Aktuelle Kardiologie 2013; 2(6): 395-400
DOI: 10.1055/s-0033-1346887
Georg Thieme Verlag KG Stuttgart · New York

Update: implantierbare Diagnostika

Update: Implantable Diagnostics
M. Busch
Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
R. Busch
Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
S. B. Felix
Innere Medizin B, Kardiologie/Angiologie/Pneumologie/internistische Intensivmedizin, Universitätsmedizin Greifswald
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2013 (online)


Kardiologische Implantate wie SM, ICD oder CRT dienen nicht mehr nur therapeutischen Zwecken. Vielmehr bieten therapeutische Aggregate heutzutage eine Vielzahl diagnostischer Funktionen. Der klinische Stellenwert dieser Informationen muss im Rahmen von Studien weiter beleuchtet werden. Außerdem haben mit den ILRs rein diagnostische Implantate einen festen Stellenwert erhalten. Im Rahmen der Synkopenabklärung sind sie zum wesentlichen Bestandteil der diagnostischen Kette geworden. Zahlreiche weitere Einsatzgebiete sind vorstellbar bzw. bereits in Reichweite (z. B. Diagnostik bei kryptogenem Schlaganfall, Steuerung der Antikoagulation bei AF, Optimierung der Rhythmuskontrolle bei AF, Verbesserung der SCD-Risikostratifizierung, etc.).


Implants in cardiology are no longer used only for therapeutic purposes. Nowadays therapeutic devices offer a variety of diagnostic functions. The clinical value of this information needs to be assessed in further clinical trials. Furthermore mere diagnostic implants in form of ILRs are of particular importance. ILRs have become an integral part of the syncope work-up. Numerous other applications can be conceived or are within reach (e.g. cryptogenic stroke, management of anticoagulation in AF, optimization of AF rhythm control, risk stratification for SCD, etc.).

  • Literatur

  • 1 Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA), Heart Rhythm Society (HRS) et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30: 2631-2671
  • 2 Healey JS, Connolly SJ, Gold MR et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-129
  • 3 Krahn AD, Klein GJ, Yee R et al. Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation 2001; 104: 46-51
  • 4 Charitos EI, Stierle U, Ziegler PD et al. A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: Insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions. Circulation 2012; 126: 806-814
  • 5 Glotzer TV, Hellkamp AS, Zimmerman J et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 2003; 107: 1614-1619
  • 6 Shanmugam N, Boerdlein A, Proff J et al. Device-detected atrial tachyarrhythmias: what do we know?. Europace 2012; 14: 157-158
  • 7 Ip J, Waldo AL, Lip GY et al. Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort The IMPACT study. Am Heart J 2009; 158: 364e1-370e1
  • 8 Safak E. Clinical efficacy and safety of an implantable cardioverter-defibrillator lead with a floating atrial sensing dipole. Pacing Clin Electrophysiol 2013; DOI: 10.1111/pace.12255.
  • 9 Yu CM, Wang L, Chau E et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005; 112: 841-848
  • 10 van Veldhuisen DJ, Braunschweig F, Conraads V et al. Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation 2011; 124: 1719-1726
  • 11 Abraham WT, Adamson PB, Bourge RC et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011; 377: 658-666
  • 12 Ritzema J, Melton IC, Richards AM et al. Direct left atrial pressure monitoring in ambulatory heart failure patients: initial experience with a new permanent implantable device. Circulation 2007; 116: 2952-2959
  • 13 Stahl C, Walker T, Straub A et al. Assessing acute ventricular volume changes by intracardiac impedance in a chronic heart failure animal model. Pacing Clin Electrophysiol 2009; 32: 1395-1401
  • 14 Ravazzi AP, Carodio G, Diotallevi P et al. Clinical assessment of the correlation between right ventricular impedance and left ventricular contractility. Progress in Biomedical Research 2000; 478-481 Im Internet: http://progress.biomed.uni-erlangen.de/documents/200005060478.pdf Stand: 31.07.2013
  • 15 Ritter P, Delnoy PP, Padeletti L et al. A randomized pilot study of optimization of cardiac resynchronization therapy in sinus rhythm patients using a peak endocardial acceleration sensor vs. standard methods. Europace 2012; 14: 1324-1333
  • 16 Krahn AD, Klein GJ, Norris C et al. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation 1995; 92: 1819-1824
  • 17 Hindricks G, Pokushalov E, Urban L et al. Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation: Results of the XPECT trial. Circ Arrhythm Electrophysiol 2010; 3: 141-147
  • 18 Giada F, Gulizia M, Francese M et al. Recurrent Unexplained Palpitations (RUP) Study. J Am Coll Cardiol 2007; 49: 1951-1956
  • 19 Menozzi C, Brignole M, Garcia-Civera R et al. Mechanism of syncope in patients with heart disease and negative electrophysiologic test. Circulation 2002; 105: 2741-2745
  • 20 Ritter MA, Kochhäuser S, Duning T et al. Occult atrial fibrillation in cryptogenic stroke: detection by 7-day electrocardiogram versus implantable cardiac monitors. Stroke 2013; 44: 1449-1452
  • 21 Sinha AM, Diener HC, Morillo CA et al. Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. Am Heart J 2010; 160: 36e1-41e1