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Indikationen für implantierbare Loop-Rekorder bei Kanalopathien und ventrikulären Tachykardien

Indications for implantable loop recorders in patients with channelopathies and ventricular tachycardias

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Zusammenfassung

Klare Leitlinien zur Implantation eines Loop-Rekorders bei Kanalopathien und ventrikulären Arrhythmien existieren nicht, außer der Empfehlung zum Einsatz in der Symptom-Rhythmus-Korrelation bei vermuteten ventrikulären Arrhythmien. Dennoch sind einige klinische Szenarien denkbar, bei denen der implantierbare Loop-Rekorder (ILR) als verlässliches Diagnostikum zum Einsatz kommen kann. Ganz entscheidend ist natürlich aufgrund der potenziellen Gefährdung durch Kammerarrhythmien eine sorgfältige Risikoanalyse vor der Entscheidung für ein rein diagnostisches Implantat. Bei den Kanalopathien mit einer Therapieoption (Long-QT-Syndrom und katecholaminergen polymorphen ventrikulären Tachykardien) könnte der ILR zur Therapiekontrolle bei Niedrigrisikopatienten eine Rolle spielen. Bei den Kardiomyopathien kann er zusätzlichen Erkenntnisgewinn, insbesondere bei erhaltender Ventrikelfunktion, bieten. Hinsichtlich seltener infiltrativer Kardiomyopathien oder auch Muskeldystrophien kann der ILR möglicherweise zu einem Wissenszuwachs beitragen, da die schlechte Evidenzlage in diesen Fällen häufig eine Einzelfallentscheidung nötig macht.

Abstract

Implantable loop recorders (ILR) do not play a pivotal role in the current guidelines on ventricular arrhythmias except in identifying rhythm–symptom correlations if ventricular arrhythmias are assumed. Before a decision for a pure diagnostic implantable device is made, a thorough arrhythmic risk assessment is of major importance due to the potential lethal outcome of ventricular arrhythmias. Nevertheless, some clinical circumstances exist where long-term monitoring by an ILR may add significant information in electrical heart diseases, in patients with ventricular arrhythmias, or structural heart diseases and a potential risk of ventricular arrhythmias. As medical therapy (β-blocker therapy) plays an important role in long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardias (cpVT), the ILR can be used to control therapy in patients at risk. In electrical diseases without pharmacologic therapeutic options (e. g., Brugada syndrome), the ILR may be used in low-risk patients with atypical syncope as benign faints may occur without association to the underlying disease. Evidence on cardiomyopathies with preserved left ventricular function and nonsustained VT or premature ventricular complexes is scarce. The ILR may also add long-term information on the individual risk in these circumstances. In very rare diseases like infiltrative disease or muscular dystrophies, the ILR may also provide evidence on risk stratification. In summary, ILR in electrical heart diseases and in patients with ventricular tachycardia remains a very individual decision taking into account various clinical, electrocardiographic, and genetic parameters. The following review aims at highlighting possible indications and clinical scenarios for ILR in ventricular tachycardias and electrical heart diseases with—probably debatable—case presentations.

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Authors and Affiliations

  1. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    Julia Köbe, Kristina Wasmer, Florian Reinke & Lars Eckardt

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  1. Julia Köbe
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  2. Kristina Wasmer
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  4. Lars Eckardt
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Correspondence to Julia Köbe.

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J. Köbe, K. Wasmer, F. Reinke und L. Eckardt: Vortragshonorare von Biotronik, Boston Scientific, St. Jude Medical, LivaNova und Medtronic.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Köbe, J., Wasmer, K., Reinke, F. et al. Indikationen für implantierbare Loop-Rekorder bei Kanalopathien und ventrikulären Tachykardien. Herzschr Elektrophys 27, 360–365 (2016). https://doi.org/10.1007/s00399-016-0474-y

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