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Komplikationen im EPU-Labor und ihre Lösungen

It’s all over!

Complications in the EP lab and their solutions

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Zusammenfassung

In der Rhythmologie stehen zunehmend komplexe Prozeduren den immer stärker prozessoptimierten Abläufen gegenüber. Dies stellt insbesondere Elektrophysiologinnen und Elektrophysiologen in der Ausbildung vor Herausforderungen, da sie nicht nur lernen müssen, den Eingriff durchzuführen, sondern auch mit möglichen Komplikationen umzugehen. Der vorliegende Artikel zeigt anhand mehrerer exemplarischer Fallbeispiele, wie Komplikationen kontrolliert oder vermieden werden können. Die Fallserie behandelt Komplikationen wie die Luftembolie bei linksatrialen Prozeduren, iatrogene Gefäßverletzungen wie eine Aortendissektion oder Dissektion des Koronarvenensinus, Komplikationen und Herausforderungen bei Elektrodenrevisionen sowie die Perikardtamponade. Zu jedem Fall werden Maßnahmen zur Vermeidung sowie Handlungsempfehlungen zum Management der jeweiligen Komplikation aufgezeigt.

Abstract

In cardiac electrophysiology, invasive procedures like catheter ablations or device implantations are getting increasingly complex. This poses challenges especially for electrophysiologists in training, not only to learn how to perform the procedure, but also how to manage possible complications. The present article uses exemplary case studies to present how to control complications and how to avoid them. The presented cases deal with complications such as air embolism in left atrial procedures, iatrogenic vascular injuries such as aortic dissection or dissection of the coronary sinus, complications and challenges with lead revisions, and pericardial tamponade. In each case, measures for avoidance as well as practical guidance for management are shown when the respective complication occurs.

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Authors and Affiliations

  1. Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    David Duncker, Henrike A. K. Hillmann, Johanna Müller-Leisse, Christian Veltmann & Christos Zormpas

  2. Klinik für Innere Medizin II, Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin, Rehabilitations- und Sportmedizin, Universitätsklinikum Ulm, Ulm, Deutschland

    Tilman Dahme & Alexander Pott

  3. Abteilung für Elektrophysiologie, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Deutschland

    Isabel Deisenhofer, Verena Kantenwein & Tilko Reents

  4. Klinikfür Herz‑, Kinderherz- und Gefäßchirurgie, Abteilung Gefäßchirurgie, Universitätsklinikum Gießen, Gießen, Deutschland

    Daniel Palacios

  5. Medizinische Klinik I, Abteilung Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland

    Jörn Schmitt & Victoria Johnson

Authors
  1. David Duncker
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  2. Tilman Dahme
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  3. Isabel Deisenhofer
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  4. Henrike A. K. Hillmann
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  6. Johanna Müller-Leisse
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  7. Daniel Palacios
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  8. Alexander Pott
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  9. Tilko Reents
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  10. Jörn Schmitt
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  11. Christian Veltmann
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  13. Victoria Johnson
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Corresponding author

Correspondence to David Duncker.

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Interessenkonflikt

D. Duncker erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Microport, Pfizer, Zoll. T. Dahme und A. Pott beziehen Vortragshonorare von Biosense Webster, Medtronic und Daiichi-Sankyo. A. Pott ist eingeladener Teilnehmer des Fellowships „Herzrhythmus“ von Boston Scientific. J. Schmitt gibt folgende Interessenskonflikte an: Speaker Bureau: Abbott, Bayer, Biotronik, BMS/Pfizer, Boston Scientific, CVRx, Daiichy Sankyo, Medtronic, Zoll CMS. Advisory Board: Biotronik, BMS/Pfizer. Scientific Grants: Abbott, Biotronik, Boston Scientific, CVRx, Medicalgorithmics, Zoll CMS. V. Kantenwein erhielt travel support from Sorin Group and Abbott Medical sowie Educational grants and training from Abbott Medical and Boston Scientific. J. Müller-Leisse erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Medtronic und Boston Scientific. C. Zormpas erhielt Reisekostenunterstützung und/oder einen Fellowship grant von Biotronik und Medtronic. V. Johnson erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Abott, Biotronik, Boston Scientific, BMS Pfizer und Zoll. C. Veltmann erhielt Vortragshonorare, Reisekostenuntersützung und/oder einen Fellowship grant von Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer, Zoll. I. Deisenhofer, H. A. K. Hillmann, D. Palacios und T. Reents geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Duncker, D., Dahme, T., Deisenhofer, I. et al. Jetzt ist alles aus!. Herzschr Elektrophys 31, 401–413 (2020). https://doi.org/10.1007/s00399-020-00716-5

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