Device-Therapie nach akutem Koronarsyndrom

Zusammenfassung

AV-Blöcke sind beim akuten Koronarsyndroms selten. Nur wenige Patienten benötigen eine Schrittmacherimplantation. Besonders beim Hinterwandinfarkt ist die Prognose gut. Die Häufigkeit anhaltender AV-Blockierungen hat durch die Akut-PTCA abgenommen.

Ventrikuläre Tachyarrhythmien sind in der Akutphase des Infarktes häufig. Treten sie als anhaltende Kammertachykardien oder Kammerflimmern > 48 Stunden nach Infarkt auf, können sie eine Indikation zur sekundärprophylaktischen ICD-Implantation darstellen. Primärprophylaktisch sollte ein Defibrillator implantiert werden, wenn die LV-EF auch > 40 Tage nach Infarkt ≤ 35 % beträgt.

Ist früh nach Infarkt eine Aggregatimplantation erforderlich, sollte bei hohem ventrikulärem Stimulationsbedarf oder Linksschenkelblock ein biventrikuläres System verwendet werden.

Abstract

Acute coronary syndromes are seldom accompanied by high degree AV blocks. Implantation of a permanent pacemaker is rarely necessary.

There is a high incidence of ventricular tachyarrhythmias during the acute phase of myocardial infarctions. Sustained VT or VF beyond 48 hours of the infarction indicate the need for an implantable cardioverter-defibrillator. If left ventricular ejecion fraction remains ≤ 35 % for > 40 days an ICD might be indicated for primary prophylaxis.

If early after infarction a device implantation becomes necessary, biventricular stimulation should be used if ventricular pacing is necessary or LBBB with markedly increased QRS-duration is present.

Schlüsselwörter

Akutes Koronarsyndrom - AV-Block - Schrittmacher - Defibrillator - kardiale Resynchronisationstherapie

Keywords

acute coronary syndrome - AV block - Pacemaker - cardioverter-defibrillator - cardiac resynchronization therapy

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