Der Kardiologe

, Volume 5, Issue 6, pp 463–478

Rhythmusstörungen bei Schwangeren

Was wann tun?
CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Supraventrikuläre Extrasystolen werden während einer Schwangerschaft (SWS) häufig beobachtet, supraventrikuläre Tachykardien eher seltener. Zur Akuttherapie (AT) ist bei hämodynamischer Instabilität (HI) eine elektrische Kardioversion (KV) mit 50–100 Joules notwendig. Bei stabiler Hämodynamik (SH) sollten primär vagale Manöver durchgeführt werden, bei Versagen vagaler Maßnahmen ist Adenosin das Medikament der 1. Wahl. Für die Langzeittherapie (LZ-T) kommen v. a. β1-selektive β-Blocker (BB) infrage, seltener spezifische Antiarrhythmika (AA) der Klassen Ic oder der Klasse III [Sotalol (Sot)]. Ventrikuläre Extrasystolen sind während einer SWS ebenfalls relativ häufig und bei den meisten Patientinnen harmlos, maligne ventrikuläre Arrhythmien [ventrikuläre Tachykardien (KT), Kammerflattern (KFlat), Kammerflimmern (KF)] werden dagegen eher seltener beobachtet. Als AT sollte bei HI eine elektrische KV erfolgen, bei SH kommen Ajmalin, Procainamid oder Lidocain in Betracht. Für die LZ-T sollten primär β1-selektive BB eingesetzt werden, bei Therapierefraktärität spezifische AA der Klasse Ic oder Sot. Für Patientinnen mit synkopaler KT, KF, KFlat oder überlebtem plötzlichem Tod ist der implantierbare Defibrillator eine therapeutische Alternative. Bei Patientinnen mit symptomatischen Bradykardien kann ein Schrittmachersystem implantiert werden. Trotz notwendiger Besonderheiten im therapeutischen Verhalten während einer SWS können alle supraventrikulären und/oder ventrikulären Arrhythmien adäquat behandelt und auch komplizierte Schwangerschaften erfolgreich beendet werden. Auch in der Stillzeit können zahlreiche Antiarrhythmika ohne Probleme angewendet werden.

Schlüsselwörter

Herzrhythmusstörungen Schwangerschaft Stillzeit Plötzlicher Tod Antiarrhythmika 

The pregnant woman with arrhythmias

What to do when?

Abstract

Atrial premature beats are frequently diagnosed during pregnancy (PR) and supraventricular tachycardia (SVT) (atrial tachycardia, AV nodal reentrant tachycardia, circus movement tachycardia) less frequently. For acute therapy, electrical cardioversion with 50–100 J is indicated in all unstable patients. In stable SVT the initial therapy includes vagal maneuvers to terminate breakthrough tachycardias. For short-term management, when vagal maneuvers fail, intravenous adenosine is the first choice drug and may safely terminate the arrhythmia. For long-term therapy, ß-blocking agents with β1 selectivity are first-line drugs; class Ic agents or the class III drug sotalol (sot) are effective and therapeutic alternatives. Ventricular premature beats are also frequently present during PR and benign in most of the patients; however, malignant ventricular tachyarrhythmias [sustained ventricular tachycardia (VT), ventricular flutter (VFlut), ventricular fibrillation (VF)] were observed less frequently. Electrical cardioversion is necessary in all patients with hemodynamically unstable situation and life-threatening ventricular tachyarrhythmias; in hemodynamically stable patients, initial therapy with ajmaline, procainamide or lidocaine is indicated. If prophylactic therapy is needed, ß-blocking agents with ß1 selectivity are considered as first choice drugs. If this therapy is ineffective, class Ic agents or sot can be considered. In patients with syncopal VT, VF, VFlut or aborted sudden death an implantable cardioverter-defibrillator is indicated. In patients with symptomatic bradycardia, a pacemaker can be implanted using echocardiography at any stage of PR. The treatment of the pregnant patient with cardiac arrhythmias requires important modification of the standard practice of arrhythmia management. The goal of therapy is to protect the patient and fetus through delivery, after which chronic or definitive therapy can be administered. In addition, antiarrhythmic therapy is also possible during breastfeeding.

Keywords

Cardiac arrhythmias Pregnancy Breastfeeding Sudden death Antiarrhythmic drugs 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie)Ruhr-Universität BochumHerneDeutschland

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