Zusammenfassung
Eine gesteigerte sympathische und reduzierte vagale Aktivität sind assoziiert mit einer erhöhten Mortalität sowohl bei Patienten nach Myokardinfarkt wie auch bei Patienten mit chronischer Herzinsuffizienz. Tierexperimentelle Studien belegen, dass die chronische Vagusstimulation über eine erhöhte Parasympathikusaktivität die Mortalität durch plötzlichen Herztod und myokardiales Pumpversagen senken kann. Die zugrunde liegenden Mechanismen hierfür sind vielfältig und beruhen neben einer bloßen Herzfrequenzreduktion und Erhöhung der Herzfrequenzvariabilität experimentell auch auf antiarrhythmischen und antiinflammatorischen Effekten, Erhöhung der Baroreflexsensitivität, Modifikation der Zytokin- und Mediatorausschüttung und Koronardilatation mit verbesserter Perfusion. Erste klinische Ergebnisse der chronischen Vagusstimulation bei Patienten mit chronischer Herzinsuffizienz und systolischer Dysfunktion sind vielversprechend und resultierten in einer Erhöhung der Lebensqualität und gesteigerten Belastbarkeit sowie einer Verbesserung der linksventrikulären Funktion bei insgesamt sicherer Durchführbarkeit.
Abstract
Increased sympathetic activity and reduced vagal activity are associated with increased mortality both after myocardial infarction and in heart failure; furthermore, vagal withdrawal has been documented to precede acute decompensation. Experimental studies indicate that increased parasympathetic activity by means of vagal stimulation may reduce mortality in animal models of post-infarction sudden cardiac death and of chronic heart failure. Initial clinical results demonstrate that chronic vagus nerve stimulation in heart failure patients with severe systolic dysfunction appears to be safe and tolerable and may improve quality of life, submaximal exercise capacity, and LV function. Vagus nerve stimulation derives these potential clinical benefits from multiple mechanisms of action. These include reduced heart rate, restoration of heart rate variability and baroreflex sensitivity, suppression of pro-inflammatory cytokines, and antiarrhythmic effects.
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Der korrespondierende Autor weisst auf folgenden Beziehungen hin: Dr. Kuschyk ist als Referent für die Firmen BioControl, Medtronic, St Jude Medical, Impulse Dynamics und Boston Scientific tätig.
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Kuschyk, J., Borggrefe, M. Vagusstimulation. Herzschr. Elektrophys. 22, 21–26 (2011). https://doi.org/10.1007/s00399-011-0119-0
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DOI: https://doi.org/10.1007/s00399-011-0119-0