Aktuelle Strategien zur Vermeidung von ICD-Therapien

Implantation of an internal cardioverter defibrillator (ICD) has become the routine therapy for primary and secondary prevention of ventricular arrhythmia due to its proven reduction of mortality. Despite the significant benefits for patients with highly reduced left ventricular function, ICD therapy, especially inappropriate ICD therapy, is a major concern in the daily routine. Causes of inappropriate ICD therapy can be divided into supraventricular arrhythmia, sensing problems and electromagnetic interference, with atrial fibrillation being the most common cause of inappropriate ICD shocks. As appropriate and inappropriate ICD therapies both seem to be associated with an increased mortality, physicians should focus on avoiding ICD therapy. Apart from enhanced detection criteria, such as stability, onset and QRS morphology as well as dual-chamber ICD algorithms, reduction of ICD therapy can safely be achieved by programming higher detection rates and prolonged detection as recent studies such as MADIT-RIT, ADVANCE III and PROVIDE were able to show. Antiarrhythmic drug therapy and catheter ablation of ventricular arrhythmia are further possibilities to reduce ICD therapy, especially in patients with repetitive ICD shocks due to recurrent ventricular arrhythmia.