Zusammenfassung
Patienten mit einem implantierbaren Cardioverter-Defibrillator (ICD) benötigen häufig zusätzlich ein antibradykardes Schrittmachersystem (SM). Die simultane Therapie führte in der Vergangenheit wiederholt zu Interaktionen zwischen den Systemen mit Therapieversagen auf beiden Seiten.
Vier Patienten mit einem ICD der neueren Generation erhielten ein antibradykardes Ein- bzw. Zweikammersystem. In allen Fällen wurden bipolare SM-Elektroden verwandt, die zusammen mit der ICD-Elektrode in den rechtsventrikulären Apex ohne Gewährleistung eines Mindestabstandes positioniert wurden. In Abhängigkeit vom primär implantierten System wurde intraoperativ zum Ausschluß möglicher Interferenzen ein entsprechendes Testverfahren durchgeführt. In einer Nachbeobachtungszeit von 4–14 Monaten ereigneten sich bei allen Patienten tachykarde Episoden, die erfolgreich terminiert werden konnten. Zwei Patienten mit einer Bradykardie nach Schockabgabe zeigten eine korrekte SM-Stimulation. Die Patienten äußerten seit Beginn der antibradykarden Therapie eine Verbesserung der Belastbarkeit, die teilweise echokardiographisch dokumentiert werden konnte. Die kombinierte ICD- und SM-Therapie ist somit grundsätzlich kompatibel. Sie erfordert bei AV-sequentieller Stimulation im Minimum drei Schrittmachersonden und zwei Aggregate. Die Entwicklung von Defibrillatoren mit der Option zur DDD-Stimulation würde die Therapie vereinfachen und seitens der Patienten eine höhere Akzeptanz bedingen.
Summary
Patients who need an implantable Cardioverter/Defibrillator (ICD) often require a cardiac pacemaker (PM) to treat underlying symptomatic bradycardia. In some cases the simultaneous therapy has caused interactions between the systems with defaults on both sides.
Four patients with an ICD of the newer generation received a single or dual chamber pacemaker system. In all cases bipolar pacemaker electrodes were used. They were positioned together with the ICD-electrode in the right ventricular apex without regard to the distance between them. In order to exclude possible interference between systems special tests were performed during the operative procedure with respect to the system implanted first. In a follow-up period of 4–14 months all patients had episodes of ventricular tachycardia or ventricular fibrillation that were terminated successfully. Two patients with a bradycardia related arrhythmia after shock delivery showed a correct pacemaker stimulation. Subsequent to the start of pacemaker therapy improvement in stress capacity could be documented, partly on the basis of echocardiography.
Combined ICD and PM therapy can thus be generally regarded as compatible. For AV-sequential pacing at least three electrodes and two aggregates are necessary. The development of an ICD with the option for a dual-chamber stimulation would simplify the therapy, along with a greater acceptance on part of the patients.
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Hailer, B., Wolfhard, U., Altmaier, K.J. et al. Klinische Erfahrungen einer kombinierten antitachykarden und antibradykarden Herzschrittmachertherapie. Herzschr Elektrophys 8, 118–123 (1997). https://doi.org/10.1007/BF03042499
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DOI: https://doi.org/10.1007/BF03042499