Zusammenfassung
Die Implantation eines Defibrillators ist Therapie der ersten Wahl bei Patienten,
die eine Episode von Kammerflimmern außerhalb eines akuten Herzinfarktes überlebt
haben. Bei vielen Patienten besteht aber auch schon vorher eine Indikation, insbesondere
bei Patienten, die nach einem Herzinfarkt oder bei einer Herzinsuffizienz eine stark
eingeschränkte Auswurffraktion haben. Eine konsequente Umsetzung bestehender Leitlinien
in diesem Bereich ermöglicht eine signifikante Verbesserung der Prognose unserer Patienten
und ist trotz des relativ hohen Aggregatpreises kosteneffizienter als viele andere
Therapien in der modernen Medizin.
Summary
The implantation of a defibrillator is the treatment of choice in patients who have
survived ventricular fibrillation outside of an acute myocardial infarction. Many
patients, however, have a prior indication, in particular patients who, following
an infarction, or who experience cardiac insufficiency, have an appreciably reduced
ejection fraction. The rigorous implementation of existing guidelines in this area
enables a significant improvement in the prognosis of our patients and, despite the
relative high equipment price, is more cost-efficient than many other treatments in
modern medicine.
Literatur
- 1
Connolly SJ, Hallstrom AP, Cappato R. et al. .
Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials.
AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac
Arrest Study Hamburg. Canadian Implantable Defibrillator Study.
Eur Heart J.
2000;
21
2071-2078
- 2
Salukhe TV, Dimopoulos K, Sutton R. et al. .
Life-years gained from defibrillator implantation: markedly nonlinear increase during
3 years of follow-up and its implications.
Circulation.
2004;
109
1848-1853
- 3
Strickberger SA, Hummel JD, Bartlett TG. et al. .
Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients
with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular
tachycardia - AMIOVIRT.
J Am Coll Cardiol.
2003;
41
1707-1712
- 4
The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators .
A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients
resuscitated from near-fatal ventricular arrhythmias.
N Engl J Med.
1997;
337
1576-1583
- 5
Bigger JT Jr. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators .
Prophylactic use of implanted cardiac defibrillators in patients at high risk for
ventricular arrhythmias after coronary-artery bypass graft surgery.
N Engl J Med.
1997;
337
1569-1575
- 6
Cleland JG, Daubert JC, Erdmann E. et al. .
The effect of cardiac resynchronization on morbidity and mortality in heart failure.
N Engl J Med.
2005;
352
1539-1549
- 7
Kuck KH, Cappato R, Siebels J. et al. .
Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators
in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH).
Circulation.
2000;
102
748-754
- 8
Bänsch D, Antz M, Boczor S. et al. .
Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the
Cardiomyopathy Trial (CAT).
Circulation.
2002;
105
1453-1458
- 9
Connolly SJ, Gent M, Roberts RS. et al. .
Canadian Implantable Defibrillator Study (CIDS): A Randomized Trial of the Implantable
Cardioverter Defibrillator Against Amiodarone.
Circulation.
2000;
101
1297-1302
- 10
Bristow MR, Saxon LA, Boehmer J. et al. .
Cardiac-resynchronization therapy with or without an implantable defibrillator in
advanced chronic heart failure.
N Engl J Med.
2004;
350
2140-2150
- 11
Kadish A, Dyer A, Daubert JP. et al. .
Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy.
N Engl J Med.
2004;
350
2151-2158
- 12
Hohnloser SH, Kuck KH, Dorian P. et al. .
Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial
infarction.
N Engl J Med.
2004;
351
2481-2488
- 13
Moss AJ, Zareba W, Hall WJ. et al. .
Prophylactic implantation of a defibrillator in patients with myocardial infarction
and reduced ejection fraction.
N Engl J Med.
2002;
346
877-883
- 14
Bardy GH, Lee KL, Mark DB. et al. .
Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
N Engl J Med.
2005;
352
225-237
Anschrift für die Verfasser
Prof. Dr. Dirk Böcker
Medizinische Klinik und Poliklinik C
Kardiologie und Angiologie-Universitätsklinik Münster
48129 Münster
Phone: 0251-8347617
Fax: 0251-8347864
Email: bockerd@uni-muenster.de