Schüchtermann-Klinik

A bstract Recruitment and resolution of immune cell accumulation after myocardial infarction (MI) is critical for effective wound healing and prevention of maladaptive remodeling. Numerous signals are known to recruit neutrophils, critical drivers of inflammation, but knowledge about signals containing and resolving their accumulation is limited. We discovered that Regenerating-islet derived protein 3 beta (REG3β) limits the persistence of neutrophils after MI, thereby promoting resolution of inflammation. REG3β selectively binds to aged and hyperactive neutrophils and induces rapid cell death, enabling clearance via macrophage-mediated efferocytosis. Selective binding of REG3β is achieved by interaction with paucimannosylated proteins that translocate from azurophile granules to the plasma membrane in an activation- and age-dependent manner. Endocytotic uptake and accumulation of REG3β in lysosomes initiates programmed cell death of neutrophils via lyosomal membrane permeabilization and release of cathepsins. Our work establishes REG3β as a local immune checkpoint essential for neutrophil resolution and cardiac repair.

Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5-6). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I/III antiarrhythmic drugs.Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.

Abstract Introduction During the COVID-19-pandemic, most elite athletes were infected with the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Initial worries of high rates of multi-organ complications including the heart and ending sporting careers were disproved by large studies. However, the effects of COVID-19 on the heart and its function in elite athletes remains unclear, especially in the prolonged post-infection follow-up and during and after return to competition. Methods In the year 2020, a cohort of 127 elite athletes (boasting an accumulated 58 Olympic and world championship medals) was recruited, 76 of them recently having undergone a SARS-CoV-2 infection. Echocardiography was conducted 1 (T0), 5 (T1) and 9 (T2) months after the infection in the infected cohort and at baseline for the control cohort. Left-ventricular global longitudinal, circumferential, and radial strain was compared cross-sectionally at baseline between athletes after a COVID-19-infection and control athletes, as well as longitudinally in the COVID-19-cohort. Results At baseline, global longitudinal strain (reported as absolute %-values) was significantly higher in the COVID-19-cohort in comparison to control-cohort (20.37 ± 1.98% vs. 19.41 ± 2.11%, respectively, p = 0.042). In the longitudinal assessment within the COVID-19-cohort the global longitudinal strain was significantly higher shortly after the infection (T0) than at the two follow-up measurements (T0: 20.37 ± 1.98%; T1: 19.34 ± 1.65%; T2: 19.30 ± 1.68% (p = 0.0052 and p = 0.0044, respectively)). No significant differences for any of the comparisons were found for circumferential or radial strain. Discussion The significantly elevated values in the COVID-19-cohort at T0 may be due to an affectation of the autonomic nervous system, which has previously been documented as a result of COVID-19-disease. No cardiac injury after COVID-19 was detected using strain analysis. All documented global longitudinal strain values were within the normal range for athletes. A return to training and competition had no deleterious effect on cardiac health in athletes after a COVID-19-infection in this trial.

Surgical atrial ablation is evaluated by surgeons in relation to the estimated surgical risk. We analyze whether high-risk patients (HRPs) experience risk escalation by ablation procedures.The CASE-Atrial Fibrillation (AF) registry is a prospective, multicenter, all-comers registry of atrial ablation in cardiac surgery. We analyzed the 1-year outcome regarding survival and rhythm endpoints of 1,000 consecutive patients according to the operative risk classification (EuroSCORE II ≤ 2 vs. >2).Higher NYHA (New York Heart Association) score, ischemic heart failure, status poststroke, renal insufficiency, chronic obstructive pulmonary disease, and diabetes mellitus were strongly represented in HRPs. HRPs exhibit more left ventricular ejection fraction < 40% (19.2 vs. 8.8%; p < 0.001) but identical left atrial diameter and left ventricular end-diastolic diameter compared with low-risk patients (LRPs). CHA2DS-Vasc-score (2.4 ± 1 vs. 3.6 ± 1.5; p < 0.001), sternotomies, combination surgeries, coronary artery bypass graft, and mitral valve procedures were increased in HRPs. LRPs underwent stand-alone ablations as well. Ablation energy did not differ. Left atrial appendage closure was performed in up to 86.1% (mainly cut-and-sew procedures). Mortality corresponded to the original risk class without an escalation that may be related to ablation, stroke rate, or myocardial infarction. A total of 60.6% of HRPs versus 75.1% of LRPs were discharged in sinus rhythm. Long-term EHRA (European Heart Rhythm Association) score symptoms were lower in HRPs. Repeated rhythm therapies were rare. Additional antiarrhythmics received a minority without group dependency. A total of 1.6 versus 4.1% of HRPs (p = 0.042) underwent long-term stroke; excess mortality was not observed. Anticoagulation remained common in HRPs.Surgical risk and long-term mortality are determined by the underlying disease. In HRPs, freedom from AF and symptom relief can be achieved. Preoperative risk scores should not lead to withholding an ablation procedure.

