Zusammenfassung
Die Katheterablation von ventrikulären Tachykardien (VT) hat sich über die letzten beiden Jahrzehnte zu einem etablierten Therapieverfahren entwickelt. Bei idiopathischen VT ist die Ablation als Goldstandard bei hoher Effektivität und geringem Komplikationsrisiko zu sehen, eine medikamentös-antiarrhythmische Therapie ist insbesondere aufgrund des Nebenwirkungsprofils bei diesen Patienten nur im Ausnahmefall sinnvoll. Bei Patienten mit strukturellen Herzerkrankungen wie einer ischämischen oder einer dilatativen Kardiomyoapthie sind VT die häufigste Todesursache. Rezidivierende ICD (implantierbarer Kardioverter-Defibrillator)-Schocks sind darüber hinaus ein Hauptgrund für die hohe Morbidität und Mortalität. Allerdings liegt bei diesen Patienten oft ein komplexes myokardiales Substrat vor, daher besteht ein relevantes Rezidivrisiko nach VT-Ablationen. Weiterhin ist eine periprozedurale Mortalität um 3 % bei den oft schwer kranken Patienten zu beachten. Trotzdem besteht insbesondere bei Patienten, die unter Amiodaron weiterhin VT-Episoden bekommen, keine sinnvolle Alternative zur Ablation. Hierbei sind in den nächsten Jahren Fragen, betreffend die optimale Technik der VT-Ablation, den Endpunkt sowie den besten Zeitpunkt der Ablation, zu klären.
Abstract
The role of catheter ablation in patients with ventricular tachycardia (VT) has evolved over the last two decades into an established treatment option. In patients with idiopathic VT catheter ablation is the gold standard treatment option with high effectiveness and low risk of complications. Due to the high risk of side effects the use of antiarrhythmic drugs is only indicated in exceptional cases. In patients with structural heart diseases, such as ischemic and dilated cardiomyopathy, VT is the most frequent cause of death. Furthermore, recurrent shocks from implantable cardioverter defibrillators (ICD) are one of the main reasons for the high morbidity and mortality; however, in these patients a complex myocardial substrate is present and consequently there is a relevant risk of recurrence after VT ablation. A periprocedural mortality of approximately 3% must be considered in these often severely ill patients. Nevertheless, there is no reasonable alternative to catheter ablation, particularly in patients who continue to have VT episodes even under therapy with amiodarone. Questions with respect to the optimal procedural technique for VT ablation, the endpoint and optimal timing of ablation need to be clarified in clinical trials.
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T. Konrad, B.A. Hoffmann und T. Rostock geben an, dass kein Interessenkonflikt besteht.
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Konrad, T., Hoffmann, B.A. & Rostock, T. Katheterablation ventrikulärer Tachyarrhythmien. Herz 42, 132–137 (2017). https://doi.org/10.1007/s00059-017-4544-7
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DOI: https://doi.org/10.1007/s00059-017-4544-7