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ICD-Therapie

Wie viel ist evidenzbasiert?

ICD therapy

How much is evidence-based?

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Der plötzliche Herztod („sudden cardiac death“, SCD) stellt eine der häufigsten Todesursachen in den Industrienationen dar. Wenngleich die zuverlässige Vorhersage des SCD als Voraussetzung für eine effektive Prävention und Therapie zu fordern ist, so gelingt die Definition harter Kriterien hierfür bislang nur unvollständig. Eine Vielzahl klinischer Studien hat die Bedeutung implantierbarer Kardioverterdefibrillatoren (ICDs) in der Prävention des SCD untersucht und neben dem unbestrittenen Wert der ICD-Therapie in der Sekundärprävention auch einen signifikanten Überlebensvorteil bei herzinsuffizienten Patienten mit ischämischer oder nichtischämischer Kardiomyopathie und eingeschränkter linksventrikulärer Ejektionsfraktion (EF) durch ICDs belegt. Derzeit helfen nationale und internationale Leitlinien bei Standardindikationen zur ICD-Implantation bei Patienten mit bekannten strukturellen oder hereditären Herzerkrankungen, die mit einem erhöhten SCD-Risiko assoziiert sind. Dennoch wissen wir, dass unsere derzeitigen Strategien bei der Patientenauswahl zur ICD-Therapie unvollkommen sind und eine erhebliche Zahl von Hochrisikopatienten nicht berücksichtigen. In jedem Fall sollte eine bestmögliche individuelle Risikoeinschätzung erfolgen, um eine optimale SCD-Prävention ohne unnötige Aggregatimplantationen zu erreichen.

Abstract

Sudden cardiac death (SCD) remains the leading common cause for overall mortality in the industrialized world. Although prediction of SCD is considered a necessary prerequisite for its effective prevention and therapy, hard criteria for that goal are difficult to identify. A number of clinical trials were conducted to define the role of implantable cardioverter-defibrillators (ICDs) in preventing SCD. In addition to its undisputed value in secondary prevention of SCD, study results have proven a reduction of mortality through ICDs in patients with both ischemic and non-ischemic cardiomyopathy and a reduced left ventricular ejection fraction (EF). To date, national and international guidelines help us to apply standard ICD indications in patients with structural or hereditary heart diseases that are associated with increased SCD risk. Yet we know that our strategies currently in use for selecting patients who require ICD therapy are imperfect and leave a large number of high-risk patients unprotected. Therefore, the best possible risk assessment should be used in each individual case for optimal SCD prevention without unnecessary device implantation.

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Authors and Affiliations

  1. Klinik für Innere Medizin/Kardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    M. Roser & S. Götze

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  1. M. Roser
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  2. S. Götze
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Correspondence to M. Roser.

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Roser, M., Götze, S. ICD-Therapie. Kardiologe 1, 149–164 (2007). https://doi.org/10.1007/s12181-007-0019-z

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