ICD-Therapie bei nicht ischämischer dilatativer Kardiomyopathie

Zusammenfassung

Derzeit wird über den Stellenwert primärprophylaktisch implantierter Kardioverter-Defibrillatoren (ICD) bei Patienten mit nicht ischämischer dilatativer Kardiomyopathie (NIDCM) diskutiert. Frühere Studien (DEFINITE, SCD-HeFT) schlossen Patienten ein, die nach heutigem Standard nicht optimal medikamentös und ohne kardiale Resynchronisation (CRT) therapiert wurden. Diese Studien bilden die Grundlage für die Empfehlung der ICD zur Primärprophylaxe des plötzlichen Herztods. Die DANISH-Studie (an der Patienten mit kontemporärer optimaler medikamentöser Therapie sowie hohem Prozentsatz von CRT teilnahmen) zeigte einen Effekt des ICD auf die kardiovaskuläre Sterblichkeit, jedoch ohne Nutzen in Bezug auf Gesamtletalität. Einige Faktoren wie Alter, Komorbiditäten oder Rechtsventrikeldysfunktion fordern Aufmerksamkeit. Insgesamt besteht die Leitlinienempfehlung fort, primärprophylaktische ICD bei NIDCM zu implantieren, wenn eine optimale medikamentöse Therapie und eine Lebenserwartung > 5 Jahren bestehen.

Abstract

There is current debate regarding the value of implantable cardioverter defibrillators (ICD) in patients with non-ischemic dilated cardiomyopathy (NIDCM). Previous studies (DEFINITE, SCD-HeFT) enrolled patients not treated with optimal medication according to our current understanding and prior to the advent of cardiac resynchronization therapy (CRT). These trials laid the fundament of ICDs for primary sudden death prevention. The recent DANISH trial (enrolling patients with contemporary optimal medical therapy and CRT) questioned the usefulness of ICDs demonstrating benefit in terms of cardiovascular but not total mortality. Currently adopted guideline recommendations still suggest to implant primary prevention ICDs in NIDCM with careful consideration of optimal medical therapy in patients with a life-expectancy of > 5 years.

Schlüsselwörter

plötzlicher Herztod - nicht ischämische dilatative Kardiomyopathie (NIDCM) - implantierbarer Kardioverter-Defibrillator (ICD)

Key words

non-ischaemic dilated cardiomyopathy (NIDCM) - sudden cardiac death (SCD) - implantable cardioverter defibrillator (ICD)

• Literatur

• 1 Akhtar M, Elliott PM. Risk stratification for sudden cardiac death in non-ischaemic dilated cardiomyopathy. Curr Cardiol Rep 2019; 21: 155 doi:10.1007/s11886-019-1236-3
• 2 Mirowski M, Reid PR, Mower MM. et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980; 303: 322-324
• 3 Packer M, Butler J, Filippatos GS. et al. Evaluation of the effect of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-Reduced trial. Eur J Heart Fail 2019; 21: 1270-1278 doi:10.1002/ejhf.1536
• 4 Shen L, Jhund PS, Petrie MC. et al. Declining risk of sudden death in heart failure. N Engl J Med 2017; 377: 41-51
• 5 McMurray JJ, Packer M, Desai AS. et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371: 993-1004
• 6 Ehrlich JR. Do we still need ICDs if we have ARNi?. Heart Rhythm 2018; 15: 403-404
• 7 Køber L, Thune JJ, Nielsen JC. et al. Defibrillator implantation in patients with nonischemic nystolic heart failure. N Engl J Med 2016; 375: 1221-1230
• 8 Stecker EC, Vickers C, Waltz J. et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol 2006; 47: 1161-1166
• 9 Haugaa KH, Goebel B, Dahlslett T. et al. Risk assessment of ventricular arrhythmias in patients with nonischemic dilated cardiomyopathy by strain echocardiography. J Am Soc Echocardiogr 2012; 25: 667-673
• 10 Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res 2014; 114: 1004-1021
• 11 Brown PF, Miller C, Di Marco A. et al. Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy. Heart 2019; 105: 270-275
• 12 Schulze-Bahr E, Klaassen S, Abdul-Khaliq H. et al. Gendiagnostik bei kardiovaskulären Erkrankungen. Kardiologe 2015; 9: 213-243
• 13 Kadish A, Dyer A, Daubert JP. et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004; 350: 2151-2158
• 14 Bardy GH, Lee KL, Mark DB. et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352: 225-237
• 15 Shun-Shin MJ, Zheng SL, Cole GD. et al. Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials. Eur Heart J 2017; 38: 1738-1746
• 16 Elming MB, Hammer-Hansen S, Voges I. et al. Right ventricular dysfunction and the effect of defibrillator implantation in patients with nonischemic systolic heart failure. Circ Arrhythm Electrophysiol 2019; 12: e007022
• 17 Priori SG, Blomstrom-Lundqvist C, Mazzanti A. et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36: 2793-2867
• 18 Seferovic PM, Ponikowski P, Anker SD. et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21: 1169-1186
• 19 Schrage B, Uijl A, Benson L. et al. Association between use of primary-prevention implantable cardioverter-defibrillators and mortality in patients with heart failure. Circulation 2019; 140: 1530-1539