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Plötzlicher Herztod ohne strukturelle Herzerkrankung

Aktuelle präventive und therapeutische Ansätze

Sudden cardiac death with no structural cardiac disease

Current preventive and therapeutic strategies

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Der Kardiologe Aims and scope

Zusammenfassung

Hintergrund

Der plötzliche Herztod gehört zu den führenden Todesursachen in der westlichen Welt. Ein kleines Kollektiv scheinbar gesunder Menschen erleidet den plötzlichen Herztod, ohne dass eine strukturelle Herzerkrankung zugrunde liegt. Bei diesen Patienten ist nicht selten der plötzliche Herztod das erste Anzeichen der Erkrankung. Es stellt eine große Herausforderung dar, gefährdete Patienten frühzeitig zu identifizieren und vor Auftreten des ersten lebensbedrohlichen Ereignisses vor dem plötzlichen Herztod zu schützen.

Ursachen

Zu den sog. elektrischen Erkrankungen gehören das lange QT-Syndrom, das kurze QT-Syndrom, das Brugada-Syndrom, die katecholaminerge polymorphe ventrikuläre Tachykardie. Auch das Wolff-Parkinson-White-Syndrom kann sich in seltenen Fällen durch einen plötzlichen Herztod manifestieren. Ein erhöhtes Risiko zum Erleiden des plötzlichen Herztodes kann bei entsprechendem Risikoprofil außerdem durch Drogen bzw. Medikamente verursacht werden.

Prävention

Der Defibrillator bietet zum heutigen Zeitpunkt den einzigen sicheren Schutz vor dem plötzlichen Herztod. Innovative subkutane Defibrillatoren können eine attraktive Alternative gegenüber den konventionellen transvenösen Systemen für diese meist jungen Patienten darstellen.

Ziel

Ziel dieses Beitrages ist es, die für das Auftreten des plötzlichen Herztodes ursächlichen Erkrankungen näher zu beleuchten sowie Hinweise zu geben, wie Risikopatienten identifiziert und behandelt werden können.

Abstract

Background

Sudden cardiac death (SCD) is one of the major causes of death in the industrialized world. A small group of apparently healthy individuals suffer SCD without any structural heart disease as the underlying cause. Often SCD is the first symptom, hence, the majority of these patients are not protected by a defibrillator as primary prevention. It is a great challenge to identify and treat patients at risk before the first event leading to SCD occurs.

Causes

Congenital diseases are long and short QT syndromes, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia. Additionally, the Wolff-Parkinson-White (WPW) syndrome still plays a rare but important role as patients may be cured by catheter ablation. In some people with predisposing risk factors, SCD may be caused by specific drugs.

Prevention

A defibrillator is currently the only certain preventive therapy. Innovative subcutaneous defibrillators may be an attractive alternative to conventional transvenous systems for high-risk patients.

Goal

The goal of this article is to depict the causes of SCD in patients without an underlying structural heart disease and give indications on how to identify and treat this patient group.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Fischer, K. Wasmer, F. Reinke, G. Frommeyer und L. Eckardt geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Fischer, A., Wasmer, K., Reinke, F. et al. Plötzlicher Herztod ohne strukturelle Herzerkrankung. Kardiologe 8, 385–392 (2014). https://doi.org/10.1007/s12181-014-0598-4

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  • DOI: https://doi.org/10.1007/s12181-014-0598-4

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