[Implantable defibrillators--current status of guidelines. Recognized and possible indications--prerequisites].
Ten to twenty percent of the patients, who were resuscitated as a result of a persistent ventricular tachycardia or ventricular fibrillation outside of an acute myocardial infarction, die of sudden cardiac death already in the first year after this event. Anti-arrhythmic agents also do not decisively improve this unfavorable prognosis. There is no doubt that the implantable cardioverter/defibrillator (ICD) safely and reliably terminates ventricular tachycardias and ventricular fibrillation and has thus led to an improvement in the care of these high risk patients. Studies have shown that the ICD reduces the risk of sudden cardiac death to 1-2% per year. However, whether the reduction of sudden cardiac death is also accompanied by a reduction in overall mortality has not yet been substantiated. It was, however, been assumed that especially patients with good left ventricular function, whose mortality risk is mainly sudden cardiac death, also profit from the overall prognosis of an ICD. The following presentation and discussion of the indication catalogue for the implantation of defibrillators is based on a guideline paper published by the study group "Interventional Electrophysiology" in the German Society for Cardiology. The statements clearly show how difficult it is to make long-term binding and valid recommendations due to insufficient scientific data and rapid technical development. Identifying patients who should be treated with an ICD requires complete noninvasive and invasive cardiological diagnostics and should ultimately be limited to cardiological centers which possess a large arsenal of diagnostic and therapeutic procedures.
Andresen
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Abteilung für Innere Medizin mit Schwerpunkt Kardiologie und Pulmologie, Freien Universität Berlin.
D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005858:Germany / Q000453:epidemiology; D006801:Humans; D010348:Patient Care Team; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality / Q000628:therapy*
Implantierbare Defibrillatoren--derzeitiger Stand der Richtlinien. Anerkannte und mögliche Indikationen--Voraussetzungen.