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Stellungnahme zum Einsatz des tragbaren Kardioverter/Defibrillators

Statement on the use of wearable cardioverter defibrillators

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Der Kardiologe Aims and scope

Zusammenfassung

Der tragbare Kardioverter/Defibrillator (WCD) ist in der Lage, lebensbedrohliche ventrikuläre Tachyarrhythmien einschließlich Kammerflimmern zu beenden. Für keines der vom plötzlichen Herztod bedrohten Patientenkollektive wurde jedoch bisher der Versuch unternommen, durch qualitativ hochwertige Studien einen möglichen Vorteil der WCDs nachzuweisen. Für kleinere spezifische Gruppen scheint eine vorübergehende WCD-Versorgung zumindest plausibel, wenn auch nicht belegt. So kann ein ICD (implantierbarer Kardioverter/Defibrillator)-Patient, bei dem wegen einer Infektion der Tasche oder Elektrode das System entfernt werden muss, zur Überbrückung der Heilungsphase einen WCD erhalten. Ebenso mag dies für Patienten gelten, die auf eine Transplantation warten. Aber auch hier muss im Einzelfall entschieden werden. Gleiches gilt für einen WCD für Patienten in der frühen Postinfarktphase. Zwei große prospektive randomisierte Studien haben nicht belegen können, dass eine ICD-Therapie über die Reduktion des plötzlichen Herztodes hinaus auch die Gesamtmortalität senkt, wobei eine Übertragung dieser Ergebnisse auf ein nichtinvasives Verfahren nicht ohne Weiteres gerechtfertigt ist und der WCD zudem ein nichtinvasives Mittel zur Patientenselektion für die ICD-Implantation darstellen kann. Es ist daher unabdingbar, dass sich auch eine WCD-Studie dieser Frage stellt und der primäre Endpunkt die Gesamtmortalität ist, bevor dazu seitens der DGK eine Empfehlung ausgesprochen werden kann.

Abstract

Wearable cardioverter defibrillators (WCD) can terminate life-threatening ventricular arrhythmias, including ventricular fibrillation; however, no high-quality studies are currently available demonstrating a benefit of WCDs for patients at risk of sudden cardiac death. Temporary treatment with a WCD seems to be an option for small selected patient groups; however, this has not been definitively proven. Specifically, a WCD may be indicated after removal of an implantable cardioverter defibrillator (ICD) system due to pocket or lead infection, for bridging until the infection is cured or in candidates for heart transplantation. An individual decision is mandatory and the same applies for patients in the early postinfarction phase. In two large prospective randomized trials ICD implantation did reduce all-cause mortality, although the rate of sudden cardiac death was lowered. A transfer of these results to a non-invasive therapy, such as a WCD, may not be fully justified. Additionally, WCDs may serve as a diagnostic tool to select patients for ICD implantation. It is therefore mandatory to carry out a specific WCD study with all-cause mortality as a primary endpoint before the German Cardiac Society can issue any recommendations.

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Abbreviations

ACVB:

aortokoronarer venöser Bypass

DCM:

dilatative Kardiomyopathie

ICD:

implantierbarer Kardioverter/Defibrillator

LVEF:

linksventrikuläre Ejektionsfraktion

nsVT:

nicht anhaltende ventrikuläre Tachykardie

PCI:

perkutane Koronarintervention

PHT:

plötzlicher Herztod

WCD:

tragbarer („wearable“) Kardioverter/Defibrillator

Literatur

  1. o A (2006) ACC/AHA/ESC 2006 guidlines for managment of patients with ventricular arrhythmias and the prevention of sudden cardiac deat. Europace 8:746–837

    Article  Google Scholar 

  2. http://www.hrsonline.org/content/download/8564/375099/file/SCD%20Primary%20Prevention%20Protocols.pdf

  3. Klein HU, Goldenberg I, Moss AJ (2013) Risk stratification for implantable cardioverter defibrillator therapy: the role of the wearable cardioverter-defibrillator. Eur Heart J 34(29):2230–2242

    Article  PubMed  Google Scholar 

  4. Klein HH, Kärmer A, Pieske BM et al (2010) Fahreignung bei kardiovaskulären Erkrankungen. Kardiologe 4(6):441–473

    Article  Google Scholar 

  5. Chung MK, Szymkiewicz SJ, Shao M et al (2010) Aggregate national experience with the wearable cardioverter-defibrillator: event rates, compliance, and survival. J Am Coll Cardiol 56(3):194–203

    Article  PubMed Central  PubMed  Google Scholar 

  6. Klein HU, Meltendorf U, Reek S et al (2010) Bridging a temporary high risk of sudden arrhythmic death. Experience with the wearable cardioverter defibrillator (WCD). Pacing Clin Electrophysiol 33(3):353–367

    Article  PubMed  Google Scholar 

  7. Lang CC, Hankins S, Hauff H et al (2003) Morbidity and mortality of UNOS status 1B cardiac transplant candidates at home. J Heart Lung Transplant 22(4):419–426

    Article  PubMed  Google Scholar 

  8. Sandner SE, Wieselthaler G, Zuckermann A et al (2001) Survival benefit of the implantable cardioverter-defibrillator in patients on the waiting list for cardiac transplantation. Circulation 104(12 Suppl 1):I171–I176

