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Die Elektroden implantierbarer Kardioverter-Defibrillatoren (ICD) müssen besondere Anforderungen erfüllen: sichere Stimulation und Wahrnehmung, Erkennung ventrikulärer Tachyarrhythmien und deren Terminierung, falls nötig auch mit (multiplen) Schockabgaben. Gleichzeitig sollten sie einfach zu implantieren sein, eine exzellente Langzeit-Stabilität besitzen und komplett sowie komplikationsfrei extrahierbar sein. Zahlreiche technische Weiterentwicklungen haben dazu geführt, dass die derzeitig verfügbaren ICD-Elektroden diese Anforderungen in sehr hohem Maße erfüllen. Einige Änderungen des Elektrodenaufbaus, der verwendeten Materialien und des Herstellungsprozesses haben jedoch auch zu gehäuften Elektrodendefekten geführt, besonders bei 2 Elektroden (Medtronic Sprint Fidelis®, St. Jude Medical Riata®). Die Häufigkeit von Elektrodenproblemen bei diesen Modellen wurde erst mehrere Jahre nach Markteinführung erkannt, auch weil geeignete Register hierzu fehlen. Die vorliegende Übersicht stellt Hintergrund und Weiterentwicklungen der ICD-Elektroden-Technologie und den Zusammenhang mit dem klinischen Einsatz der ICD-Therapie dar. Für eine optimale ICD-Therapie mit einem Nutzen auch für Patienten mit einem leicht bis moderat erhöhten Risiko für ventrikuläre Tachyarrhythmien sind optimale Elektroden und ausreichend erfahrene Implanteure nötig.
Herzschrittmachertherapie + Elektrophysiologie – Springer Journals
Published: Jun 3, 2015
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