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Aktuelle Kardiologie 2013; 2(6): 401-408
DOI: 10.1055/s-0033-1351080
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Update: ICD und CRT

Update ICD and CRT
M. Vöhringer
Cardio-Centrum-Ludwigsburg-Bietigheim
,
R. F. Bosch
Cardio-Centrum-Ludwigsburg-Bietigheim
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
17. Dezember 2013 (online)

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Zusammenfassung

Die Behandlung mit einem ICD oder einem CRT-Device hat sich zu einer etablierten, breit angewandten kardiologischen Therapie entwickelt. Sowohl in der Sekundärprophylaxe nach hämodynamisch relevanter Kammertachykardie als auch in der Primärprophylaxe, insbesondere bei herzinsuffizienten Patienten, ist der signifikante Effekt eines ICD auf die Mortalität gesichert. Ebenso hat die CRT einen signifikanten Effekt auf Morbidität und Mortalität gezeigt – und dies bei immer mehr Patientengruppen, z. B. im Falle einer Herzinsuffizienz im Stadium NYHA II oder einer schrittmacherinduzierten Dyssynchronie. LSB-Morphologie und QRS-Dauer sind aber die wesentlichen Prädiktoren für einen Therapieerfolg geblieben. Wichtige Innovationen umfassen die Entwicklung rein subkutan implantierbarer ICDs und kabelloser Aggregate, die Verkleinerung der Aggregate, Verbesserung der Batterietechnik, neue Algorithmen zur Vermeidung inadäquater Schocks, MRT-Tauglichkeit sowie Fernabfrage und Fernmonitoring. All dies trägt zu besserem Patientenkomfort und Therapieerfolg bei.

Abstract

The implantation of an ICD or a CRT has evolved as a well-established and prevalent therapy. The significant impact of an ICD on mortality is well proven in secondary prevention and also in primary prevention, especially in patients with heart failure. CRT as well has shown a significant effect on morbidity and mortality in patients with heart failure and prolonged QRS-interval. This is shown for increasing subgroups of patients as recently for patients in NYHA II and patients with dyssynchrony through a conventional pacemaker. But LBB-morphology and QRS-duration remain the main predictors of therapy response. New developments include the subcutaneous ICD, leadless pacers, improved battery technology, new algorithms to avoid inadaequate shocks, MR-compatibility and telemonitoring of the devices. All this will further improve patientsʼ convenience and effectiveness of ICD and CRT therapy.

Schlüsselwörter

ICD - implantierbarer Kardioverter/Defibrillator - CRT - kardiale Resynchronisationstherapie

Key words

ICD - implantable defibrillator - CRT - cardiac resynchronisation therapy
 

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