Welchen Stellenwert hat die Medikamentöse Therapie?

Zusammenfassung

Trotz des gegenüber der ICD-Therapie heutzutage eher gering einzuschätzenden Stellenwerts der medikamentösen Therapie in der Primär- und Sekundärprophylaxe des plötzlichen arrhythmogenen Herztodes ist die flankierende antiarrhythmische Medikation bei ICD-Patienten häufig notwendig und trägt zur Reduktion der Inzidenz symptomatischer ventrikulärer Tachykardien mit Interventionsnotwendigkeit und zur Verbesserung der Lebensqualität bei. Amiodaron gilt hier, neben seiner gesicherten Indikation beim Vorhofflimmern, als immer noch effektivstes Antiarrhythmikum. Der ß-Blocker Therapie bei Patienten mit struktureller Herzerkrankung kommt demgegenüber eine ungebrochene Bedeutung mit signifikanter Verminderung der Gesamtmortalität und insbesondere auch des Risikos des plötzlichen Herztodes zu.

Summary

Despite the present tendency to underestimate the value of drug treatment in the primary and secondary prophylaxis of sudden arrhythmogenic cardiac death, it should be noted that the use of supportive antiarrhythmic medication in ICD recipients is often necessary, and can help to reduce the incidence of symptomatic ventricular tachycardias requiring an intervention, and thus improve the quality of life of the patient. In this respect amiodarone with its proven effect in the treatment of ventricular fibrillation, continues to be the most effective antiarrhythmic agent. Treatment with beta blockers in patients with structural heart disease continues to be of importance, and is associated with a significant reduction in overall mortality, and, in particular, in the risk of sudden cardiac death.

Literatur

• 1 Bänsch D, Antz M, Boczor S. et al. . Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT).  Circulation. 2002;  105 1453-1458
• 2 Bardy GH, Lee KL, Mark DB. et al. . Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.  N Engl J Med. 2005;  352 225-237
• 3 Bigger JT. Expanding indications for implantable cardiac defibrillators.  N Engl J Med. 2002;  346 931-933
• 4 Bollmann A, Husser D, Cannom DS. Antiarrhythmic drugs in patients with implantable cardioverter-defibrillators.  Am J Cardiovasc Drugs. 2005;  5 371-378
• 5 Boutitie F, Boissel JP, Connolly SJ. et al. . Amiodarone interaction with beta-blockers: analysis of the merged EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) databases.  The EMIAT and CAMIAT Investigators. Circulation. 1999;  99 2268-2275
• 6 Buxton AE, Lee KL, DiCarlo L. et al. . Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial Investigators.  N Engl J Med. 2000;  342 1937-45
• 7 Cairns JA, Connolly SJ, Roberts R, Gent M. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators.  Lancet. 1997;  349 675-682
• 8 CIBIS-II study-group. . The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial.  Lancet. 1999;  353 9-13
• 9 Connolly SJ, Gent M, Roberts RS. et al. . Canadian implantable defibrillator study (CIDS): a randomized trial of the implantable cardioverter defibrillator against amiodarone.  Circulation. 2000;  101 1297-1302
• 10 Dorian P, Borggrefe M, Al-Khalidi HR. et al. . Inhibition Evaluation with azimiLiDe (SHIELD) Investigators. Placebo-controlled, randomized clinical trial of azimilide for prevention of ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator.  Circulation. 2004;  110 3646-3654
• 11 Echt DS, Liebson PR, Mitchell LB. et al. . Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.  N Engl J Med. 1991;  324 781-78
• 12 Gregoratos G, Abrams J, Epstein AE. et al. . ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines.  Circulation. 2002;  106 2145-2161
• 13 Hinkle LE Jr, Thaler HT. Clinical classification of cardiac deaths.  Circulation. 1982;  65 457-464
• 14 Julian DG, Camm AJ, Frangin G. et al. . Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators.  Lancet. 1997;  349 667-674
• 15 Kadish A, Quigg R, Schaechter A. et al. . Defibrillators in nonischemic cardiomyopathy treatment evaluation.  Pacing Clin Electrophysiol. 2000;  23 338-343
• 16 Kannel WB, Plehn JF, Cupples LA. Cardiac failure and sudden death in the Framingham Study.  Am Heart J. 1988;  115 869-875
• 17 Knight BP, Goyal R, Pelosi F. et al. . Outcome of patients with nonischemic dilated cardiomyopathyand unexplained syncope treated with an implantable defibrillator.  J Am Coll Cardiol. 1999;  33 1964-1970
• 18 Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg (CASH).  Circulation. 2000;  102 748-754
• 19 MERIT-HF study group . Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF).  Lancet. 1999;  353 2001-2007
• 20 Moss AJ, Hall WJ, Cannom DS. et al. . Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators.  N Engl J Med. 1996;  335 1933-1940
• 21 Moss AJ. MADIT-II and implications for noninvasive electrophysiologic testing.  Ann Noninvasive Electrocardiol. 2002;  7 179-180
• 22 Packer M, Bristow MR, Cohn JN. et al. . The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group.  N Engl J Med. 1996;  334 1349-1355
• 23 Priori SG, Aliot E, Blomstrom-Lundqvist C. et al. . Update of the guidelines on sudden cardiac death of the European Society of Cardiology.  Eur Heart J. 2003;  24 13-15
• 24 Saksena S, Waldo AL, Wilber D. et al. . Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators.  N Engl J Med. 1996;  335 1933-1940
• 25 Sesselberg HW, Moss AJ, Steinberg J. et al. . Factors associated with ventricular inducibility in the MADIT-II study population.  Am J Cardiol. 2003;  91 1002-1004
• 26 Sheldon R, Connolly S, Krahn A. et al. . Identification of patients most likely to benefit from implantable cardioverter-defibrillator therapy: the Canadian Implantable Defibrillator Study.  Circulation. 2000;  101 1660-1664
• 27 Waldo AL, Camm AJ, deRuyter H. et al. . Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol.  Lancet. 1996;  348 7-12
• 28 Zipes DP, Wellens HJ. Sudden cardiac death.  Circulation. 1998;  98 2334-2351

Anschrift für die Verfasser