German Cardiac Society Working Group on Cellular Electrophysiology state-of-the-art paper: impact of molecular mechanisms on clinical arrhythmia management

Abstract

Cardiac arrhythmias remain a common challenge and are associated with significant morbidity and mortality. Effective and safe rhythm control strategies are a primary, yet unmet need in everyday clinical practice. Despite significant pharmacological and technological advances, including catheter ablation and device-based therapies, the development of more effective alternatives is of significant interest to increase quality of life and to reduce symptom burden, hospitalizations and mortality. The mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches. Current management of arrhythmias, however, is primarily guided by clinical and demographic characteristics of patient groups as opposed to individual, patient-specific mechanisms and pheno-/genotyping. With this state-of-the-art paper, the Working Group on Cellular Electrophysiology of the German Cardiac Society aims to close the gap between advanced molecular understanding and clinical decision-making in cardiac electrophysiology. The significance of cellular electrophysiological findings for clinical arrhythmia management constitutes the main focus of this document. Clinically relevant knowledge of pathophysiological pathways of arrhythmias and cellular mechanisms of antiarrhythmic interventions are summarized. Furthermore, the specific molecular background for the initiation and perpetuation of atrial and ventricular arrhythmias and mechanism-based strategies for therapeutic interventions are highlighted. Current "hot topics" in atrial fibrillation are critically appraised. Finally, the establishment and support of cellular and translational electrophysiology programs in clinical rhythmology departments is called for to improve basic-science-guided patient management.

Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients

“…This hypothesis is supported by the histopathological observation that the most common change in victims of electrocution is myofibre break-up leading to inhomogenity of the conduction system of the heart [19]. Rarely transient Brugada type repolarisation abnormalities may occur after AE caused possibly through an imbalance of ion currents leading to an arrhythmogenic trigger [20–22].…”

Cardioprotection by SGLT2 Inhibitors—Does It All Come Down to Na+?

“…Heart failure patients are at an increased risk for atrial as well as ventricular arrhythmias. While there may be pronounced heterogeneities regarding the pathomechanisms of different types of arrhythmias, they all have one thing in common: arrhythmias occur when arrhythmic substrates (structural and/or electrical abnormalities, e.g., fibrosis) and triggers (early (EADs) and delayed afterdepolarizations (DADs)) coincide [ 137 ]. Typically, EADs result from prolongation of the APD allowing for the reactivation of LTCC.…”

Epicardial access for VT ablation: analysis of two different puncture techniques, incidence of adhesions and complication management

“…Endocardial catheter ablation of ventricular arrhythmias (VA) has become a widely established treatment modality in recent time [1,2]. Since the first report on percutaneous subxiphoid puncture of the epicardial space by Sosa et al in patients with Chagas disease the worldwide number of epicardial procedures increased rapidly and the indication for these procedures has been extended for different entities of cardiomyopathies [3][4][5][6]. However, epicardial ablation of VA is still challenging and time-consuming.…”