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Langzeitergebnisse der Katheterablation bei AV-Knoten-Reentry-Tachykardien und akzessorischen Leitungsbahnen

Long-term results of catheter ablation for AV nodal reentry tachycardias and accessory pathways

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Zusammenfassung

Die AV-Knoten-Reentry-Tachykardie (AVNRT) sowie AV-Reentry-Tachykardie (AVRT) bei akzessorischen Leitungsbahnen (AP) gehören zu den häufigsten supraventrikulären Tachykardien. Aktuelle Langzeitergebnisse der Katheterablation zeigen bei Kindern und Erwachsenen hohe Erfolgsraten von ca. 97 % (AVNRT) bzw. 92 % (AP). Das Risiko für schrittmacherpflichtige atrioventrikuläre (AV) Blockierungen liegt für die AVNRT bei 0,4–0,8 % bzw. für AP bei 0,1–0,2 %. Reduzierte Erfolgsraten von 87–93 % und erhöhte AV-Blockierungsraten bis zu 10 % zeigen sich bei Patient:innen mit komplexen kongenitalen Herzfehlern. Eine im Rahmen dyssynchroner Ventrikelerregung bei Präexzitation oder permanenten Reentry-Tachykardien auftretende Herzinsuffizienz zeigt nach Katheterablation eine hohe Remissionsrate von > 90 %. Zusammenfassend zeigt die Ablationstherapie von AVNRT und AP populationsübergreifend eine hohe Erfolgsrate bei sicherer Anwendbarkeit und stellt daher heute für die meisten Betroffenen die langfristige Therapie der ersten Wahl dar.

Abstract

Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia in patients with accessory pathways (AP) are common supraventricular tachycardias. High long-term efficacy of about 97% (AVNRT) and 92% (AP) has been observed in children and adults. The risk of occurring atrioventricular block is low (0.4–0.8% during AVNRT, 0.1–0.2% for AP). Catheter ablation shows a lower efficacy of 87–93% and elevated atrioventricular block risk up to 10% in patient groups with complex congenital heart disease. Nonsynchronized ventricular activation during preexcitation or permanent reentrant tachycardias can induce heart failure, and remission of left ventricular function can be expected in > 90% after successful catheter ablation. Therefore, catheter ablation is the long-term therapy of choice for AVNRT and AP with high efficacy and safety for most patient populations.

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Change history

  • 08 November 2023

    Der Titel des Korrespondenzautors wurde im Originalbeitrag vergessen.

Abbreviations

AP:

Akzessorische Leitungsbahn

AVNRT:

AV-Knoten-Reentry-Tachykardie

AVRT:

AV-Reentry-Tachykardie

FBI-Tachykardie:

Fast-broad-irregular-Tachykardie

SP:

Slow-Pathway

WPW-Syndrom:

Wolff-Parkinson-White-Syndrom

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Authors and Affiliations

  1. Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland

    Fares-Alexander Alken, Katharina Scherschel, Ernan Zhu, Ann-Kathrin Kahle &  Christian Meyer M.A.

  2. Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland

    Katharina Scherschel &  Christian Meyer M.A.

  3. Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    Ann-Kathrin Kahle

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  1. Fares-Alexander Alken
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  2. Katharina Scherschel
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  4. Ann-Kathrin Kahle
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  5. Christian Meyer M.A.
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Correspondence to Christian Meyer M.A..

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Interessenkonflikt

F.-A. Alken: Fellow des deutschen Herzrhythmus Fellowship gesponsert von Boston Scientific, Reisehonorare von Bayer Pharmaceuticals. C. Meyer: Sprecher und consulting für Abbott, Boston Scientific, Daiichi Sankyo, Bristol Myers Squibb/Pfizer, Biosense Webster. A.-K. Kahle: Fellow des deutschen Herzrhythmus Fellowship gesponsort von Boston Scientific, Reisehonorare von Abbott. K. Scherschel und E. Zhu geben an, dass kein Interessenkonflikt besteht.

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

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Alken, FA., Scherschel, K., Zhu, E. et al. Langzeitergebnisse der Katheterablation bei AV-Knoten-Reentry-Tachykardien und akzessorischen Leitungsbahnen. Herzschr Elektrophys 34, 278–285 (2023). https://doi.org/10.1007/s00399-023-00965-0

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