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Aktuelle Kardiologie 2018; 7(06): 458-463
DOI: 10.1055/a-0762-0101
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Der tragbare Defibrillator – für wen und wie lange?

The Wearable Defibrillator – for Whom and How Long?
Christian Veltmann
Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
,
David Duncker
Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
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Publication History

Publication Date:
21 December 2018 (online)

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Zusammenfassung

Die Verhinderung des plötzlichen Herztodes stellt weiterhin eine große und relevante klinische Herausforderung dar. Implantierbare Kardioverter/Defibrillatoren (ICD) verhindern den plötzlichen Herztod, allerdings besteht die Indikation zur primärprophylaktischen Implantation eines ICDs erst nach mindestens 3-monatiger optimierter Herzinsuffizienztherapie. Nach neu diagnostizierter Herzinsuffizienz mit schwer reduzierter linksventrikulärer Funktion besteht ein erhöhtes Risiko für den plötzlichen Herztod. In der Phase der Etablierung und Optimierung der Herzinsuffizienzmedikation und Evaluation des Risikos für einen plötzlichen Herztod kann der tragbare Defibrillator (WCD) zum Schutz vor dem plötzlichen Herztod sicher eingesetzt werden. Neben diesem klinischen Szenario kann der WCD auch bei Patienten mit etablierter ICD-Indikation zum Einsatz kommen. Sollte die Implantation eines ICDs aufgrund von Komorbiditäten oder anderen Umständen nicht möglich sein, kann der WCD zur Überbrückung der Zeit bis zur Implantation des ICD zum Schutz vor dem plötzlichen Herztod erwogen werden. Diese Übersichtsarbeit bietet eine Zusammenfassung der aktuellen Daten zur Indikation des WCDs bei Patienten mit und ohne etablierte ICD-Indikation.

Abstract

Prevention of sudden cardiac death remains one of the most relevant clinical challenges. Implantable cardioverter defibrillators (ICD) are able to prevent sudden cardiac death. However, according to current guidelines primary preventive ICD implantation is indicated in patients with heart failure with reduced ejection fraction (HFrEF) despite optimized heart failure therapy for a minimum of three months. After newly diagnosed heart failure patients are at risk for sudden cardiac death. In this phase of initiation and uptitration of heart failure medication the wearable cardioverter defibrillator (WCD) can be prescribed for prevention of sudden cardiac death. The WCD may also be indicated in patients with an established indication for an ICD if the implantation has to be postponed due to comorbidities or other circumstances. This review serves as overview on indication of the WCD in patients with and without an established ICD indication.

Was ist wichtig?

  • Der WCD ist bei Patienten mit neu-diagnostizierter Herzinsuffizienz im Rahmen der Initiierung und Optimierung der Herzinsuffizienztherapie indiziert.

  • Bei Patienten mit ICD-Indikation und Komorbiditäten oder Umständen, die eine Implantation verhindern, kann der WCD die Zeit bis zur Implantation überbrücken.

  • Die Datenlage zum WCD beruht auf retrospektiven und prospektiven Registern mit mehr als 2000 Patienten. Die Publikation der ersten randomisierten prospektiven Studie wird erwartet.

  • Wenn der WCD verordnet wird, sollte auf eine hohe Tragecompliance geachtet werden, da nur so die WCD-Therapie Sinn macht.

Schlüsselwörter

Defibrillatorweste - tragbarer Defibrillator - plötzlicher Herztod

Key words

sudden cardiac death - heart failure - wearable defibrillator
 

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