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Herz

, Volume 43, Issue 8, pp 701–709 | Cite as

Synkopenmanagement in der Praxis

Was ändert sich gemäß den neuen ESC-Leitlinien 2018?
  • S. Oebel
  • G. Hindricks
Schwerpunkt
  • 167 Downloads

Zusammenfassung

Synkopen stellen ein häufiges Problem im klinischen Alltag dar und bedingen rund 1 % der Vorstellungen in europäischen Notaufnahmen. Die Leitlinien zum Management von Synkopen der European Society of Cardiology (ESC) geben klinisch tätigen Kardiologen bereits seit mehreren Jahren eine auf den neuesten verfügbaren wissenschaftlichen Daten basierende Anleitung zur strukturierten Diagnostik und weiterführenden Therapie betroffener Patienten, wobei die letzte Version der ESC im Jahr 2009 erschienen ist und mit der aktuellen Fassung von 2018 verglichen wird. Diese Übersicht fasst die wichtigsten Neuerungen der Synkopendiagnostik und -therapie zusammen und möchte einen Schwerpunkt auf die initiale Risikostratifizierung bei der Erstversorgung setzen. Der Stellenwert von implantierbaren Loop-Rekordern für die Diagnostik unklarer Synkopen und die Präzisierung von Indikationen für eine definitive Versorgung mit Herzschrittmachern (HSM) oder implantierbaren Kardioverter-Defibrillatoren (ICD) ist in der klinischen Praxis von zunehmendem Interesse und wurde in den aktuellen Leitlinien adäquat abgebildet. Weitere Änderungen betreffen den Empfehlungsgrad bezüglich des Einsatzes weiterer diagnostischer (EKG-Monitoring, Kipptischuntersuchung) bzw. therapeutischer Maßnahmen (Indikationsstellung HSM-Implantation, Katheterablation tachykarder Rhythmusstörungen).

Schlüsselwörter

Kreislaufkollaps Herzschrittmacher Kipptischuntersuchung Implantierbarer Loop-Rekorder Karotissinussyndrom 

Management of syncope in clinical practice

What has changed according to the new ESC guidelines 2018?

Abstract

Syncope is a common problem in clinical practice, which affects approximately 1% of patients admitted to European emergency departments. The clinical practice guidelines for the diagnosis and management of syncope published by the European Society of Cardiology (ESC) are based on the newest scientific data in the field and have provided clinical cardiologists with a structured therapeutic approach for affected patients over many years. The previous ESC guidelines on syncope were published in 2009 and are compared to the most recent edition, which was published in 2018. This review summarizes the most important innovations with respect to the diagnostic principles and treatment of syncope. The initial assessment of the patient and the risk stratification in the emergency department are the focus of the review. Another important topic that is adequately covered in the current guidelines is the rising significance of implantable loop recorders for the evaluation of unexplained syncope and the assessment of potential indications for a definitive treatment with a pacemaker or implantable cardioverter defibrillator (ICD). Additional changes involve the evidence level with respect to the use of other diagnostic (ECG monitoring, tilt testing) and therapeutic measures (indications for pacemaker implantation, catheter ablation of tachycardiac rhythm disorders).

Keywords

Shock Cardiac pacemaker Tilt testing Implantable loop recorder Carotid sinus syndrome 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Oebel und G. Hindricks geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Abteilung für RhythmologieHELIOS Herzzentrum LeipzigLeipzigDeutschland

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