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Ein- und Zweikammer-ICD: Sind die Unterschiede zum Schrittmacher in Implantation und Nachsorge heutzutage noch bedeutsam?

Single- and dual-chamber ICDs: Are there still significant differences compared to pacemakers with regard to implantation and follow-up?

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

Due to bulky generator size, abdominal pocket preparation and epicardial defibrillator lead placement, cardioverter-defibrillator (ICD) implantation was initially an extensive surgical intervention, which had to be performed in the operating room by cardiac surgeons under general anesthesia. The development of transvenously applicable endocardial defibrillator leads rendered thoracotomy unnecessary. The decrease in generator size enabled pectoral implantation. As a consequence of the simplified surgical procedure, implantation by cardiologists or electrophysiologists in the catheterization laboratory under local anesthesia and brief deep sedation with preserved spontaneuos respiration was made possible. As a result, the implantation techniques of ICDs and pacemakers are converging. The present article illustrates the still existing significant differences between ICD and pacemaker treatment with regard to implantation and follow-up.

Zusammenfassung

Bedingt durch die Größe der Aggregate, durch abdominelle Taschenpräparation und epikardiale Sondenapplikation war die Implantation eines Kardioverter-Defibrillators (ICD) anfänglich ein ausgedehnter operativer Eingriff, der nur in der Kardiochirurgie und ausschließlich in Vollnarkose erfolgen konnte. Die Entwicklung transvenös-endokardial platzierbarer Defibrillatorsonden machte die Thorakotomie überflüssig. Durch die Verkleinerung der ICD-Aggregate wurde die pektorale Implantation möglich. Die konsekutive Vereinfachung der Operationstechnik ermöglicht die Implantation im Herzkatheterlabor durch Kardiologen oder Elektrophysiologen in Lokalanästhesie und kurzzeitiger Narkose bei erhaltener Spontanatmung. ICD- und Schrittmacherimplantation haben sich in der Folge technisch angenähert. Die vorliegende Arbeit beleuchtet, welche bedeutsamen Unterschiede dennoch weiterhin bezüglich Implantation und Nachsorge zwischen ICD- und Schrittmachertherapie bestehen.

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

    Martin Stockburger

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Correspondence to Martin Stockburger.

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Interessenkonflikt MS erhält Forschungsunterstützung und Vortragshonorare von Biotronik, Boston Scientific, Medtronic, Sorin Group.

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Stockburger, M. Ein- und Zweikammer-ICD: Sind die Unterschiede zum Schrittmacher in Implantation und Nachsorge heutzutage noch bedeutsam?. Herzschr. Elektrophys. 19 (Suppl 1), 6–13 (2008). https://doi.org/10.1007/s00399-008-0610-4

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