Prädiktoren von Schocks und Mortalität – Eine klinische Analyse bei Patienten mit implantierbarem Kardioverter-Defibrillator (ICD)

Prädiktoren von Schocks und Mortalität – Eine klinische Analyse bei Patienten mit implantierbarem Kardioverter-Defibrillator (ICD)

Predictors of Shocks and Mortality - A Clinical Analysis in Patients with Implantable cardioverter-defibrillator (ICD)

Hannes Wenk

Doctoral thesis

Date of Examination: 2017-01-25

Date of issue: 2016-12-19

Advisor: Zabel, Markus Prof. Dr.

Referee: Kazmaier, Stephan PD Dr.

Referee: Schön, Margarete Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-002B-7CE7-E

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Abstract

English

Sudden cardiac death, one of the most common causes of death, is usually caused by tachyarrhythmias and can be effectively prevented by an implantable cardioverter-defibrillator (ICD). Therefore the most accurate selection of patients who have an increased risk of sudden cardiac death is needed. The present study investigated the existence of predictors for the occurrence of appropriate and inappropriate shocks as well as death without previous appropriate therapy in 1484 ICD patients. As independent predictors of the occurrence of appropriate ICD shocks showed up a male sex, intake of Amiodarone at the time of implantation and a secondary prophylactic implantation indication. Atrial fibrillation and an implantation age below 67 years were associated with a more frequent occurrence of inappropriate shocks. The risk of dying without prior appropriate therapy of the ICD was increased in patients With advanced cardiac insufficiency, according to NYHA stage III / IV, the use of diuretics and an implantation age over 67 years. The predictive analysis is relevant for several reasons. It is necessary to identify patients with elevated risk of ventricular tachyarrhythmias to optimize therapy for these patients. Since inappropriate shocks are the most common side effect of ICD therapy, which are also associated with restrictions on quality of life and acceptance of therapy, it is important to find strategies for prevention and dealing with inappropriate shocks. Despite careful indication for ICD implantation there is a significant part of the examined patient population who has died without previous appropriate ICD therapy. Identifying patients who do not benefit from an implantation, not only helps to make the therapy cost-effective but also avoids possible complications from the start. Since this is not easy to solve, because the mentioned patients have a high risk of arrhythmic sudden cardiac death as well as a high mortality rate for competing reasons, it should once again be emphasized how important a tailored use of this life-saving therapy is.

Keywords: ICD

Schlagwörter: ICD