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Kommentar zu den ESC-Leitlinien 2015 „Ventrikuläre Arrhythmien und Prävention des plötzlichen Herztodes“

Comments on the 2015 ESC guidelines on ventricular arrhythmia and prevention of sudden cardiac death

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die aktuelle Leitlinie der Europäischen Gesellschaft für Kardiologie „Ventrikuläre Arrhythmien und Prävention des plötzlichen Herztodes“ aus 2015 aktualisiert die Leitlinie aus 2006 und beinhaltet eine Vielzahl von Neuerungen und Bewertungen, welche auf aktuellen Studien beruhen. In diesem Kommentar werden die europäischen Empfehlungen unter Berücksichtigung der Bedürfnisse der Versorgungsstrukturen in Deutschland interpretiert und hierfür angepasste Empfehlungen spezifiziert. Die neue Leitlinie fokussiert auf die Prävention des plötzlichen Herztodes unter besonderer Berücksichtigung von strukturell assoziierten ventrikulären Arrhythmien und angeborenen Arrhythmieerkrankungen. Neu sind Empfehlungen zur autoptischen Klärung inklusiver molekularer Untersuchungen bei plötzlichen Todesfällen, detaillierte Empfehlungen zur Anwendung subkutaner und tragbarer Defibrillatoren, das psychosoziale Management nach Implantation von Defibrillatoren sowie der Risikostratifizierung früh nach einem Myokardinfarkt. Die Empfehlungen zur kardialen Resynchronisationstherapie wurden anhand aktueller Studien adaptiert, die Indikationen zur Versorgung mit implantierbaren Defibrillatoren bei Patienten ohne ischämische Kardiomyopathie wurden anhand aktuellster Studien im Vergleich zur europäischen Leitlinie für Deutschland modifiziert. Die Leitlinie zeigt eine deutliche Aufwertung der Katheterablation ventrikulärer Arrhythmien sowie Empfehlungen zur frühzeitigen interventionellen Therapie beim Auftreten einer ventrikulären Tachykardie. In diesem Kommentar werden zu jedem Themenkomplex die Neuheiten der aktuellen europäischen Leitlinie herausgestellt sowie in diesem Zusammenhang mögliche Anpassungen der Empfehlungen für Deutschland nach Meinung der Autoren dargestellt.

Abstract

The current 2015 guidelines of the European Society of Cardiology (ESC) on ventricular arrhythmias and the prevention of sudden cardiac death update the ESC guidelines from 2006 and incorporate multiple novel aspects and recommendations based on currently published data. This manuscript comments on the European recommendations with respect to the specific situation regarding the requirements of the healthcare structure in Germany. The new guidelines focus on the prevention of sudden cardiac death and include new information on ventricular arrhythmia associated with structural heart disease and congenital arrhythmia syndromes. New aspects in the guidelines include recommendations for autopsy clarification, including molecular genetic investigations in cases of sudden cardiac death. Detailed recommendations for subcutaneous and wearable defibrillators are given based on current data as well as psychosocial management after implantation of defibrillators and risk stratification early after myocardial infarction. Recommendations for cardiac resynchronization therapy have been adapted based on novel study outcomes and indications for implantable cardioverter defibrillators (ICD) in patients with non-ischemic cardiomyopathy were modified for Germany in the light of recently published randomized trials in comparison to European guidelines. The guidelines show a clear upgrading of catheter ablation for ventricular arrhythmia and recommendations for early interventional treatment after first onset of ventricular tachycardia. These comments discuss the novel aspects of each subject complex of the current European guidelines and in this context possible adaptations and modifications of the ESC guidelines for use in Germany from the perspective of the authors.

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Authors and Affiliations

  1. Klinik für Kardiologie/Rhythmologie, Herz- und Gefäß-Klinik Campus Bad Neustadt, Salzburger Leite 1, 97616, Bad Neustadt a. d. Saale, Deutschland

    T. Deneke

  2. Med. I – Kardiologie, Angiologie, Pneumologie, Universitätsmedizin Mannheim, Mannheim, Deutschland

    M. Borggrefe

  3. Abt. für Rhythmologie, Herzzentrum der Universität Leipzig, Leipzig, Deutschland

    G. Hindricks

  4. Institute for Biomedical Research, Institute of Cardiovascular Sciences, Birmingham, UK

    P. Kirchhof

  5. Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland

    K.-H. Kuck

  6. Klinik f. Kardiologie und intern. Intensivmedizin, Städt. Kliniken Bielefeld, Klinikum Mitte, Bielefeld, Deutschland

    C. Stellbrink

  7. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland

    L. Eckardt

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  1. T. Deneke
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Deneke, T., Borggrefe, M., Hindricks, G. et al. Kommentar zu den ESC-Leitlinien 2015 „Ventrikuläre Arrhythmien und Prävention des plötzlichen Herztodes“. Kardiologe 11, 27–43 (2017). https://doi.org/10.1007/s12181-016-0115-z

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