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Ereignis- bzw. Schleifenrekorder mit diskontinuierlicher EKG-Dokumentation ermöglichen, den Herzrhythmus über lange Zeit zu überwachen. Dadurch können sie bei Patienten, die an seltenen, kurzfristigen und selbst terminierenden Attacken leiden, ein EKG im Anfall aufzeichnen, um das Symptom mit dem Herzrhythmus im Anfalls-EKG zu korrelieren. Externe Ereignisrekorder mit intermittierender Überwachung d.h. mit im Gerät integrierten Elektroden sind für Patienten mit Palpitationen oder Herzrasen ohne Bewusstseinsverlust geeignet. Externe Ereignisrekorder mit kontinuierlicher Überwachung werden häufig nur für wenige Wochen vom Patienten toleriert und zeigten bei Patienten mit rezidivierenden Synkopen unklarer Genese einen begrenzten diagnostischen Gewinn; eine Sondergruppe sind Patienten mit häufigen Rezidivsynkopen innerhalb weniger Wochen. Kleine implantierbare Schleifenrekorder (ILR) mit einer Verwendbarkeitsdauer von einem Jahr überwachen permanent den Herzrhythmus und speichern nach Patienten- oder automatischer Aktivierung ein bipolar abgeleitetes 1-Kanal-EKG bis zu 42 Minuten vor der Aktivierung ab. Die diagnostische Überlegenheit des implantierbaren Ereignisrekorders gegenüber der bisherigen Standarddiagnostik wurde in randomisierten Studien belegt. Mit dem implantierbaren Ereignisrekorder lässt sich bei Patienten mit rezidivierenden Synkopen eine Rhythmusstörung am besten als Ursache der Synkope nachweisen bzw. ausschließen und ferner lassen sich solche Patienten identifizieren, die von einer Schrittmacherimplantation profitieren. Weitere mögliche Indikationen wie die Überwachung von Vorhofflimmern, die Diagnostik bei Palpitationen oder epileptischen Anfällen sind bei der technischen Weiterentwicklung des Geräts in der Zukunft abzusehen.
Herzschrittmachertherapie + Elektrophysiologie – Springer Journals
Published: Oct 25, 2008
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