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Ventrikuläre Stimulationsvermeidung bei Patienten mit Sinusknotenerkrankung oder intermittierendem AV-Block

Avoidance of ventricular pacing in patients with sinus node disease or intermittent AV block

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Abstract

In patients with frequent right ventricular stimulation, worsening of heart failure and atrial fibrillation may occur. Avoidance of unnecessary right ventricular pacing is a major requirement for pacemaker selection and programming in patients with sinus node disease or intermittent AV block. In dual chamber pacemakers this goal can be achieved by programming a long AV delay or an AV delay hysteresis. Algorithms that allow AAI pacing in a dual chamber pacing mode and change to DDD mode in case of high degree AV block are a new attempt to avoid unnecessary right ventricular pacing. The article describes various strategies to avoid unnecessary ventricular pacing and discusses their advantages and disadvantages.

Zusammenfassung

Eine häufige rechtsventrikuläre Stimulation kann zur Verschlechterung einer Herzinsuffizienz und zu Vorhofflimmern führen. Ihre Vermeidung ist bei Patienten mit Sinusknotenerkrankung und intermittierenden AV-Blockierungen eine wesentliche Anforderung an die Systemauswahl und Schrittmacherprogrammierung. Bei Zweikammerschrittmachern kann eine Reduktion der ventrikulären Stimulationshäufigkeit durch die Programmierung eines langen AV-Intervalls oder einer AV-Intervall-Hysterese erreicht werden. Einen neuen Ansatz stellen Algorithmen dar, die bei Zweikammerschrittmachern eine AAI-Stimulation zulassen und erst dann in den DDD-Modus wechseln, wenn höhergradige AV-Blockierungen vom Schrittmacher detektiert werden. Die verschiedenen Möglichkeiten zur Reduktion der ventrikulären Stimulation mit ihren jeweiligen Vor- und Nachteilen werden in der Übersichtsarbeit vorgestellt.

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  1. Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany

    U. K. H. Wiegand

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  1. U. K. H. Wiegand
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Wiegand, U.K.H. Ventrikuläre Stimulationsvermeidung bei Patienten mit Sinusknotenerkrankung oder intermittierendem AV-Block. Herzschr. Elektrophys. 19, 3–10 (2008). https://doi.org/10.1007/s00399-008-0595-z

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  • DOI: https://doi.org/10.1007/s00399-008-0595-z

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