Der Patient mit chronischer Herzinsuffizienz

Abstract

An expansion of the indications for the implantation of defibrillators (ICD) has not occurred as such in recent years. Nevertheless, an increase in the number of implantation figures can be expected due to the aging population and an increasing recruitment of undersupplied regions in upcoming years. Although the first defibrillator was implanted over 20 years ago in Germany and that ICD therapy is considered as the medical standard in secondary and primary prophylaxis, there are still basic questions that can only be prospectively clarified: (1) when is the right point in time for ICD implantation? (2) Can predictors, especially those with a negative predictive value, be used to exclude patients from ICD therapy? (3) Should risk stratification, which documents the current risk for a single point in time during the illness like a snapshot, more strongly reflect the development over time of the risk? In this case, it is likely that a rethinking of risk stratification, in general, to risk stratification in the sense of observation would be necessary. An adjuvant therapy in the sense of ablation of ventricular tachycardia (VT) or antiarrhythmic therapy for primary prevention of frequently occurring episodes seems to be advised based on current data. However, the right point in time for a complementary intervention is still not clear.