Köbe Julia, Gradaus Rainer, Zumhagen Sven, Böcker Dirk
Medizinische Klinik und Poliklinik C, Universitäts-klinikum Münster.
Herz. 2005 Nov;30(7):625-9. doi: 10.1007/s00059-005-2747-9.
Patients with an implantable cardioverter defibrillator (ICD) may experience loss of consciousness. Electromagnetic interference (EMI) may trigger undesired or inhibit necessary therapy in patients with an ICD. Therefore, questions about personal or professional activities for ICD patients arise. Restricting driving or other personal activities has adverse effects on the patient's quality of life. The national Societies of Cardiology provide recommendations for ICD patients concerning driving of motor vehicles. Patients with an ICD that is implanted prophylactically do not have to refrain from driving after recovery from the implantation procedure. Patients with arrhythmias are classified into different groups depending on the risk of recurrence of tachycardias and symptoms. Commercial driving is not allowed for patients with an ICD in Germany except for those with a prophylactic indication without a history of arrhythmias. Those patients may drive small cars but no trucks or busses. Guidelines for medical fitness in commercial or military flying are regulated by the Joint Aviation Authorities (JAA) and ventricular tachycardias are a contraindication for both. Fortunately, loss of consciousness is not dangerous in most jobs. Strong sources of EMI can occur at special workplaces. Patients have to be advised and tested individually concerning their risk for EMI at their employment site before returning safely. Modern life exposes to an increasing amount of EMI. Intact household devices usually do not interfere with ICDs. Mobile phones may interfere with implanted devices. Interaction can be minimized by special precautions like maintaining a distance of minimum 10 cm between mobile phone and ICD. Electronic surveillance systems work differently and have the potential to interact with devices. Patients should be advised to pass those systems with avoiding longer exposure. The presence of an ICD is presently a contraindication for undergoing magnetic resonance imaging (MRI) because of a high risk of destruction of the system with even potential harm to the patient. High-frequency application for electrocautery devices or ablation is possible under certain precautions that have to be planned before. There is a high sensitivity of ICD systems to ionizing radiation with defect of the devices after a cumulative dose > 5 Gy.
植入式心脏复律除颤器（ICD）患者可能会出现意识丧失。电磁干扰（EMI）可能会在ICD患者中引发不必要的治疗或抑制必要的治疗。因此，出现了关于ICD患者个人或职业活动的问题。限制驾驶或其他个人活动会对患者的生活质量产生不利影响。各国心脏病学会为ICD患者提供了关于驾驶机动车的建议。预防性植入ICD的患者在植入手术后康复后无需避免驾驶。心律失常患者根据心动过速复发风险和症状被分为不同组。在德国，ICD患者禁止从事商业驾驶，除非是有预防性指征且无心律失常病史的患者。这些患者可以驾驶小型汽车，但不能驾驶卡车或公共汽车。商业或军事飞行的医学健康指南由联合航空管理局（JAA）制定，室性心动过速是两者的禁忌症。幸运的是，在大多数工作中意识丧失并不危险。在特殊工作场所可能会出现强EMI源。在安全返回工作岗位之前，必须就患者在工作场所遭受EMI的风险对其进行个别咨询和测试。现代生活中暴露于EMI的情况越来越多。完好的家用设备通常不会干扰ICD。手机可能会干扰植入设备。通过采取特殊预防措施，如保持手机与ICD之间至少10厘米的距离，可以将相互作用降至最低。电子监控系统的工作方式不同，有可能与设备相互作用。应建议患者通过这些系统时避免长时间暴露。目前，由于存在系统被破坏甚至对患者造成潜在伤害的高风险，ICD的存在是进行磁共振成像（MRI）的禁忌症。在必须事先规划的某些预防措施下，可以进行电灼设备或消融的高频应用。ICD系统对电离辐射高度敏感，累积剂量>5 Gy后设备会出现故障。
