Prognose von ICD-Patienten – Rolle der Komorbiditäten

Zusammenfassung

Der implantierbare Kardioverter-Defibrillator ist eine der großen Errungenschaften der kardiovaskulären Medizin der letzten 3 Jahrzehnte. In mehreren großen randomisierten Studien konnte belegt werden, dass er bei ausgewählten Patienten sowohl in der Sekundär- als auch in der Primärprophylaxe Leben rettet. Die Evidenz ist besonders stark bei Patienten mit chronisch eingeschränkter Pumpfunktion ≤ 35 % auf dem Boden einer ischämischen Herzerkrankung. Technische Fortschritte mit deutlicher Reduktion der Aggregatgröße und Verbesserungen der Wahrnehmungsalgorithmen haben den chirurgischen Teil der Implantation deutlich vereinfacht und standardisiert. Es handelt sich jedoch immer noch um eine deutlich komplexere und damit auch nebenwirkungsbehaftetere Therapie als etwa die Schrittmachertherapie. Hierbei gilt: Je geringer das Risiko für den plötzlichen Herztod ist, desto ungünstiger wird das Verhältnis adäquater zu inadäquaten Therapien. Wegen Veränderungen der Komorbiditäten und der zugrundeliegenden strukturellen Herzerkrankung sollte die Therapieindikation differenziert gestellt und auch im Verlauf, vor allem zum Zeitpunkt eines anstehenden ICD-Wechsels, kritisch überprüft werden [23].

Abstract

Implantable defibrillators have revolutionized the therapy of patients with survived sudden cardiac death or a high risk thereof. Improvements in device technology allow for easy and standardized implantation. One has to bear in mind, however, that ICD therapy is associated with specific risks that are different and higher than in the pacemaker population. The lower the absolute arrhythmogenic risk, the higher is the risk of untoward side effects without benefiting from the ICD therapy. Moreover, the presence of certain comorbidities and competing risks preclude an appropriate ICD therapy before death of another cause in many patients. Due to the changes in competing risk factors but also a possible decrease of the arrhythmogenic risk, the ICD indication should be reassessed, especially at the time of generator replacement [23].

Schlüsselwörter

plötzlicher Herztod - implantierbarer Defibrillator - Komorbiditäten - Elektrodenprobleme - Risikoabschätzung

Key words

sudden cardiac death - implantable cardioverter defibrillator - comorbidities - lead problems - risk assessment

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