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Device-Device-Interaktion

Device-device interaction

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Mit stetiger Zunahme der Zulassung von kardialen implantierbaren Devices, insbesondere auf dem Gebiet der chronischen Herzinsuffizienz, steigt auch die theoretische Möglichkeit von Device-Device-Interaktionen, mit teilweise letalen Folgen. Auf Grund der doch insgesamt kleinen Patientenzahl gibt es hierzu kaum wissenschaftliche Studien, jedoch einzelne Fallberichte. Devices, bei denen es zu Interaktionen kommen kann, sind insbesondere die tragbare Defibrillatorweste (WCD) oder auch der subkutane implantierbare Defibrillator (S-ICD), da diese Devices bzw. ihr Algorithmus ein Oberflächen-EKG zur Detektion von ventrikulären Herzrhythmusstörungen nutzen und dieses anfälliger für Fehler in der Detektion durch z. B. unipolare Herzschrittmacherstimulationsartefakte ist. Mit Hilfe der richtigen Programmierung der vorbestehenden Herzschrittmacher-Devices in einen bipolaren Stimulationsmodus lassen sich diese Interaktionen vermeiden. Die Barorezeptor-Aktivator-Therapie (BAT) scheint zum aktuellen Stand keine Interaktionen mit implantierbaren ICDs zu haben, auch wenn es hier im Oberflächen-EKG durch die unipolare Stimulation zu erheblichen hochfrequenten Artefakten kommt. Auch die Cardiac-Contractility-Modulation(CCM)-Systeme scheinen zum aktuellen Kenntnisstand sowohl mit transvenösen und subkutanen ICD sicher zu sein, wenn auch die Datenlage sehr gering ist.

Abstract

With a continuous increase in the approval of cardiac implantable electronic devices (CIED), not only pacemakers (PM) and implantable cardioverter defibrillators (ICD) but especially devices for treating chronic heart failure, more and more possibilities of device-device interactions arise, which in isolated cases can lead to death of the patient. Because of the still low numbers of patients overall, there are very few scientific studies and only isolated case reports on this topic. Devices which are at risk of interaction with a previously implanted PM are wearable cardioverter defibrillators (WCD) and subcutaneous ICDs (S-ICD). These two devices both use the surface electrocardiogram (ECG) in their algorithm for detecting ventricular arrhythmia. These surface ECGs seem to be prone to unipolar pacemaker stimulation artefacts. By correct programming of implanted pacemakers in the bipolar stimulation mode it is possible to avoid ECG artefacts and inadequate treatment. In baroreceptor activation therapy (BAT) there seem to be no device interactions so far, even though this device shows substantial highly frequent artefacts in the ECG. The cardiac contractility modulation (CCM) system has also until now not shown interactions with transvenous or subcutaneous ICD devices, even though randomized trials are missing.

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Authors and Affiliations

  1. Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland

    Victoria Johnson,  Christian W. Hamm &  Jörn Schmitt

  2. Deutsches Zentrum für Herzinsuffizienz, Translationale Forschung, Uniklinikum Würzburg, Würzburg, Deutschland

    Victoria Johnson

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  1. Victoria Johnson
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  2. Christian W. Hamm
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  3. Jörn Schmitt
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Correspondence to Victoria Johnson.

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Interessenkonflikt

V. Johnson: Vortragshonorare von Biotronik und Pfizer/BMS. Fellowship-Programme von Biotronik und Boston Scientific sowie ein Forschungsstipendium der Deutschen Gesellschaft für Kardiologie. C.W. Hamm: Beraterverträge Zoll CMS, CVRx. J. Schmitt unrestricted grants from Abott, CVRx; Vortragshonoroare: Zoll CMS; Biotronik, Abott, Medtronic; Beraterverträge: Abott, Biotronik, CVRx

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Johnson, V., Hamm, C.W. & Schmitt, J. Device-Device-Interaktion. Herzschr Elektrophys 30, 183–190 (2019). https://doi.org/10.1007/s00399-019-0617-z

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  • DOI: https://doi.org/10.1007/s00399-019-0617-z

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