Zusammenfassung
Tachykarde Herzrhythmusstörungen treten bei Kindern und Jugendlichen mit angeborenen Herzfehlern (AHF) häufiger auf, als bei normal angelegtem Herzen. Die Ursachen hierfür können sowohl angeboren und dann oft auch mit spezifischen AHF assoziiert sein oder als Folge myokardialer Veränderungen im Langzeitverlauf des AHF oder herzchirurgischer Eingriffe auftreten. Der Einfluss auf Lebensqualität, Morbidität und Mortalität ist wegen der meist geringeren hämodynamischen Toleranz erhöht, so dass die Tachykardien häufig bereits im Kindesalter behandelt werden müssen. In den vergangenen 20 Jahren hat sich die interventionelle Elektrophysiologie als Therapie der Wahl im Kindesalter für die Mehrheit chronischer oder chronisch rezidivierender Tachykardien auch bei Patienten mit AHF etabliert. Erfolg und Risiko dieser Therapie werden wesentlich durch die hohe Varianz und das individuelle Ausmaß der kardialen Anomalie bestimmt, sowie ggf. durch die unterschiedliche postoperative Anatomie. Die Einführung dreidimensionaler (3D-)elektroanatomischer Rekonstruktionssysteme hat zusammen mit modernen Bildgebungsverfahren dazu beigetragen, das Verständnis für insbesondere postoperative Tachykardieformen zu erhöhen. Dennoch weisen die wenigen publizierten Daten eine geringere Erfolgsrate und eine höhere Rezidivquote aus als bei Patienten ohne AHF. Ursächlich hierfür sind oft komplexe und multiple Tachykardieverläufe sowie eine häufig unzureichende Läsionsbildung bei der Hochfrequenzstromapplikation im hypertrophierten und fibrosierten Myokard. Die Elektrophysiologie bei Kindern und Jugendlichen mit AHF stellt eine Spezialdisziplin innerhalb der invasiven Rhythmologie dar, die eine hohe Expertise des behandelnden Teams bezüglich AHF, AHF-Chirurgie und Elektrophysiologie erfordert und idealerweise in einer kardiologisch-interdisziplinären Umgebung eingebettet sein sollte.
Abstract
In children and adolescents with congenital heart disease (CHD) tachyarrhythmia occurs more frequently compared to patients with otherwise normal hearts. Arrhythmia substrates may be a natural part of certain congenital cardiac malformations or may result from long lasting myocardial deterioration as a result of CHD and/or cardiac surgery. Treatment of tachycardia is more frequently required even in early childhood, as the impact on quality of life, morbidity and mortality is higher due to an often reduced hemodynamic tolerance. Over the past 20 years interventional electrophysiology has been established as the therapy of choice for the majority of chronic or chronically recurrent tachycardia even in children with CHD. The success and risks of treatment are predominantly influenced by the individual expression of the cardiac anomaly and, if surgery has been performed, the highly variant postoperative anatomy. Introduction of 3D electroanatomical mapping systems together with modern cardiac imaging tools have significantly contributed to an improved understanding, particularly in postoperative tachycardia. Despite such progress, success rates are lower and recurrences are more frequent compared to patients without CHD. Complex and often multiple tachycardia courses account for the still limited performance as well as a frequently insufficient lesion formation with the use of radiofrequency current in the hypertrophic and fibrotic myocardium. Electrophysiology in children and adolescents, particularly if CHD is present, represents a highly specialized discipline requiring a high expertise in CHD, CHD surgery and cardiac electrophysiology and is ideally imbedded within an interdisciplinary cardiological and cardiosurgical setting.
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Hebe, J., Nürnberg, JH. & Langes, K. Interventionelle Therapie von tachykarden Herzrhythmusstörungen bei Kindern mit angeborenem Herzfehler. Herzschr Elektrophys 25, 172–182 (2014). https://doi.org/10.1007/s00399-014-0333-7
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DOI: https://doi.org/10.1007/s00399-014-0333-7
Schlüsselwörter
- Katheterablation
- Angeborener Herzfehler
- Supraventrikuläre Tachykardie
- Atriale Tachykardie
- Inzisionale Tachykardie