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Neue Technologien zur Optimierung in der CRT-Programmierung

New technologies in the optimization of CRT programming

  • BEITRAG ZUM THEMENSCHWERPUNKT
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

After implanting a CRT device, consistent and scheduled patient follow-up is mandatory. Besides determining electrode parameters and reviewing arrhythmic episodes, these follow-ups focus on monitoring and optimizing congestive heart failure therapy. Therefore new CRT devices present methods for heart failure surveillance and telemetric transmission of the acquired data, which allows the physician to respond immediately to the varying needs of the respective heart failure patient. In addition to cardiac resynchronization, optimization of atrioventricular (AV) and interventricular (VV) delay provide major hemodynamic benefits. As echocardiographic optimization of AV and VV delay is time consuming it is often not feasible during daily clinical practice. Therefore implemented algorithms that automatically determine and adapt AV and VV delays with respect to the fluctuating needs of the patients are essential. This article presents the current state of monitoring and optimization methods in CRT devices.

Zusammenfassung

Patienten, die mit einem CRT-System versorgt werden, bedürfen einer konsequenten und regelmäßigen Nachsorge. Diese umfasst nicht nur die elektrischen Parameter der Elektroden und die Auswertung kardialer Arrhythmie-Episoden, sondern besonders die Kontrolle und Optimierung der Therapie einer sich beständig variierenden Herzinsuffizienz. Neuere Anwendungen der CRT-Systeme überwachen den klinischen Verlauf des Patienten und versenden die erhobenen Befunde ganz oder teilweise telemetrisch an den behandelnden Arzt, der so schon frühzeitig therapeutische Konsequenzen einleiten kann.

Weitere implementierte Algorithmen dienen der Optimierung dieser Systeme. Neben der Resynchronisation der kardialen Kontraktion ist die Optimierung der atrioventrikulären (AV)- und interventrikulären (VV)-Überleitungszeit für den Füllungszustand beider Ventrikel von entscheidender Bedeutung. Diese Optimierung erfolgt bislang überwiegend echokardiographisch, ist zeitaufwendig und untersucherabhängig. Für die klinische Praxis sind deshalb CRT-Systeme mit implementierten Algorithmen sinnvoll, welche die AV- und VV-Zeiten rezidivierend und individuell, abhängig vom aktuellen Stadium der Herzinsuffizienz anpassen. Dieser Artikel gibt eine Übersicht der aktuell vorhandenen Überwachungs- und Optimierungssysteme für CRT-Geräte.

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Authors and Affiliations

  1. Innere Medizin III, Abteilung für Kardiologie and Angiologie, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515, Lüdenscheid, Germany

    A. Kloppe, B. Lemke & M. Zarse

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  1. A. Kloppe
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  2. B. Lemke
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  3. M. Zarse
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Correspondence to A. Kloppe.

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Kloppe, A., Lemke, B. & Zarse, M. Neue Technologien zur Optimierung in der CRT-Programmierung. Herzschr. Elektrophys. 19, 19–29 (2008). https://doi.org/10.1007/s00399-008-0596-y

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  • DOI: https://doi.org/10.1007/s00399-008-0596-y

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