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Katheterablation bei supraventrikulären Tachykardien

Catheter ablation of supraventricular tachycardia

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Zusammenfassung

Supraventrikuläre Tachykardien (SVT) sind ein häufiger Befund, wobei die AV-Knoten-Reentry-Tachykardie (AVNRT) die häufigste paroxysmale supraventrikuläre Tachykardie darstellt. Das pathophysiologische Verständnis und die Katheterablation von SVT haben sich in den vergangenen Jahren ständig weiterentwickelt. Es wird beispielsweise eine Unterteilung der AVNRT nach typisch und atypisch in Abhängigkeit von HA-/VA-Intervall und AH/HA-Ratio empfohlen. Die Kryoablation konnte sich jedoch gegenüber der Radiofrequenzablation bei AVNRT aufgrund der erhöhten Rezidivrate nicht durchsetzen. In den aktuellen ESC-Leitlinien für SVT wurde die Ablation von akzessorischen Leitungsbahnen bei asymptomatischen Hochrisikopatienten aufgewertet und ist nun eine Klasse-I-Empfehlung. Hinsichtlich des Zugangswegs bei linksseitigen Bahnen gibt es keine Empfehlung, wobei der transseptale gegenüber dem transaortalen Zugangsweg in Bezug auf den akuten Erfolg vielversprechender zu sein scheint. Die Verwendung eines 3‑D-Mappingsystems führt zu einer Verkürzung der Durchleuchtungszeiten und Eingriffsdauer. Die Ablation von fokalen atrialen Tachykardien bleibt trotz Verwendung eines elektroanatomischen 3‑D-Mappingsystems eine Herausforderung. Neue Technologien wie High-density-multipoint(HD)-Mappingsysteme können hier jedoch hilfreich sein. HD-Mappingsysteme ermöglichen auch ein besseres Verständnis von links- und rechtsatrialen Makro-Reentry-Tachykardien sowohl nach vorangegangener Ablation oder kardiochirurgischen Eingriffen als auch bei primärer Natur. Jedoch sollten bei allen technologischen Fortschritten die Grundtechniken in der Elektrophysiologie, wie das Entrainment-Mapping, sicher beherrscht werden.

Abstract

Supraventricular tachycardias (SVT) are common, with atrioventricular nodal reentry tachycardias (AVNRT) being the most common paroxysmal supraventricular tachycardia. The pathophysiological understanding and the catheter ablation of SVTs have developed steadily in recent years. For example, dividing AVNRT into “typical” and “atypical” depending on the HA-, VA-interval and AH/HA ratio is recommended. Because of higher rates of recurrences after cryoablation, radiofrequency ablation has prevailed in AVNRT. The current ESC guidelines for SVTs recommend the ablation of accessory pathways in asymptomatic high-risk patients and it is now a Class I recommendation. There is no recommendation for the access in left-sided accessory pathways. However, a transseptal compared to transaortic approach seems more promising in acute success. The use of a three-dimensional (3D) mapping system leads to a reduction of the fluoroscopy times and procedure duration. Ablation of focal atrial tachycardia remains challenging despite the use of 3D electroanatomical mapping systems. However, new technologies such as high-density (HD) multipoint mapping systems can be helpful. HD mapping systems also allow a better understanding of left and right atrial macroreentry tachycardia after previous ablation or cardiac surgery and in primary nature. However, in all technological advances, a proficient understanding of the basic techniques in electrophysiology, such as entrainment mapping, is mandatory.

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Authors and Affiliations

  1. II. Med. Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland

    Mathias Forkmann, Carolina Schwab &  Sonia Busch

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  1. Mathias Forkmann
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  2. Carolina Schwab
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Correspondence to Sonia Busch.

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Interessenkonflikt

M. Forkmann, C. Schwab und S. Busch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Forkmann, M., Schwab, C. & Busch, S. Katheterablation bei supraventrikulären Tachykardien. Herzschr Elektrophys 30, 336–342 (2019). https://doi.org/10.1007/s00399-019-00654-x

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