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HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen

Kommentar der AG Herzrhythmusstörungen der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie

HRS expert consensus (2017) lead management and extraction of cardiac implantable electronic devices as well as EHRA expert consensus (2018) on scientific analysis of lead extraction

Comments of the Working Group on Heart Rhythm Disorders of the German Society for Thoracic, Cardiac and Vascular Surgery

  • Aus der DGTHG
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

In den vergangenen Jahren wurden zwei wesentliche internationale Experten-Empfehlungen zum Sondenmanagement kardialer implantierbarer elektronischer Devices (CIED) überarbeitet.

So veröffentlichte zum einen die Heart Rhythm Society (HRS) 2017 einen Expertenkonsensus zum Thema Sondenmanagement unter Einschluss der Aspekte Haltbarkeit, Fehlfunktionen und Rückrufe, der Indikationen von Revisionseingriffen, des periprozeduralen Managements, einschließlich der personellen und logistischen Voraussetzungen von Sondenextraktionen, und gab zudem Empfehlungen zur Qualitätssicherung und zum Datenmanagement. Zum anderen publizierte die European Heart Rhythm Association (EHRA) 2018 Empfehlungen zum Design von klinischen Studien und Registern und forderte zudem eine intensivere wissenschaftliche Aufarbeitung der Sondenextraktionsprozeduren und benannte bestehende Wissenslücken („gaps in evidence“). Beide Manuskripte ergänzen sich thematisch und verfolgen das gemeinsame Ziel einer flächendeckenden qualitativ hochwertigen klinischen Versorgung sowie einer zukünftig fundierteren Aufarbeitung offenstehender wissenschaftlicher Fragen. Die gewählten Schwerpunkte adressieren explizit nicht ausschließlich Elektroden-revidierende Zentren, sondern alle in die Behandlung von CIED-Patienten involvierten Ärzte.

Der vorliegende Kommentar der Arbeitsgemeinschaft Herzrhythmusstörungen der DGTHG fasst die wesentlichen Empfehlungen der beiden Stellungnahmen zusammen, erläutert Hintergründe und diskutiert kritisch kontroverse Auffassungen.

Abstract

In the past few years two major international expert recommendations on lead management of cardiac implantable electronic devices (CIED) have been revised. Accordingly, in 2017 an expert consensus on lead management under the patronage of the Heart Rhythm Society (HRS) was published. It focused mainly on aspects of durability, malfunctions and recalls, indications for revision interventions, periprocedural management including personnel and logistic requirements for lead removal. Additionally, the recommendations on quality assurance and data management were addressed as well. Subsequently, the European Heart Rhythm Association (EHRA) published expert recommendations in 2018, which mainly dealt with the design of clinical studies and registries and requested a comprehensive analysis of lead extraction procedures and specified existing gaps in evidence. The papers complemented each other in terms of content and had a common denominator for high-quality clinical care that was based on well-supported clinical evidence. Importantly, both consensus statements address, besides lead extraction centers, explicitly all physicians involved in the treatment of CIED patients.

The present comments by the Working Group on Heart Rhythm Disorders of the German Society for Thoracic, Cardiac and Vascular Surgery (DGTHG) summarizes the most important recommendations of the two statements, explains the background and discusses critical controversies.

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Authors and Affiliations

  1. Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. T. Starck

  2. Abteilung für Herzchirurgie, Herzzentrum Kerckhoff-Klinik, Benekestraße 2–8, 61231, Bad Nauheim, Deutschland

    H. Burger

  3. Herzzentrum Duisburg, Klinik für Herzchirurgie, Duisburg, Deutschland

    B. Osswald

  4. Abteilung für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland

    S. Hakmi

  5. Klinik für Herzchirurgie, Herzzentrum Dresden Universitätsklinik an der Technischen Universität, Dresden, Deutschland

    M. Knaut

  6. Klinik für Innere Medizin/Kardiologie, GFO Kliniken Bonn, Bonn, Deutschland

    D. Bimmel

  7. Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Marien Kliniken Siegen, Siegen, Deutschland

    V. Bärsch

  8. Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland

    T. Eitz

  9. Klinik für Herzchirurgie, Zentralklinik Bad Berka, Bad Berka, Deutschland

    M. Mierzwa

  10. Helios Klinik für Herzchirurgie, Karlsruhe, Deutschland

    N. Ghaffari

  11. Klinik für Herz- und Gefäßchirurgie, Campus Bad Neustadt, Bad Neustadt an der Saale, Deutschland

    A. Siebel

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  1. C. T. Starck
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Correspondence to C. T. Starck or H. Burger.

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Interessenkonflikt

C.T. Starck, H. Burger, B. Osswald, S. Hakmi, M. Knaut, D. Bimmel, V. Bärsch, T. Eitz, M. Mierzwa, N. Ghaffari und A. Siebel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Autoren C.T. Starck und H. Burger haben zu gleichen Teilen zum Manuskript beigetragen.

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Starck, C.T., Burger, H., Osswald, B. et al. HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen. Z Herz- Thorax- Gefäßchir 35, 103–118 (2021). https://doi.org/10.1007/s00398-021-00421-6

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