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Risikostratifikation des plötzlichen Herztodes bei ischämischer Herzerkrankung

Programmierte Ventrikelstimulation

Risk stratification for sudden cardiac death in ischemic heart disease

Programmed ventricular stimulation

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die programmierte Ventrikelstimulation wurde in den 1970er Jahren viel eingesetzt und hat unser pathophysiologisches Wissen über die Mechanismen der ventrikulären Tachykardien erheblich bereichert. In zahlreichen Studien konnte gezeigt werden, dass eine im Rahmen einer programmierten Ventrikelstimulation induzierbare monomorphe Kammertachykardie mit einem erhöhten Risiko verbunden war, im weiteren Verlauf eine spontane Kammertachykardie oder sogar einen plötzlichen Herztod zu erleiden. Trotz dieser Ergebnisse, und obwohl die Leitlinien der ACC und ESC die Durchführung einer programmierten Ventrikelstimulation bei Patienten mit abgelaufenem Herzinfarkt und eingeschränkter linksventrikulärer Funktion sowie komplexen ventrikulären Arrhythmien oder Synkope empfehlen, wird die programmierte Ventrikelstimulation im klinischen Alltag nur selten angewandt. Ziel dieser Übersicht ist es, die Bedeutung der programmierten Ventrikelstimulation unter Berücksichtigung der aktuellen Literatur neu zu bewerten.

Abstract

Programmed ventricular stimulation was used extensively in the 1970s and has markedly improved our knowledge about the electrophysiological mechanisms of reentrant ventricular arrhythmias. In numerous observational but also randomized studies, it was shown that the induction of a monomorphic ventricular tachycardia by programmed ventricular stimulation was associated with an increased risk of spontaneous ventricular tachycardia or even sudden cardiac death in the future. Despite these results and the guidelines of ACC and ESC recommending the use of programmed ventricular stimulation in patients with recent and remote myocardial infarction, reduced ejection fraction, and complex ventricular arrhythmias or syncope, programmed ventricular stimulation is only seldom used and does not play a relevant role in clinical practice today. The purpose of this overview is to reevaluate the importance of programmed ventricular stimulation for the risk evaluation of patients with ischemic heart disease in consideration of the current literature.

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  1. Klinik für Allgemeine Innere Medizin, Kardiologie, Intensivmedizin, Hämatologie, Onkologie und Geriatrie, Med. Klinik I Agaplesion Diakonieklinikum Rotenburg/Wümme, Elise-Averdieck-Straße 17, 27356, Rotenburg, Deutschland

    Jürgen Potratz

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Potratz, J. Risikostratifikation des plötzlichen Herztodes bei ischämischer Herzerkrankung. Herzschr Elektrophys 26, 5–7 (2015). https://doi.org/10.1007/s00399-015-0355-9

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  • DOI: https://doi.org/10.1007/s00399-015-0355-9

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