostic criteria. Idiopathic RV outflow tract tachycardia, Brugada Syndrome, athlete's heart, dilated cardiomyopathy, myocarditis, cardiac sarcoidosis, congenital aneurysms and diverticula may mimic clinical phenotypes of ARVC. This review aims to provide an update on the differential diagnosis of ARVC

Einfluss der Nierenfunktion auf Mortalität und Prognose bei Leberzirrhose

Die Leberzirrhose ist durch eine steigende Inzidenz sowie hohe Morbidität und Mortalität gekennzeichnet. Eine renale Dysfunktion stellt bei Patienten mit fortgeschrittener Lebererkrankung eine schwerwiegende Komplikation dar, daher sollte in der vorliegenden Untersuchung die Bedeutung einer renalen Funktionsstörung für das Outcome von Patienten mit manifester Leberzirrhose untersucht werden. In einer retrospektiven Analyse wurden 245 Patienten erfasst, die im Zeitraum von 2004-2011 eine orthotope Lebertransplantation (OLTx) erhielten, oder mit selbiger Diagnose einer Dialyse zugeführt werden mussten. Die Patienten wurden hinsichtlich prädiktiver Parameter auf das 1-Jahres-Outcome untersucht, wobei die Nierenfunktion mittels MDRD4 und CKD-EPI-Formel abgeschätzt wurde und Kaplan-Meier sowie multivariate Cox-Hazard-Analysen erstellt wurden. Die 1-Jahres-Mortalität in der Gruppe der transplantierten Patienten betrug mehr als 22 %; bei Dialysepflichtigkeit stieg sie je nach Subgruppe auf 54-64 % an. Als führende Todesursache war in allen Gruppen eine Sepsis mit konsekutivem Multiorganversagen auszumachen. Auffällig war dabei, dass über 90 % der verstorbenen Patienten bei stationärer Aufnahme eine eine geschätzte GFR <30ml/min/1,73m2 aufwiesen und im Verlauf eine entzündliche Komponente in Form eines SIRS oder einer Sepsis entwickelten. Die Analysen zeigten, dass mit abnehmender Nierenfunktion die Mortalität signifikant zunimmt. Dies gilt sowohl für das Überleben nach Transplantation, als auch für das Überleben ohne OLTx. Die höchste Mortalität fand sich bei dialysepflichtigen Patienten; bei diesen Patienten konnte keine signifikante Verbesserung des Überlebens durch eine OLTx nachgewiesen werden. Niereninsuffizienz und Dialysepflicht konnten als stärkste prädiktive und unabhängige Faktoren für das Überleben bei Patienten mit Leberzirrhose ermittelt werden

Swiss National Registry on Catheter Ablation Procedures: Changing Trends over the Last 20 Years

The Swiss Ablation Registry provides a national database for electrophysiologic studies and catheter ablations. We analyzed the database to provide an in-depth look at changing trends over the last 20 years. During the study period a total of 78622 catheter ablations (age 61.0 ± 1.2 years; 63.7% male) were performed in 29 centers. The number of ablations increased by approximately ten-fold in 20 years. Ablation for atrial fibrillation (AF) was the main driver behind this increase, with more than hundred-fold (39.7% of all ablations in 2019). Atrioventricular-nodal-reentrant-tachycardia (AVNRT) and accessory pathways, being the main indications for ablation in 2000 (44.1%/25.1%, respectively), made up of only a small proportion (15.2%/3.5%,) respectively in 2019. Fluoroscopy, ablation, and procedure durations were reduced for all ablations over time. The highest repeat ablations were performed for ventricular tachycardia and AF (24.4%/24.3%). The majority of ablations (63.0%) are currently performed in private hospitals and non-university public hospitals whereas university hospitals had dominated (82.4%) at the turn of the century. A pronounced increase in the number of catheter ablations in Switzerland was accompanied by a marked decrease in fluoroscopy, ablation, and procedure durations. We observed a shift toward more complex procedures in older patients with comorbidities

Arrhythmogenic Right Ventricular Cardiomyopathy and Differential Diagnosis with Diseases Mimicking Its Phenotypes

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease, which is characterized by fibro-fatty replacement of predominantly the right ventricle (RV). The disease can result in ventricular tachyarrhythmias and sudden cardiac death. Our understanding of the pathophysiology and clinical expressivity of ARVC has been continuously evolving. The diagnosis can be challenging due to its variable expressivity, incomplete penetrance and the lack of specific diagnostic criteria. Idiopathic RV outflow tract tachycardia, Brugada Syndrome, athlete&rsquo;s heart, dilated cardiomyopathy, myocarditis, cardiac sarcoidosis, congenital aneurysms and diverticula may mimic clinical phenotypes of ARVC. This review aims to provide an update on the differential diagnosis of ARVC

CME-EKG 67/Antworten: Arrhythmie bei Belastung

CME ECG 67/Answers: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias

CME-EKG 67: Arrhythmie bei Belastung

Ventrikuläre Tachykardien sind potenziell lebensbedrohliche Herzrhythmusstörungen mit einer Herzfrequenz >100 Schläge/min und einem Ursprungsort der Arrhythmie unterhalb des Hisbündels im spezifischen Reizleitungssystem oder im ventrikulären Myokard. Die Morphologie im Oberflächen-EKG kann bereits Hinweise auf den zugrundeliegenden Mechanismus und die damit assoziierte Grunderkrankung liefern. Der jeweilige Pathomechanismus ist entscheidend für die weiterführende Therapie. Dieser Artikel soll einen Einblick in die verschiedenen Ursachen und Therapieoptionen sowie die Differenzialdiagnose der ventrikulären Tachykardien geben. = CME ECC 67: Arrhythmia on Exertion Abstract. Ventricular tachycardias are potentially life-threatening cardiac arrhythmias with a heart rate >100 beats/min, originating from the specific conduction system below the His or the ventricular myocardium. The morphology of the surface ECG can provide valid information about the underlying mechanism and the associated cardiac disorder. The according pathomechanism is of paramount importance for further management. This article is intended to provide an insight into the various causes and treatment options as well as the differential diagnosis of ventricular tachycardias

Transfer for Sustainable Development at Higher Education Institutions—Untapped Potential for Education for Sustainable Development and for Societal Transformation

Higher education institutions (HEIs) are increasingly confronted with societal needs beyond research and teaching. These include sustainable development and technology transfer as well as the practical application of knowledge and ideas. Several HEIs already put sustainable development and transfer into practice. These practitioner&ndash;university partnerships comprise a broad range of actors, disciplines, topics, and formats. However, transfer activities that contribute to sustainable development in society still make up only a very small part of HEIs&rsquo; activities. In response to calls from society as a whole, HEIs could combine transfer and sustainable development more systematically. In this article, we suggest a concept of transfer for sustainable development. The focus is on sustainability transfer in teaching. We used mixed methods for this conceptual work: exploratory workshops, expert interviews, and a case study of transfer in teaching. One of the results presented in this article is a working definition of sustainability transfer at HEIs. In addition, six characteristics for describing sustainability transfer in its various forms are formulated. This conceptualization makes it possible to analyze the diversity of HEIs&rsquo; sustainability transfer activities, it helps to identify and encourage potential transfer actors at HEIs as well as practitioners, and, thus, tap the full potential of sustainability transfer