Herzschrittmachertherapie & Elektrophysiologie

, Volume 17, Issue 4, pp 211–217 | Cite as

Koronare Herzkrankheit – Bedeutung der Ischämiebeseitigung für das Arrhythmieverhalten

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Zusammenfassung

Myokardiale Ischämie verursacht massive Veränderungen der transmembranären Ionenflüsse (H+, K+, Na+ und Ca++) sowie eine intrazelluläre ATP-Verarmung des Kardiomyozyten. Die daraus resultierenden Veränderungen der elektrischen Eigenschaften wie eine veränderte Erregbarkeit, Refraktärität und das Auftreten später Nachpotentiale können maligne Rhythmusstörungen verursachen oder unterhalten. Die Übererregbarkeit in sympathisch denervierten Myokardarealen kann die arrhythmogene Instabilität darüber hinaus noch verstärken.

Ischämieinduzierte Kammerarrhythmien sind, dies zeigen zahlreiche, methodisch allerdings nicht uneingeschränkt valide Studien, mit einer schlechten Prognose assoziiert. Patienten mit koronarer Herzkrankheit und relevanter Ischämie sind in erhöhtem Maße vom plötzlichen Herztod bedroht.

Verschiedene Studien geben Hinweise darauf, dass eine Beseitigung der Ischämie zur rhythmogenen Stabilisierung von Koronarpatienten und zur Verbesserung derer Prognose führen kann. Die definitive Beantwortung der Frage ob die Ischämiebeseitigung bei Koronarpatienten deren Prognose verbessert und wann, welche Strategie (medikamentös, interventionell oder operativ) in welchen Patientengruppen die besten Resultate verspricht, bleibt jedoch mangels methodisch hinreichender Studien in größeren Patientenkohorten weiterhin offen.

Schlüsselwörter

Ischämie Herzrhythmusstörungen Plötzlicher Herztod Koronare Herzerkrankung Revaskularisation 

Coronary artery disease – relevance of total coronary revascularization on the incidence of malignant arrhythmias

Summary

Myocardial ichemia induces redistribution of different ions (H+, K+, Na+, Ca++) across the cardiomyocyte membrane, as well as the loss of intracellular ATP content. This results in changes in the electrical properties including shortening of the action potential, appearance of delayed afterpotentials, and a modified refractoriness of the cardiomyocyte. These changes may induce or support malignant cardiac arrhythmias. Supersensitivity of sympathetic denervated myocardium may further support the electrical instability of ischemic myocardium.

Virtues of studies indicate that patients with coronary artery disease who develop complex arrhythmias during or after exercise bear a substantially increased risk for sudden cardiac death. Other studies report about arrhythmic stabilization and reduced mortality if patients with reversible myocardial ischemia receive complete revascularization. However, none of these studies is without methodological flaws. Due to the lack of methodologically sound studies in sufficiently large patient cohorts, the question whether complete coronary revascularisation improves the prognosis of patients with coronary artery disease and which strategy (medical, interventional, or surgical) warrants the best outcomes remains open.

Key words

Ischemia cardiac arrhythmias sudden coronary death coronary artery disease revascularization 

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  1. 1.Medizinische Klinik I, Schwerpunkte Kardiologie, Angiologie, Pulmologie und Internistische IntensivmedizinKrankenhaus Düren gGmbHDürenGermany

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