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Zusammenfassung Die kardiale Resynchronisationstherapie (CRT) ist ein fester Bestandteil in der Behandlung der chronischen Herzinsuffizienz, wobei ein möglichst hoher biventrikulärer Stimulationsanteil für die Effektivität dieser Therapie von großer Bedeutung ist. Eine vermehrte ventrikuläre Extrasystolie (VES) stellt neben atrialen Arrhythmien wie Vorhofflimmern die häufigste Ursache einer ineffektiven Resynchronisationstherapie dar. Neben der prognostisch ungünstigen Reduktion des Stimulationsanteils ist eine ventrikuläre Extrasystolie beim Vorliegen einer strukturellen Herzerkrankung generell mit einem reduzierten Outcome assoziiert, was die Bedeutung einer adäquaten Therapie der VES in diesem Kollektiv unterstreicht. Die Optionen, durch Anpassung der Geräteprogrammierung den Stimulationsanteil zu erhöhen, sind insgesamt limitiert. Aufgrund des wechselseitigen Zusammenhangs zwischen Kardiomyopathie bzw. Herzinsuffizienz und ventrikulärer Arrhythmielast ist eine adäquate Herzinsuffizienztherapie essenziell zur Reduktion der Extrasystolie. Neben einer Betablockertherapie sind die spezifischen medikamentös-antiarrhythmischen Therapieoptionen aufgrund der in der Regel bei CRT-Patienten zugrundeliegenden strukturellen Herzerkrankung auf die Klasse-III-Antiarrhythmika Amiodaron und mit Einschränkungen Sotalol beschränkt. Insbesondere bei idiopathischer Extrasystolie ist die Katheterablation der medikamentösen Therapie überlegen, aber auch zur Ablationsbehandlung von VES bei struktureller Herzerkrankung und bei CRT-Nonrespondern liegen vielversprechende Daten vor.
Herzschrittmachertherapie + Elektrophysiologie – Springer Journals
Published: Mar 1, 2021
Keywords: cardiology; cardiac imaging; cardiac surgery
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