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Der Klinikarzt 2016; 45(06): 304-311
DOI: 10.1055/s-0042-109038
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© Georg Thieme Verlag Stuttgart · New York

Probleme und Komplikationen bei Defibrillator-Patienten

Was kann prä- und intrahospital auftreten? Was tun?Problems and complications in defibrillator patients – What can happen on the way to and in the hospital? What to do?
Konstantin M. Heinroth
1   Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Halle
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Publication Date:
29 June 2016 (online)

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Probleme und Komplikationen bei ICD-Patienten können sowohl durch eine Verschlechterung der kardialen Grunderkrankung mit Auftreten von Tachyarrythmien, die vom ICD-System adäquat als auch inadäquat therapiert werden, als auch durch eine Funktionsstörung einschließlich Infektion des ICD-Systems bedingt sein. Für eine effiziente Diagnostik und Therapie sind ein EKG und Permanentmagnet als Notfallausrüstung essentiell. Zudem ist ein zeitnaher Zugriff auf das implantierte Device mittels eines herstellerspezifischen Programmiergeräts erforderlich. Zur Identifizierung des implantierten Gerätes kann eine zusätzliche Röntgen-Thorax-Aufnahme helfen

Problems and complications with ICD patients can be caused not only by a deterioration of the underlying heart disease with the occurrence of tachyaarythmia that can be managed adequately or even inadequately by the ICD system but also by a functional disorder, including infection, of the ICD system. For the efficient diagnosis and therapy, an ECG and a permanent magnet are essential as emergency equipment as also is an early intervention on the implanted device by means of the manufacturer’s specific programming apparatus. An additional thorax X-ray may be helpful to identify the implanted device.

Key words

Implantable cardioverter defibrillator (ICD) - S-ICD - inadequate/adequate shocks - emergency management
 

  • Literatur

  • 1 Dickstein K, Vardas PE, Auricchio A et al. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Europace 2010; 12: 1526-1536
    CrossrefPubMedGoogle Scholar
  • 2 Fink T, Kuck KH, Metzner A. ESC guidelines 2015 for ventricular arrhythmias and prevention of sudden cardiac death : What is new?. Herz 2015; 40: 1034-1042
    CrossrefPubMedGoogle Scholar
  • 3 Burke MC, Gold MR, Knight BP et al. Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator: 2-Year Results From a Pooled Analysis of the IDE Study and EFFORTLESS Registry. J Am Coll Cardiol 2015; 65: 1605-1615
    CrossrefPubMedGoogle Scholar
  • 4 Jacob S, Shahzad MA, Maheshwari R et al. Cardiac rhythm device identification algorithm using X-Rays: CaRDIA-X. Heart Rhythm 2011; 8: 915-922
    CrossrefPubMedGoogle Scholar
  • 5 Moss AJ. What we have learned from the family of multicenter automatic defibrillator implantation trials. Circ J 2010; 74: 1038-1041
    CrossrefPubMedGoogle Scholar
  • 6 Moss AJ, Greenberg H, Case RB et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 2004; 110: 3760-3765
    CrossrefPubMedGoogle Scholar
  • 7 Poole JE, Johnson GW, Hellkamp AS et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008; 359: 1009-1017
    CrossrefPubMedGoogle Scholar
  • 8 Kleemann T, Strauss M, Kouraki K, Zahn R. Clinical course and prognostic relevance of antitachycardia pacing-terminated ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients. Europace 2015; 17: 1068-1075
    PubMedGoogle Scholar
  • 9 Daubert JP, Zareba W, Cannom DS et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 2008; 51: 1357-1365
    CrossrefPubMedGoogle Scholar
  • 10 Proietti R, Labos C, Davis M et al. A systematic review and meta-analysis of the association between implantable cardioverter-defibrillator shocks and long-term mortality. Can J Cardiol 2015; 31: 270-277
    CrossrefPubMedGoogle Scholar
  • 11 Moss AJ, Schuger C, Beck CA et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367: 2275-2283
    CrossrefPubMedGoogle Scholar
  • 12 Ruwald AC, Schuger C, Moss AJ et al. Mortality reduction in relation to implantable cardioverter defibrillator programming in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT). Circ Arrhythm Electrophysiol 2014; 7: 785-792
    CrossrefPubMedGoogle Scholar
  • 13 Credner SC, Klingenheben T, Mauss O et al. Electrical storm in patients with transvenous implantable cardioverter-defibrillators: incidence, management and prognostic implications. J Am Coll Cardiol 1998; 32: 1909-1915
    CrossrefPubMedGoogle Scholar
  • 14 Israel CW, Manegold JC. Electrical storm: definition, prevalence, causes and prognostic implications. Herzschrittmacherther Elektrophysiol 2014; 25: 59-65
    PubMedGoogle Scholar
  • 15 Sorajja D, Munger TM, Shen WK. Optimal antiarrhythmic drug therapy for electrical storm. J Biomed Res 2015; 29: 20-34
    PubMedGoogle Scholar
  • 16 Nedios S, Darma A, Stevanello C et al. Electrical storm in patients with implantable cardioverter-defibrillator in the era of catheter ablation: Implications for better rhythm control. Heart Rhythm 2015; 12: 2419-2425
    CrossrefPubMedGoogle Scholar
  • 17 Nabauer M. Medicinal rate control in atrial fibrillation. Herzschrittmacherther Elektrophysiol 2014; 25: 12-18
    PubMedGoogle Scholar
  • 18 De SA, Marquez MF, Tonet J et al. Adverse effects of long-term right ventricular apical pacing and identification of patients at risk of atrial fibrillation and heart failure. Pacing Clin Electrophysiol 2012; 35: 1035-1043
    CrossrefPubMedGoogle Scholar
  • 19 Sohinki D, Ho J, Srinivasan N et al. Outcomes after atrioventricular node ablation and biventricular pacing in patients with refractory atrial fibrillation and heart failure: a comparison between non-ischaemic and ischaemic cardiomyopathy. Europace 2014; 16: 880-886
    CrossrefPubMedGoogle Scholar
  • 20 Israel CW, Sheta MK. ICD leads. Herzschrittmacherther Elektrophysiol 2015; 26: 94-104
    PubMedGoogle Scholar
  • 21 Habib G, Lancellotti P, Antunes MJ et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128
    CrossrefPubMedGoogle Scholar
  • 22 Prutkin JM, Reynolds MR, Bao H et al. Rates of and factors associated with infection in 200 909 Medicare implantable cardioverter-defibrillator implants: results from the National Cardiovascular Data Registry. Circulation 2014; 130: 1037-1043
    CrossrefPubMedGoogle Scholar
  • 23 Ipek EG, Guray U, Demirkan B et al. Infections of implantable cardiac rhythm devices: predisposing factors and outcome. Acta Cardiol 2012; 67: 303-310
    PubMedGoogle Scholar
  • 24 Almomani A, Siddiqui K, Ahmad M. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators. Echocardiography 2014; 31: 388-399
    CrossrefPubMedGoogle Scholar
  • 25 Nagano Y, Nakagawa M, Teshima Y, Takahashi N. Infective Endocarditis--Blood Culture and Echocardiography. Rinsho Byori 2015; 63: 949-955
    PubMedGoogle Scholar