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Prävention des plötzlichen Herztodes

Prevention of sudden cardiac death

  • Schwerpunkt: Herzrhythmusstörungen
  • Published:
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Zusammenfassung

Das Problem des PHT ist komplex, und viele Fragen über den pathophysiologischen Mechanismus bei der Entstehung des PHT sind noch offen. Die Erkennung des gefährdeten Patienten verlässt sich gegenwärtig auf die gestörte linksventrikuläre Funktion (LV-EF≤35%). Andere Risikomarker haben eine zu niedrige positive Vorhersagbarkeit des PHT. Antiarrhythmika haben sich bisher als unwirksam herausgestellt. Mehr als 25 Jahre klinische Erfahrung mit dem implantierbaren Defibrillator (ICD) und seine kontinuierliche technische Verbesserung haben ihn zur wirksamsten Waffe gegen den PHT gemacht. Seine Wirksamkeit ist durch viele Studien und daran orientierte Leitlinien gesichert. Dies ersetzt aber nicht die klinische Erfahrung und die Patienteneinschätzung durch den behandelnden Arzt. ICD-Therapie – sowohl in der Sekundär- wie auch der Primärprävention des PHT – ohne leitliniengestützte Behandlung einer sehr oft mit dem Risiko zum PHT vergesellschafteten Herzinsuffizienz ist nicht gerechtfertigt.

Abstract

The problem of sudden cardiac death (SCD) is complex and many questions concerning the pathophysiologic mechanism are still unanswered. At present the only reliable way of recognizing high risk patients is by means of left ventricular dysfunction, measured as LV-EF ≤35%. The positive predictive accuracy for other non-invasive risk markers is too low. So far, antiarrhythmic drugs have failed to successfully prevent SCD. More than 25 years of clinical experience with the implantable defibrillator (ICD) with its continuous technical improvement has made the ICD the most effective weapon against SCD. Its effectiveness has been demonstrated in many prospective trials and the use of the ICD is fully enclosed within the current guidelines for the prevention of SCD. Guidelines do not, however, replace the physician’s judgement and experience to correctly evaluate the patient’s status. ICD therapy in the primary and secondary prevention of heart failure, which is often accompanied by a high risk of SCD is, however, not justified without guideline-adjusted therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: Forschungsfinanzierung durch Boston-Scientific Guickent. Inc.

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  1. Klinik für Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120 , Magdeburg, Deutschland

    H. U. Klein

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Klein, H.U. Prävention des plötzlichen Herztodes. Internist 47, 1040–1050 (2006). https://doi.org/10.1007/s00108-006-1713-9

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  • DOI: https://doi.org/10.1007/s00108-006-1713-9

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