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Doctors newspaper online, 07.09.2019
Heart rhythm disorder
Who do precautionary implanted defibrillators help? This has now been investigated in a pan-European study.
GÖTTINGEN. The implantation of so-called cardioverter-defibrillators (ICD) is now routine: It is performed more than 100,000 times a year in Europe, the University Medical Center Göttingen (UMG) reports.
Not only is this at enormous cost to the healthcare system, but it also poses some risk: every ten defibrillators will have complications within ten years.
Data from 44 clinical centers evaluated
As part of the EU-CERT ICD (Comparative Effectiveness Research on Assessing the Use of Primary Prophylactic Implantable Cardioverter Defibrillators in Europe) study, the data from 2327 patients from 44 clinical centers in 15 European countries were evaluated using the following questions: Which patients with cardiac arrhythmias can benefit from precautionary treatment with an ICD and explicitly protect them from sudden cardiac death?
The study was coordinated by the UMG Heart Center under the direction of Professor Markus Zabel, Head of the Clinical Electrophysiology Unit at UMG's Department of Cardiology and Pulmonology, the report says.
Four partner institutions of the German Center for Cardiovascular Research (DZHK) were involved in the study: the University Medical Center Göttingen (UMG), the Charité Universitätsmedizin Berlin as well as the Ludwig-Maximilians-Universität (LMU) and the Technical University (TU) , both Munich.
Result surprised researcher
For the researchers, the study yielded a surprising result: the overall group showed a clear survival advantage of 27 percent. "Prophylactic defibrillators should generally continue to be prescribed and implanted after individual evaluation of a single patient," said Professor Gerd Hasenfuss, chairman of the UMG Cardiac Center and director of UMG's Department of Cardiology and Pulmonology.
In addition to the average survival advantage of all patients, the study also showed that patients over the age of 75, diabetics, or patients with multiple concomitant diseases do not or no longer benefit from the prophylactic use of an ICD. In these patients, cardiac arrhythmias are much rarer. "In this group of patients, prophylactic defi-implantation should only be performed under certain conditions," says Zabel.
However, the benefits are even greater in younger patients with heart failure and heart failure (DCM). The results of the study were presented at the ESC Congress in Paris, according to the UMG. The EU funded the project with a total of six million euros. (eb)
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