    Article  CAS  PubMed  Google Scholar 

  9. Da Rosa MR, Sapp JL, Howlett JG et al (2007) Implantable cardioverter-defibrillator implantation as a bridge to cardiac transplantation. J Heart Lung Transplant 26(12):1336–1339

    Article  Google Scholar 

  10. Lampert R, Hayes DL, Annas GJ et al (2010) HRS expert consensus statement on the management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm 7(7):1008–1026

    Article  PubMed  Google Scholar 

  11. Peters S, Klein HU (2011) WCD LifeVest: risk stratification in a case of tako-tsubo cardiomyopathy with QT interval prolongation. Herz 37(2):219–221

    Article  PubMed  Google Scholar 

  12. Kadish A, Dyer A, Daubert JP et al (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathie. N Engl J Med 350(21):2151–2158

    Article  CAS  PubMed  Google Scholar 

  13. Kadish A, Schaechter A, Subacius H et al (2006) Patients with recently diagnosed nonischemic cardiomyopathy benefit from implantable cardioverter-defibrillators. J Am Coll Cardiol 47:2477–2482

    Article  PubMed  Google Scholar 

  14. Hilfiker-Kleiner D, Meyer GP, Schieffer E et al (2007) Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. J Am Coll Cardiol 50(24):2354–2355

    Article  PubMed  Google Scholar 

  15. Sliwa K, Blauwet L, Tibazarwa K et al (2010) Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 121(13):1465–1473

    Article  CAS  PubMed  Google Scholar 

  16. Saltzberg MT, Szymkiewicz S, Bianco NR (2012) Characteristics and outcomes of peripartum versus nonperipartum cardiomyopathy in women using a wearable cardiac defibrillator. J Card Fail 18(1):21–27

    Article  PubMed  Google Scholar 

  17. Fox K, Garcia MA, Ardissino D et al (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27(11):1341–1381

    Article  PubMed  Google Scholar 

  18. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10(10):933–989

    Article  PubMed  Google Scholar 

  19. Moss AJ, Zareba W, Hall WJ et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12):877–883

    Article  PubMed  Google Scholar 

  20. Bigger JT Jr (1997) Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med 337(22):1569–1575

    Article  PubMed  Google Scholar 

  21. Feldman AM, Klein H, Tchou P et al (2004) Use of a wearable defibrillator in terminating tachyarrhythmias in patients at high risk for sudden death: results of the WEARIT/BIROAD. Pacing Clin Electrophysiol 27(1):4–9

    Article  PubMed  Google Scholar 

  22. Zishiri E, Williams S, Cronin EM et al (2013) Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator. Circ Arrhythm Electrophysiol 6(1):117–128

    Article  PubMed Central  PubMed  Google Scholar 

  23. Pouleur AC, Barkoudah E, Uno H et al (2010) Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. Circulation 122(6):597–602

    Article  PubMed  Google Scholar 

  24. Dorian P, Hohnloser SH, Thorpe KE et al (2010) Mechanisms underlying the lack of effect of implantable cardioverter-defibrillator therapy on mortality in high-risk patients with recent myocardial infarction: insights from the Defibrillation in Acute Myocardial Infarction Trial (DINAMIT). Circulation 122(25):2645–2652

    Article  PubMed  Google Scholar 

  25. Hohnloser SH, Kuck KH, Dorian P et al (2004) Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 351(24):2481–2488

    Article  CAS  PubMed  Google Scholar 

  26. Steinbeck G, Andresen D, Seidl K et al (2009) Defibrillator implantation early after myocardial infarction. N Engl J Med 361(15):1427–1436

    Article  CAS  PubMed  Google Scholar 

  27. Gronda E, Bourge RC, Costanzo MR et al (2006) Heart rhythm considerations in heart transplant candidates and considerations for ventricular assist devices: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates – 2006. J Heart Lung Transplant 25(9):1043–1056

    Article  PubMed  Google Scholar 

  28. Epstein AE, Dimarco JP, Ellenbogen KA et al (2008) ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 5(6):e1–e62

    Article  PubMed  Google Scholar 

  29. Dickstein K, Vardas PE, Auricchio A et al (2010) 2010 Focused update of ESC guidelines on device therapy in heart failure: an update of the 2008 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J 31(21):2677–2687

    Article  PubMed  Google Scholar 

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Danksagung

J.O. Schwab dankt Herrn Dr. F. Horlbeck für die rege Mithilfe bei der Erstellung des Manuskriptes.

Interessenkonflikt

Den Interessenkonflikt der Autoren finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/bei der entsprechenden Publikation.

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Authors and Affiliations

  1. Med. Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    J.O. Schwab

  2. Medizinische Klinik I, Universitätsklinikum Rostock, Rostock, Deutschland

    D. Bänsch

  3. Klinik für Innere Medizin – Kardiologie, Diabetologie und Nephrologie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Deutschland

    C. Israel

  4. CCB – Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Deutschland

    B. Nowak

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  1. J.O. Schwab
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  2. D. Bänsch
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  3. C. Israel
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  4. B. Nowak
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Correspondence to J.O. Schwab.

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Schwab, J., Bänsch, D., Israel, C. et al. Stellungnahme zum Einsatz des tragbaren Kardioverter/Defibrillators. Kardiologe 9, 165–170 (2015). https://doi.org/10.1007/s12181-015-0651-y

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  • DOI: https://doi.org/10.1007/s12181-015-0651-y

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