Update Ventrikuläre Tachykardien

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Idiopathische ventrikuläre Tachykardien Die Inzidenz dieser Rhythmusstörungen nimmt zu. 5 % der Patienten mit idiopathischen ventrikulären Tachykardien (IVT) sind von einer assoziierten Kardiomyopathie betroffen. Gemäß der aktuellen ESC-Leitlinien ist bei symptomatischen Patienten die Katheterablation bei den häufigsten Formen Therapie der 1. Wahl.

Ventrikuläre Tachykardien bei struktureller Herzerkrankung Subkutan implantierbare Cardioverter-Defibrillatoren erweitern insbesondere bei jungen Patienten oder erhöhter sondenassoziierter Infektionsgefahr die therapeutischen Möglichkeiten, das Risiko des plötzlichen Herztodes zu senken. Aktuelle Metaanalysen zur Behandlung rezidivierender ICD-Schockabgaben zeigen eine signifikante Reduktion durch die Katheterablation, pharmakologisch ist nur für Amiodaron ein signifikanter Effekt nachweisbar. In dieser Indikation besteht gemäß aktueller ESC-Leitlinie für beide Therapiealternativen eine Klasse-I-Indikation, eine Klasse-IIa-Indikation nach einmaligem Auftreten einer anhaltenden VT bei Patienten mit ICD.

Abstract

Idiopathic ventricular tachycardia: Frequent monomorphic premature ventricular contractions or non-sustained ventricular tachycardia without underlying structural heart disease is not a rare condition and may cause significant symptoms. A subgroup of patients develops IVT-associated cardiomyopathy. Current ESC guidelines recommend primary catheter ablation in symptomatic patients with right ventricular outflow tract IVT. Catheter ablation is also recommended in symptomatic patients with a left ventricular outflow tract (or other rare) origin, if antiarrhythmic drugs are ineffective or not desired.

Ventricular tachycardia associated with structural heart disease: Scar-associated ventricular arrhythmias may cause sudden cardiac death in a variety of heart diseases. While ICD implantation has been shown to reduce mortality, repetitive ICD shocks impact on survival and quality of life. In a recent meta-analysis, both amiodarone and catheter ablation reduce the incidence of recurrent ICD shocks. Discontinuation of amiodarone due to side effects is common. Current ESC guidelines recommend both strategies (class 1 indication). Catheter ablation is also recommended in drug-resistant VT or electrical storm. A totally subcutaneous ICD is a novel option in patients not requiring pacing.

Schlüsselwörter

Ventrikuläre Tachykardie - Cardioverter-Defibrillator - ICD-Schockabgabe - Amiodaron

Key words

ventricular arrhythmia - tachycardia - cardioverter defibrillator - amiodarone

• Literatur

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