Electrical implants Current trends and developments

This overview shows current trends and developments in electrical device treatment and risk stratification. Sudden cardiac death due to ventricular arrhythmia remains one of the most frequent causes of death in industrial nations. The majority of defibrillators in Germany have been implanted years ago for primarily prophylactic indications. Recent studies, however, show that the benefits of implantable cardioverter defibrillator (ICD) treatment have been overestimated at least in some patients in view of the improved pharmacotherapy and cardiac resynchronization therapy (CRT), especially in non-ischemic cardiomyopathy or impaired renal function. The risk of sudden cardiac death has decreased in recent years, especially in patients with heart failure and reduced left ventricular ejection fraction and/or CRT treatment. Despite continuous development, electrode dysfunctions, infections of the transvenous ICD systems and limitations in venous access problems are an increasing challenge. Against this background the purely subcutaneous ICD system (S-ICD) represents an attractive option for which, however, randomized data on effectiveness and safety are still lacking. Relatively simple new risk scores, such as the PADIT score enable the risk of infection during device surgery to be estimated and results for new antibiotic-coated protective covers provide promising new therapeutic options for device surgery. In the field of pacemaker therapy, based on current studies resynchronization by means of His bundle stimulation is gaining in importance, although as for S-ICD, randomized data must be awaited in order to assess the future role of the therapy.