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The possibility to correct left bundle branch block by His bundle pacing seems to contradict our understanding of the conduction system. However, we present a series of 6 consecutive patients in which distal, nonselective His bundle pacing led to partial or complete correction of left bundle branch block which suggests a damage of fibers of the left bundle within the His bundle proximal to the pacing site. Also left bundle branch block morphologies with electrocardiogram (ECG) criteria predictive of diffuse or distal conduction block were successfully corrected by His bundle pacing. Therefore, we postulate that His bundle pacing can have a positive impact even on left bundle branch block with multiple, diffuse, and distal conduction disturbances. Mechanisms for this are not clear but may relate to "recruitment" of diffusely disturbed conduction fibers, capture of distal fibers of the left bundle as well as areas of septal myocardium by pacing and concealed conduction. These observations question our understanding of left bundle branch block and suggest that the block is frequently located proximal to the division in right and left Tawara branches and can be corrected by His bundle pacing. Die Möglichkeit einer Korrektur eines Linksschenkelblocks durch eine His-Bündel-Stimulation scheint unserem Verständnis des Reizleitungssystems zu widersprechen. Wir stellen aber eine Fallserie von 6 konsekutiven Patienten vor, bei denen eine distale, nichtselektive His-Bündel-Stimulation zu einer partiellen oder kompletten Korrektur des Linksschenkelblocks geführt hat, was eine Schädigung des linken Schenkels im His-Bündel proximal der Stimulation suggeriert. Da auch Linksschenkelblock-Morphologien, deren EKG prädiktiv für eine distale oder diffuse Linksschenkelblockierung war, durch His-Bündel-Stimulation erfolgreich korrigiert werden konnten, postulieren wir, dass diese auch multiple, diffuse und distale Leitungshindernisse des linken Tawara-Schenkels günstig beeinflussen kann. Die Mechanismen hierfür sind unklar, könnten jedoch auf einem „Recruitment“ von gestörten Leitungsfasern, Erreichen distalerer Areale sowohl des linken Schenkels als auch myokardialer Septumstrukturen über eine Stimulation und einer verborgenen Leitung beruhen.Die Beobachtungen hinterfragen unser Verständnis eines Linksschenkelblocks und suggerieren, dass die Blockierung häufig proximal der Aufteilung in rechten und linken Tawara-Schenkel lokalisiert ist und durch eine His-Bündel-Stimulation korrigiert werden kann.
Cardiac pacemaker therapy began with successful stimulation of human hearts already in the first half of the 20th century. Complete implantation of a pacemaker by the cardiac surgeon Åke Senning on October 8, 1958 at the Karolinska Hospital in Stockholm is considered the actual birth of today's pacemaker therapy. The first pacemaker implantation in Germany was performed by Hans-Joachim Sykosch on October 6, 1961 at the Surgical Clinic of the University of Düsseldorf. Two years later, the first implantation in East Germany (GDR) was carried out by Friedrich Flemming on September 2, 1963 at the Charité in East Berlin. The first pacemaker manufactured in West Germany arrived on the market 1963; East Germany started device production in 1978. In 1974, pacemaker therapy in West Germany showed a 50% survival rate after 6.3 years compared to < 1 year with drug therapy. After initially using bare metal wires, pacemaker leads have significantly improved in both quality and reliability. Development culminated in the leadless pacemaker. Battery development led to a variety of inventions: rechargeable pacemakers, biogalvanic cells, bioenergy sources, nuclear generators and lithium batteries, the latter ultimately prevailed. In the beginning, only fixed-rate ventricular pacemakers were available. Subsequently, systems adapted to physiological requirements were developed: on-demand pacemakers, atrial-based pacing and rate-adaptive systems. However, it was not until the return to direct stimulation of the conduction system that truly physiological stimulation of the heart became possible. Die Herzschrittmachertherapie beginnt bereits in der ersten Hälfte des 20. Jahrhunderts mit ersten erfolgreichen Herzstimulationen beim Menschen. Als eigentliche Geburtsstunde der heutigen Schrittmachertherapie gilt die erste vollständige Implantation eines Herzschrittmachers durch den Herzchirurgen Ake Senning am 08.10.1958 im Karolinska-Hospital in Stockholm. Die erste Herzschrittmacher-Implantation in Deutschland führte Heinz-Joachim Sykosch am 06.10.1961 in der Chirurgischen Klinik der Universität Düsseldorf durch. Zwei Jahre später erfolgte die erste Implantation in der DDR durch Friedrich Flemming am 02.09.1963 an der Charité in Ost-Berlin. Der erste in der BRD produzierte Schrittmacher kam 1963 auf den Markt, die DDR startete eine eigene Schrittmacherproduktion 1978. Im Jahr 1974 führte die Herzschrittmachertherapie in der BRD zu einer 50 %-Überlebensdauer von 6,3 Jahren im Vergleich zur medikamentösen Therapie mit < 1 Jahr. Schrittmacherelektroden haben seit der Verwendung blanker Metalldrähte eine deutlich verbesserte Qualität und Zuverlässigkeit erlangt. Einen vorläufigen Abschluss bildet hier der sondenlose Herzschrittmacher. Die Batterieentwicklung führte zu einer Flut erfinderischer Aktivitäten: wieder aufladbare Herzschrittmacher, biogalvanische Zelle, Bioenergiequellen, Nukleargeneratoren und Lithiumbatterien, die sich letztlich durchsetzten. Nach der Anfangsphase starrfrequenter Ventrikelstimulation wurden zunehmend an die Physiologie angepasste Systeme entwickelt: Bedarfsschrittmacher, vorhofbeteiligte Stimulation und frequenzadaptive Systeme. Aber erst die Rückbesinnung auf eine direkte Stimulation des Reizleitungssystems ermöglichte eine wirklich physiologische Stimulation des Herzens.
Correction to: Herzschr Elektrophys 2017 https://doi.org/10.1007/s00399-017-0543-x Please accept the Publisher's apologies for the following mistake:In the first online version of this contribution the title was incomplete. The correct version reads: "Atrial thrombogenesis in atrial fibrillation. Results from atrial fibrillation models and AF-patients".The ….
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