Häufige Schocks nach ICD-Implantation

Abstract

Frequent VTs after ICD implantation

Frequent VTs and shocks occur in about 20 % of patients after ICD-implantation for secondary prevention of sudden cardiac death. They impair quality of life and signify an impaired prognosis. Data on VT-treatment are rare and inconsistent. The best medical treatment seems to a combination of amiodarone and beta blocker. Sedation and anxiolysis is warranted if shock clusters occur. Hemodynamic support with intraaortic bolloon counterpulsation seems to be helpful in selected cases. The best though infrequently used ablation therapy seems to have the highest efficacy with respect to suppression of VT-clusters. When patients should be referred for an ablation therapy in the time course of ICD-therapy, is still a matter of debate.

Kernaussagen

• VT-Stürme sind ein ernstes klinisches Ereignis, das die Prognose und Lebensqualität der Patienten erheblich einschränkt.

• Die wahrscheinlich beste Therapie ist die Kombination aus Betablocker und Amiodaron mit dem Nachteil der VT-Verlangsamung.

• Gleichwertig oder sogar überlegen ist die VT-Ablation, die nur in Zentren mit entsprechender Erfahrung durchgeführt werden sollte und wahrscheinlich zu selten eingesetzt wird. Mit diesem Verfahren lässt sich eine Rezidivfreiheit für VTs überhaupt bei 70 % der Patienten erreichen. Eine Reduktion der VT-Häufigkeit ist bei über 90 % der Patienten zu erzielen.

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