Elektrischer Sturm in der Notaufnahme: Klinische Pfade

  • Anja Schade
  • Karin Nentwich
  • Patrick Müller
  • Joachim Krug
  • Sebastian Kerber
  • Thomas Deneke
Schwerpunkt
  • 342 Downloads

Zusammenfassung

Patienten mit einer strukturellen Herzerkrankung, die einen elektrischen Sturm erleiden, weisen besonders in den ersten 3 Monaten eine stark erhöhte rhythmogene und nichtrhythmogene Mortalität auf. Nach notfallmäßiger Terminierung der ventrikulären Arrhythmie müssen, abhängig vom Ergebnis einer Analyse der zugrunde liegenden Art und Ursache der Arrhythmie, verschiedene Therapiepfade eingeschlagen werden, um eine dauerhafte Rhythmusstabilisierung zu erreichen. Eckpfeiler der Therapie sind Triggerausschaltung, Sympathikusblockade (initial mittels β-Blocker und Sedierung), antiarrhythmische Therapie mit Amiodaron und Katheterablation, aber auch eine Behandlung der Herzinsuffizienz bzw. kreislaufunterstützende Maßnahmen. Der dargestellte Algorithmus kann helfen, auch invasive Maßnahmen, wie invasive Koronardiagnostik, Katheterablation oder invasive Kreislaufunterstützung rechtzeitig in die Therapiestrategie zu integrieren. Durch ein strukturiertes Vorgehen bei der Behandlung von Patienten mit elektrischem Sturm kann eine hohe Effektivität der Akuttherapie erreicht werden. Ob dies auch zu einer Verbesserung des Outcomes führt, muss im Weiteren evaluiert werden.

Schlüsselwörter

Elektrischer Sturm Katheterablation Konservative Therapie Algorithmus Ventrikuläre Tachykardie 

Electrical storm in the emergency room: clinical pathways

Abstract

In patients with structural heart disease, occurrence of an electrical storm (ES) is associated with increased mortality acutely and during medium term follow-up. Depending on the underlying heart disease and baseline type of arrhythmia, different clinical pathways have to be followed to reach sustained freedom from ventricular arrhythmia recurrences. Trigger elimination, sympathetic blockade (initially using betablockers and sedation), antiarrhythmic therapy with amiodarone and catheter ablation, treatment of heart failure and invasive hemodynamic support are cornerstones of the treatment. We present an algorithm which may help to organize an optimized treatment for each ES patient, implementing invasive treatment options like coronary angioplasty, catheter ablation and invasive circulatory support. Further studies are necessary to evaluate medium term outcome of such a structured therapy.

Keywords

Electrical storm Catheter ablation Conservative therapy Algorithm Ventricular arrhythmias 

Notes

Interessenkonflikt. A. Schade, K. Nentwich, P. Müller, J. Krug, S. Kerber und T. Deneke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anja Schade
    • 1
  • Karin Nentwich
    • 1
  • Patrick Müller
    • 1
  • Joachim Krug
    • 1
  • Sebastian Kerber
    • 2
  • Thomas Deneke
    • 1
  1. 1.Klinik für Kardiologie II (Interventionelle Elektrophysiologie)Herz-und Gefäßklinik Bad NeustadtBad Neustadt a.d. SaaleDeutschland
  2. 2.Klinik für Kardiologie I (Interventionelle Kardiologie)Herz-und Gefäßklinik Bad NeustadtBad Neustadt a.d. SaaleDeutschland

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