Abstract Background Dual-chamber (DC) cardiac pacing is thought to offer a clinical benefit as compared to single-chamber (SC) cardiac pacing. With the introduction of leadless pacers and the recommendation for DC-pacing in sinus node dysfunction, the implantation rates of SC-pacemaker have markedly decreased. However, little is known from real word national healthcare data. The purpose of this VIDEO substudy is to analyze the German national healthcare situation with regards to SC- vs. DC-pacing. Methods German hospitals are obliged to provide a dataset including case data, diagnosis, operational and procedural codes to the Institute for hospital remuneration system (InEK) every year. The VIDEO project aims at analyzing these data to report real world data on patients undergoing Cardiac implantable electronic device (CIED) surgery in Germany. As of now, 22 German centers were contacted by the Institute for Myocardial Infarction Research (IHF). Ten centers provided their data from 2018 to 2023. Datasets from the remaining centers are pending. The project is supported by the German Heart Foundation. Results A total of 12,474 patients (35.6% females, mean age 71.2 ± 14.5 years) underwent CIED surgery at 10 centers in Germany. A SC-pacemaker was implanted in 1071 patients (group A), a DC-pacemaker in 6343 patients (group B) and other CIEDs including defibrillators in the remaining 5060 patients. Only a minority of the surgeries in both groups were revisions. The median patient age in group A was 81 years (IQR 77;85) compared to 78 years (IQR 70;83) in group B. Of the patients receiving a SC-pacemaker only 4.2% were adults between 40-64 years old compared to 13.4% in the DC-pacemaker group. Diabetes mellitus, chronic obstructive pulmonary disease and a heart failure were more common in group A (30.5% vs. 25.1%, 9.0 vs. 6.0%, 53.2% vs. 35.9%, p &amp;lt;0.01). Atrial fibrillation was known in 942/1050 (89.7%) in patients receiving as SC-pacemaker and in 2589/6197 (42.4%) in those with a DC-pacemaker (p &amp;lt; 0.01). The main indication for pacemaker implantation in both groups was atrioventricular block (41.5% vs. 69.5%, p &amp;lt;0.01) followed by sinus node dysfunction (19.7% vs 27.6%, p &amp;lt; 0.01). All patients were treated as inpatients. The median hospital stay in group A was significantly longer than in group B (8.0 (IQR 3.0; 16.0) vs. 6.0 (IQR 2.0; 13.0), p &amp;lt; 0.01). Half of the patients in both groups were treated on an intensive care unit (ICU) (51.7% and 56.6%) with a median ICU stay of 2.8 (IQR 1.1;5.8) in group A and 2.3 (IQR 1.0;10.0) in Group B. The in-hospital mortality was higher in patients receiving a SC-pacemaker (2.6%) as compared to the DC-pacemaker group (1.6%). Conclusion In Germany, single-chamber pacemakers are implanted six times less common than dual-chamber pacemakers. Patients receiving SC-pacemakers are older, more likely to suffer from permanent atrial fibrillation and have a prolonged in-hospital stay.