RSS-Feed abonnieren
DOI: 10.1055/s-0033-1360043
Bradykarde Rhythmusstörungen
Teil 2: TherapieBradycardic arrhythmiasPart 2: treatmentPublikationsverlauf
22. April 2013
19. November 2013
Publikationsdatum:
11. Februar 2014 (online)
Zusammenfassung
Klinisch symptomatische bradykarde Herzrhythmusstörungen aufgrund von Reizbildungs- und Reizleitungsstörungen führen in der Regel zur Indikation einer Schrittmacherimplantation. Es gibt aber auch eine Reihe von prognostischen Indikationen für eine Schrittmacherimplantation bei asymptomatischen Patienten, allerdings häufig mit einem niedrigeren Empfehlungsgrad. Nach akutem Myokardinfarkt bzw. herzchirurgischen Eingriffen kann bei Auftreten von Bradykardien die Implantation eines Schrittmachers notwendig werden. Vor einer definitiven Schrittmacherimplantation müssen reversible bzw. vermeidbare Ursachen abgeklärt bzw. behandelt werden. Nur zur Akuttherapie symptomatischer Bradykardien kann als überbrückende Maßnahme eine medikamentöse Therapie in Betracht kommen. Zur Schrittmacherversorgung stehen verschiedene Systeme zur Verfügung. Es werden temporäre von permanenten sowie Ein-, Zwei- und Dreikammersysteme unterschieden. Darüber hinaus werden sondenlose Schrittmachersysteme erprobt.
Abstract
Clinically symptomatic bradycardia arrhythmias due to disorders of impulse formation and conduction usually lead to an indication for pacemaker implantation. On the other hand, there are also a number of prognostic indications for pacemaker implantation in asymptomatic patients, but often with a lower class of recommendation. After acute myocardial infarction or cardiac surgery the implantation of a pacemaker may be necessary for the occurrence of bradycardia. Prior to a definitive pacemaker implantation reversible or preventable causes must be investigated and treated. Only for acute treatment of symptomatic bradycardia as a bridging measure drug therapy can be considered. For pacemaker supply various systems are available. We distinguish temporary from permanent systems and one-, two-and three-chamber systems. In addition, leadless pacemaker systems are tested.
-
Literatur
- 1 Brignole M, Auricchio A, Baron-Esquivias G et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281-2329
- 2 Cheng A, Tereshchenko LG. Evolutionary innovations in cardiac pacing. J Electrocardiol 2011; 44: 611-615
- 3 Connolly SJ, Kerr CR, Gent M et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med 2000; 342: 1385-1391
- 4 Curtis AB, Worley SJ, Adamson PB et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med 2013; 368: 1585-1593
- 5 Dickstein K, Vardas PE, Auricchio A et al. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J 2010; 31: 2677-2687
- 6 Kumar P, Kusumoto FM, Goldschlager N. Bradyarrhythmias in the elderly. Clin Geriatr Med 2012; 28: 703-715
- 7 McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
- 8 Moya A, Sutton R, Ammirati F et al. Guidelines for the diagnosis and management of syncope (version 2009). Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS). Eur Heart J 2009; 30: 2631-2671
- 9 Paul T, Ruschewski W, Janoušek J. Leitlinie Pädiatrische Kardiologie: Bradykarde Herzrhythmusstörungen. Deutsche Gesellschaft für Pädiatrische Kardiologie; 23.03.2010. www.kinderkardiologie.org
- 10 Rybak K, Nowak B, Pfeiffer D et al. Kommentar zu den ESC-Leitlinien "Guidelines for cardiac pacing and cardiac resynchronization therapy". Kardiologe 2008; 2: 463-478
- 11 Shaw DB, Kekwick CA, Veale D et al. Survival in second degree atrioventricular block. Br Heart J 1985; 53: 587-593
- 12 Steg PG, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012; 33: 2569-2619
- 13 Strasberg B, Amat-Y-Leon F, Dhingra RC et al. Natural history of chronic second-degree atrioventricular nodal block. Circulation 1981; 63: 1043-1049
- 14 Tang AS, Roberts RS, Kerr C et al. Relationship between pacemaker dependency and the effect of pacing mode on cardiovascular outcomes. Circulation 2001; 103: 3081-3085
- 15 Tang AS, Wells GA, Talajic M et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010; 363: 2385-2395
- 16 Thibault B, Harel F, Ducharme A et al. Cardiac resynchronization therapy in patients with heart failure and a QRS complex <120 milliseconds: the Evaluation of Resynchronization Therapy for Heart Failure (LESSER-EARTH) trial. Circulation 2013; 127: 873-881
- 17 Vardas PE, Auricchio A, Blanc JJ et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Eur Heart J 2007; 28: 2256-2295