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ICD-Therapie zur Primärprävention

Seltene Indikationen

The ICD as primary prevention

Rare indications

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die häufigste Ursache für den plötzlichen Herztod ist eine zugrundeliegende koronare Herzerkrankung. Nur selten sind scheinbar gesunde junge Menschen von einem plötzlichen Herztod betroffen. Bei diesen Patienten wird meist eine elektrische oder eine genetisch bedingte strukturelle Herzerkrankung diagnostiziert. Zu diesen seltenen, dem plötzlichen Herztod junger Menschen aber häufig zugrundeliegenden Erkrankungen bzw. Syndromen gehören vor allem die arrhythmogene rechtsventrikuläre Kardiomyopathie, die hypertrophe Kardiomyopathie, das lange und kurze QT-Syndrom, das Brugada-Syndrom, die katecholaminerge polymorphe Kammertachykardie und das Syndrom der frühen Repolarisation. Die Patienten fallen klinisch durch Synkopen oder ein Reanimationsereignis auf. Gelegentlich wird eine Erkrankung auch zufällig oder im Rahmen einer Familienuntersuchung diagnostiziert. Die Schwierigkeit besteht für die Primärprophylaxe darin, besonders gefährdete Patienten zu identifizieren. Anhand verschiedener Risikofaktoren muss das Risiko individuell abgeschätzt und gegen die Nachteile einer ICD-Implantation bei den überwiegend jungen Patienten abgewogen werden.

Abstract

The most frequent cause of sudden cardiac death (SCD) is underlying coronary artery disease. Healthy appearing young individuals are affected in a minority of cases. These individuals are usually diagnosed with electrical or genetically determined structural heart disease. Arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, long and short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and early repolarization syndrome are generally considered rare underlying causes of SCD in these young patients. Affected patients typically present with syncope or cardiac arrest. Occasionally, disease is diagnosed during family screening. Risk stratification is difficult in this patient population. Risk of sudden death has to be weighed individually against risks associated with an implantable cardioverter defibrillator (ICD) in these young patients.

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Erklärung zum Interessenkonflikt

Prof. Dr. Eckardt erhielt Reisekostenübernahmen und Honorare für Vorträge von Biotronic, Medtronic, St. Jude Medical, Sanofi. Dr. J. Köbe erhielt Reisekostenübernahmen und Honorare für Vorträge von Biotronic, Medtronic, St. Jude Medical, Boston Scientific und Sanofi. PD Dr. C. Pott erhielt Reisekostenübernahmen von Sanofi. Dr. K. Wasmer erhielt Reisekostenübernahmen und Honorare für Vorträge von Biotronic, Medtronic, St. Jude Medical und Sanofi.

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Authors and Affiliations

  1. Medizinische Klinik C - Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48149, Münster, Deutschland

    K. Wasmer, J. Köbe, C. Pott & L. Eckardt

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  1. K. Wasmer
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  2. J. Köbe
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  3. C. Pott
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  4. L. Eckardt
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Correspondence to K. Wasmer.

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Wasmer, K., Köbe, J., Pott, C. et al. ICD-Therapie zur Primärprävention. Herzschr. Elektrophys. 21, 117–122 (2010). https://doi.org/10.1007/s00399-010-0079-9

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  • DOI: https://doi.org/10.1007/s00399-010-0079-9

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