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Kardiale implantierbare elektronische Devices

Elektromagnetische Interferenzen bei Elektrokauterisation, Lithotripsie und Physiotherapie

Cardiac implantable electronic devices

Electromagnetic interference from electrocauterization, lithotripsy and physiotherapy

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die Versorgung von Patienten mit kardialen implantierbaren elektronischen Devices („cardiac implantable electronic devices“, CIED) stellt insbesondere im interventionellen und operativen Bereich aufgrund einer Vielzahl von möglichen elektromagnetischen Interferenzen eine besondere Herausforderung dar. Trotz der Komplexität heutiger CIED-Systeme lässt sich die überwiegende Mehrheit aller Eingriffe mit hoher Sicherheit für den Patienten durchführen. Aufgrund der eingeschränkten Datenlage haben die vorhandenen Positionspapiere einen insgesamt geringen Evidenzgrad und sind zudem häufig widersprüchlich. Insbesondere bezüglich des perioperativen Managements von CIED-Patienten beim Einsatz der Hochfrequenzchirurgie, einer der bedeutendsten Quellen elektromagnetischer Interferenzen im medizinischen Bereich, wurden jedoch in letzter Zeit einige neue Studien veröffentlicht, welche teilweise ein pragmatischeres Konzept vorschlagen als es sich in den aktuellen Gesellschaftsempfehlungen wiederfindet. Der aktuelle Artikel gibt ein Beispiel für ein entsprechend an die neuere Evidenz angepasstes Versorgungskonzept. Die Anwendung der extrakorporalen Stoßwellen-Lithotripsie bei CIED-Patienten wurde aufgrund früherer Studien mit besonderer Vorsicht gesehen. Die klinischen Erfahrungen mit aktuellen CIED-Systemen zeigen jedoch, dass ein Einsatz dieser Technik in der Regel sicher möglich ist. Physiotherapeutische Maßnahmen beinhalten häufig die Anwendung elektromechanischer Hilfsmittel, welche teilweise ein relevantes Interaktionsrisiko mit CIED-Systemen bergen. Auch hier ist ein sicherer Einsatz teilweise möglich, dieser sollte jedoch nach Rücksprache mit der betreuenden CIED-Ambulanz erfolgen.

Abstract

The management of patients with a cardiac implantable electronic device (CIED) poses a particular challenge in the peri-interventional and perioperative medical environment due to the many forms of possible electromagnetic interference. Although the devices encountered nowadays are of increasing complexity, the vast majority of procedures can be safely performed in patients. The existing position statements and recommendations, however, have a low level of evidence and are often contradictory. In the context of intraoperative electrocauterization, one of the most important sources of electromagnetic interference in the medical environment, recent studies have suggested an increasingly pragmatically perioperative CIED management, which is not represented in the existing recommendations. This article gives an example of these newer findings and reports the currently used and appropriately adapted perioperative CIED management protocol. Extracorporeal shock wave lithotripsy was thought to cause severe interference in CIED patients based on older studies and in vitro experiments. Although electromagnetic interference is possible, clinical observations with modern devices show that the procedure can generally be safely applied in CIED patients. Physiotherapy often utilizes a variety of electromechanical devices, which can be a relevant source of electromagnetic interference. Although some of these therapies can be safely used, coordination with the responsible CIED unit is recommended.

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  1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland

    Thomas Czermak &  Stephanie Fichtner

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  1. Thomas Czermak
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Correspondence to Thomas Czermak.

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Interessenkonflikt

T. Czermak und S. Fichtner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Czermak, T., Fichtner, S. Kardiale implantierbare elektronische Devices. Herzschr Elektrophys 30, 168–176 (2019). https://doi.org/10.1007/s00399-019-0620-4

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