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Erschienen in: Die Innere Medizin 10/2018

13.08.2018 | ICD-Implantation | Schwerpunkt: Kardiale Device-Therapie

Sondenlose Schrittmacher und subkutan implantierbare Kardioverter-Defibrillatoren

verfasst von: Prof. Dr. C. Stellbrink, B. Hansky, D. Meyer zu Vilsendorf

Erschienen in: Die Innere Medizin | Ausgabe 10/2018

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Zusammenfassung

Obwohl Herzschrittmacher und implantierbare Defibrillatoren heute der therapeutische Standard in der Behandlung bradykarder und tachykarder Herzrhythmusstörungen sind, kommt es doch insbesondere durch die transvenösen Stimulations- und Defibrillationselektroden im Langzeitverlauf nicht selten zu Komplikationen wie Elektrodenbruch, Infektionen und Trikuspidalinsuffizienzen. Daher sind in den letzten Jahren sondenlose Herzschrittmacher und rein subkutan implantierbare Kardioverter-Defibrillatoren (S-ICD) entwickelt worden, die ohne transvenöse Elektroden implantiert werden und so die Langzeitkomplikationsrate der Implantate reduzieren sollen. Allerdings sind bisher verfügbare sondenlose Herzschrittmacher auf die einfache 1‑Kammer-Stimulation und der S‑ICD auf einen reinen Defibrillator ohne die Möglichkeit der antibrady- bzw. antitachykarden Stimulation oder kardialen Resynchronisation beschränkt. Daher können diese Geräte nicht als Mehrkammerschrittmacher bzw. -defibrillatoren dienen, obwohl gerade bei diesen aufgrund der Zahl der transvenösen Sonden auch mit mehr Langzeitkomplikationen zu rechnen ist. Der vorliegende Beitrag fasst die aktuelle Datenlage zu den sondenlosen Schrittmachern und S‑ICD zusammen, diskutiert die Limitationen dieser Systeme und gibt einen Ausblick, wohin sich die Therapien entwickeln könnten.
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Zurück zum Zitat Nordkamp OLR, Brouwer TF, Barr C, Theuns DA, Boersma LV, Johansen JB, Neuzil P, Wilde AA, Carter N, Husby M, Lambiase PD, Knops RE (2015) Inappropriate shocks in the subcutaneous ICD: incidence, predictors and management. Int J Cardiol 195:126–133CrossRef Nordkamp OLR, Brouwer TF, Barr C, Theuns DA, Boersma LV, Johansen JB, Neuzil P, Wilde AA, Carter N, Husby M, Lambiase PD, Knops RE (2015) Inappropriate shocks in the subcutaneous ICD: incidence, predictors and management. Int J Cardiol 195:126–133CrossRef
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Zurück zum Zitat Brouwer TF, Smeding L, Berger WR, Driessen AHG, Groot DEJR, Wilde AAM, Knops RE (2017) Assessment of the extravascular implantable defibrillator: feasibility of substernal ventricular pacing. J Cardiovasc Electrophysiol 28(6):674–676CrossRef Brouwer TF, Smeding L, Berger WR, Driessen AHG, Groot DEJR, Wilde AAM, Knops RE (2017) Assessment of the extravascular implantable defibrillator: feasibility of substernal ventricular pacing. J Cardiovasc Electrophysiol 28(6):674–676CrossRef
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Zurück zum Zitat Sholevar DP, Tung S, Kuriachan V, Leong-Sit P, Roukoz H, Engel G, Kutalek SP, Akula D, Thompson AE, Christie MGT, Ostanniy M, Molin F, SPACE Study Investigators (2018) Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study. Heart Rhythm 15:536–542CrossRef Sholevar DP, Tung S, Kuriachan V, Leong-Sit P, Roukoz H, Engel G, Kutalek SP, Akula D, Thompson AE, Christie MGT, Ostanniy M, Molin F, SPACE Study Investigators (2018) Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study. Heart Rhythm 15:536–542CrossRef
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Zurück zum Zitat Chan JYS, Lelakowski J, Murgatroyd FD, Boersma LV, Cao J, Nikolski V, Wouters G, Hall MCS (2017) Novel extravascular defibrillation configuration with a coil in the substernal space: the ASD clinical study. Jacc Clin Electrophysiol 3(8):905–910CrossRef Chan JYS, Lelakowski J, Murgatroyd FD, Boersma LV, Cao J, Nikolski V, Wouters G, Hall MCS (2017) Novel extravascular defibrillation configuration with a coil in the substernal space: the ASD clinical study. Jacc Clin Electrophysiol 3(8):905–910CrossRef
Metadaten
Titel
Sondenlose Schrittmacher und subkutan implantierbare Kardioverter-Defibrillatoren
verfasst von
Prof. Dr. C. Stellbrink
B. Hansky
D. Meyer zu Vilsendorf
Publikationsdatum
13.08.2018

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