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Strategien zur Vermeidung von Komplikationen und Lösung von Problemen bei der Implantation von CRT- und CRT-D-Systemen

Strategies to avoid complications and to solve technical problems during the implantation of CRT and CRT-D systems

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Summary

Cardiac resynchronization with or without antitachycardiac treatment is now an established option to improve the functional status, morbidity and mortality of patients with severe symptomatic systolic heart failure, ventricular conduction delay and asynchrony. Increasing implant numbers are to be expected. The transvenous left ventricular lateral lead placement can now be achieved in up to 97% of patients. But due to the coronary venous anatomy it may still constitute a challenge even for experienced pacemaker and ICD implanters. In addition, it confers a considerable risk for complications like coronary sinus dissection and perforation, diaphragmatic stimulation and lead dislodgement. An overview is given on possible technical problems, solutions, complications and preventive strategies.

Zusammenfassung

Die kardiale Resynchronisationstherapie ist nun eine etablierte Therapieoption zur Verbesserung der Belastbarkeit und Minderung von Morbidität und Mortalität bei Patienten mit schwerer symptomatischer systolischer Herzinsuffizienz, ventrikulärer Leitungsverzögerung und Asynchronie. Von steigenden Implantationszahlen ist auszugehen. Die transvenöse linksventrikulär laterale Sondenplatzierung wird bei bis zu 97% der Patienten mit Erfolg durchgeführt. Aber angesichts der koronarvenösen Anatomie kann sie auch für den erfahrenen Implanteur konventioneller Schrittmacher und ICDs eine Herausforderung darstellen. In nennenswerter Zahl treten Komplikationen wie Koronarsinusdissektionen und -perforationen, Zwerchfellstimulation und Sondendislokationen auf. Der Artikel gibt einen Überblick über mögliche technische Probleme und Lösungen sowie Komplikationen und präventive Strategien.

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  1. Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, 13353, Berlin

    M. Stockburger

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  1. M. Stockburger
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Stockburger, M. Strategien zur Vermeidung von Komplikationen und Lösung von Problemen bei der Implantation von CRT- und CRT-D-Systemen. Herzschr. Elektrophys. 17 (Suppl 1), i20–i27 (2006). https://doi.org/10.1007/s00399-006-1104-x

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