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Pharmakotherapie der ventrikulären Rhythmusstörungen

Was kommt, was bleibt, was geht?

Pharmacological therapy for ventricular arrhythmias: evidence for current treatment strategies and perspectives for the future

  • Arzneimitteltherapie
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Zusammenfassung

Der vorliegende Artikel beschreibt den derzeitigen Stellenwert der pharmakologischen Antiarrhythmikatherapie ventrikulärer Rhythmusstörungen aus symptomatischer Indikation und bewertet ihre prognostische Bedeutung zur Primär- sowie Sekundärprophylaxe des plötzlichen Herztods anhand aktueller kontrollierter Studien. Zudem wird die wachsende Bedeutung einer adjuvanten medikamentösen Therapie bei Patienten mit implantiertem Defibrillator (sogenannte „Hybridtherapie“) zur Reduktion von gerechtfertigten (zur Behandlung von Kammertachykardien oder -flimmern abgegebenen) und inadäquaten (z. B. infolge von Vorhofflimmern mit schneller AV-Überleitung abgegebenen) ICD-Schocktherapien, Verminderung des Leidendruckes der Patienten, Morbiditäts- und Mortalitätsreduktion sowie der enormen Kosten durch häufige Rehospitalisationen aufgezeigt. Letzteres stellt heute vielleicht den wichtigsten Aspekt der Pharmakotherapie bei Patienten mit prognostisch bedeutsamen Kammerarrhythmien dar.

Abstract

This review summarizes the current status of pharmacological therapy for ventricular arrhythmias in symptomatic patients. The selection of specific drugs for this indication is highly dependent on the underlying heart disease. In primary prevention of sudden death, antiarrhythmic agents do not play a role — except betareceptor antagonists. Similarly, in patients treated for secondary prevention of cardiac arrest or hemodynamically symptomatic ventricular tachycardia, the implantable defibrillator constitutes the therapy of choice with hardly any role left for antiarrhythmic drugs. An emerging role for antiarrhythmic drug therapy is represented by the concomitant pharmacological treatment in ICD recipients who experience shocks from their devices (hybrid therapy). Several randomized clinical trials have recently evaluated this issue and permit an evidence-based treatment strategy. Currently, most patients receive sotalol or amiodarone for hybrid therapy with azimilide as a potential new class III antiarrhythmic drug for this treatment indication.

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Authors and Affiliations

  1. Abteilung Klinische Elektrophysiologie, Medizinische Klinik III der Johann Wolfgang Goethe-Universität Frankfurt am Main

    F. T. Wegener, G. C. Grönefeld, G. Duray, J. R. Ehrlich &  S. H. Hohnloser

  2. Abteilung Klinische Elektrophysiologie, Medizinische Klinik III der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt

    S. H. Hohnloser

Authors
  1. F. T. Wegener
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  2. G. C. Grönefeld
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  3. G. Duray
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  4. J. R. Ehrlich
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  5. S. H. Hohnloser
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Correspondence to S. H. Hohnloser.

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Wegener, F.T., Grönefeld, G.C., Duray, G. et al. Pharmakotherapie der ventrikulären Rhythmusstörungen. Internist 47, 297–307 (2006). https://doi.org/10.1007/s00108-005-1561-z

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  • DOI: https://doi.org/10.1007/s00108-005-1561-z

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