Herzschrittmachertherapie + Elektrophysiologie

Although ‘athlete’s heart’ usually constitutes a balanced dilation and hypertrophy of all four chambers, there is increasing evidence that intense endurance activity may particularly tax the right ventricle (RV), both acutely and chronically. We review the evidence that the high wall stress of the RV during intense sports may explain observed B-type natriuretic peptide (BNP) elevations immediately after a race, may lead to cellular disruption and leaking of cardiac enzymes, and may even result in transient RV dilatation and dysfunction. Over time, this could lead to chronic remodelling and a pro-arrhythmic state resembling arrhythmogenic RV cardiomyopathy (ARVC) in some cases. ARVC in high-endurance athletes most often develops in the absence of underlying desmosomal abnormalities, probably only as a result of excessive RV wall stress during exercise. Therefore, we have labelled this syndrome ‘exercise-induced ARVC’. Sports cardiologists should be aware that excessive sports activity can lead to cardiac sports injuries in some individuals, just like orthopaedic specialists are familiar with musculoskeletal sports injuries. This does not negate the fact that moderate exercise has positive cardiovascular effects and should be encouraged.

With the growing recognition of the clinical need and wider indications for cardiovascular implantable electronic devices (CIED), the number of implant procedures has increased considerably. Consequently, the rate of complications related to these devices has also increased. Transvenous lead extraction (TLE) is the gold standard in the treatment of CIED-related infective complications and is often required in the management of lead malfunction. An increasing number of centers currently perform TLE procedures. The ELECTRa (European Lead Extraction ConTRolled) Registry is the first large prospective multicenter registry of consecutive patients undergoing TLE in Europe, conducted by the European Heart Rhythm Association (EHRA) and managed by the European Society of Cardiology (ESC) EURObservational Research Department. The primary objective of the registry is to evaluate the acute and long-term safety of TLE; the secondary objective is to describe the characteristics of the patients, the leads, the indications for TLE, and the tools and techniques currently used for TLE. About 100 centers will be enrolled on a voluntary basis from European countries; they are anonymous and stratified on the basis of their volume of activity into high-volume centers (> 30 patients/year) and low-volume centers: (≤ 30 patients/year). Each participating center will have to enroll and follow up for 1 year consecutively assessed patients undergoing TLE from November 2012 to January 2014. The target is to achieve a sample size of at least 3,500 patients for statistical analysis. Data will be collected using a Web-based system and will be audited at randomly selected centers. The official start was on 6 November. Eighty-nine centers have joined so far, 65 centers are currently active, those who have already obtained the approval of their own ethics committee, and 1,099 patients were enrolled at the end of June 2013. The independence of the registry, the consecutiveness of the patient enrolment, and the monitoring of the study are characteristics of this registry that will contribute to the scientific validity of the objectives to be achieved.