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Herzrhythmusstörungen bei der Schwangeren und beim Fetus

Cardiac arrhythmias in the pregnant woman and the fetus

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Zusammenfassung

Bei Schwangeren ist zur Akuttherapie supraventrikulärer (SVT) und ventrikulärer Tachykardien (VT) bei hämodynamischer Instabilität eine elektrische Kardioversion mit 50–100 Joules notwendig. Bei stabiler Hämodynamik sollten bei SVT primär vagale Manöver durchgeführt werden, ansonsten ist Adenosin das Medikament der 1. Wahl. Für die Langzeittherapie kommen vor allem β1-selektive β-Blocker in Frage, bei VT auch spezifische Antiarrhythmika. Auch der implantierbare Defibrillator ist eine therapeutische Alternative. Bei symptomatischen Bradykardien kann in jedem Stadium der Schwangerschaft ein Schrittmachersystem implantiert werden. Die Diagnostik bei fetalen Herzrhythmusstörungen basiert auf einer Abschätzung der chronologischen Verhältnisse zwischen Vorhof- und Ventrikelkontraktionen (M-Mode- und Doppler-Sonographie oder Magnetokardiographie). Die meisten supraventrikulären Tachykardien können mit Antiarrhythmika intrauterin behandelt werden. Der AV-Block mit Hydrops fetalis bei Feten mit Herzanomalien hat oft eine infauste Prognose. Bei durch Antikörper verursachtem AV-Block verwendet man zur intrauterinen Therapie eine Kortikoid- und β-Mimetika-Applikation der Mutter.

Abstract

For the acute treatment of supraventricular (SVT) and ventricular tachycardias (VT) in pregnant women, electrical cardioversion with 50–100 J is indicated in all unstable patients. In stable SVT the initial therapy includes vagal maneuvers or intravenous adenosine. For long-term therapy, β-blocking agents with β1-selectivity are first-line drugs or specific anti-arrhythmic drugs. An implantable cardioverter-defibrillator is another approach. In patients with symptomatic bradycardia, a pacemaker can be implanted using echocardiography at any stage of pregnancy. Evaluation of fetal arrhythmias in clinical practice is based on assessment of the chronological relationship between atrial and ventricular contraction (M-mode and Doppler ultrasound or magnetocardiography). Most forms of SVT can be treated with transplacental administration of anti-arrhythmic drugs. Atrioventricular (AV) block in fetuses with structural heart disease is frequently associated with hydrops fetalis and intrauterine death. Administration of corticoids and β-mimetic drugs is used to treat antibody-mediated AV block and cardiomyopathy.

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Authors and Affiliations

  1. Medizinische Klinik II, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    H.J. Trappe

  2. Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55101, Mainz, Deutschland

    M. Tchirikov

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Trappe, H., Tchirikov, M. Herzrhythmusstörungen bei der Schwangeren und beim Fetus. Internist 49, 788–798 (2008). https://doi.org/10.1007/s00108-008-2072-5

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