[History of the implantable cardioverter-defibrillator in Germany].

Q4 Medicine Herzschrittmachertherapie und Elektrophysiologie Pub Date : 2024-03-01 Epub Date: 2024-02-29 DOI:10.1007/s00399-024-01001-5
Michael Block, Helmut U Klein
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Abstract

The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.

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[德国植入式心律转复除颤器的历史]。
植入式心律转复除颤器(ICD)是预防心脏性猝死方面的一项突破。在美国经过多年的技术研发后,米歇尔-米洛斯基(Michel Mirowski)克服重重困难,于 1980 年通过首次人体植入成功证明了室性快速性心律失常自动除颤的可靠性。将近 4 年后,第一批患者在德国的多个中心接受了 ICD。随后,在美国之外,德国成为植入率最高的国家。由于植入 ICD 需要心外膜除颤电极,因此需要心脏外科医生进行开胸手术,因此植入的绝对数量仍然很少。20 世纪 90 年代初,使用经静脉除颤电极和胸腔 ICD 进行起搏器式植入变得可行,将植入率推向了新的高度。在技术进步的同时,德国也开展了临床研究,并且经常在德国进行首次人体研究。1991 年,美国和德国制定了第一份适应症指南。1996 年至 2009 年间,发表了几项关于适应症的随机研究,大部分由美国团队领导,德国团队参与,但也有德国领导的研究(CASH、CAT、DINAMIT、IRIS)。2016 年的丹麦研究对这些长期研究的结果提出了质疑。未来的工作目标是确定哪些患者尽管接受了最佳的药物治疗、心脏再同步化治疗(CRT)和/或导管消融治疗,但仍需要保护以防心脏性猝死,而不是根据广泛的适应症为患者提供 ICD。结合磁共振成像(MRI)中的心肌疤痕和遗传信息的风险评分有望促进更个性化和更有效的适应症。
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来源期刊
Herzschrittmachertherapie und Elektrophysiologie
Herzschrittmachertherapie und Elektrophysiologie Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.10
自引率
0.00%
发文量
76
期刊介绍: Mit wissenschaftlichen Original- und Übersichtsarbeiten, Berichten über moderne Operationstechniken und experimentelle Methoden ist die Zeitschrift Herzschrittmachertherapie + Elektrophysiologie ein Diskussionsforum für Themen wie: - Zelluläre Elektrophysiologie - Theoretische Elektrophysiologie - Klinische Elektrophysiologie - Angewandte Herzschrittmachertherapie - Bradykarde und tachykarde Herzrhythmusstörungen - Plötzlicher Herztod und Risikostratifikation - Elektrokardiographie - Elektromedizinische Technologie - Experimentelle und klinische Pharmakologie - Herzchirurgie bei Herzrhythmusstörungen Mitteilungen der Arbeitsgruppen Herzschrittmacher und Arrhythmie der Deutschen Gesellschaft für Kardiologie - Herz und Kreislaufforschung e.V. (DGK) sowie Stellungnahmen und praktische Hinweise runden das breite Spektrum dieser Zeitschrift ab. Interessensgebiete: Kardiologie, Herzschrittmachertherapie, Herzschrittmachertechnologie, klinische Elektrophysiologie
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[Controversies in rhythmology]. [Atrial fibrillation in combination with severe mitral regurgitation : Which should be treated first, the atrial fibrillation or the mitral valve?] [Initial ablation of atrial fibrillation-Is pulmonary vein isolation sufficient? : Pro and contra]. [(LV)EF is a poor predictor of sudden cardiac death : Pro/Contra]. Erratum zu: Herzrhythmusstörungen bei Erwachsenen mit angeborenen Herzfehlern.
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