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Kardiale Resynchronisationstherapie

Voraussetzungen, Ergebnisse, Perspektiven

Cardiac resynchronization therapy

Prerequisites, results, outlook

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die kardiale Resynchronisationstherapie (CRT) ist ein relativ neues Konzept zur Behandlung von Patienten mit medikamentös nicht ausreichend beeinflussbarer Herzinsuffizienz. Kandidaten für eine CRT sind Patienten mit Herzinsuffizienz des Schweregrades NYHA III–IV, Linksschenkelblock (LSB) und einer QRS-Breite ≥0,12 s. Die CRT kann nicht nur akut, sondern auch langfristig die kardiopulmonale Hämodynamik und Belastbarkeit verbessern. Auch die Mortalität wird durch CRT mit und ohne „ICD-back-up“ reduziert. Auch bei Vorhofflimmern und Herzinsuffizienz ist eine CRT sinnvoll und führt zu besserer Hämodynamik und höherer Belastbarkeit. Für Patienten mit Herzinsuffizienz, schlechter Pumpfunktion (EF), CRT-Indikation und koronarer Herzkrankheit erscheint ein CRT-ICD sinnvoll, ebenso für Patienten mit dilatativer Kardiomyopathie nach Kriterien der SCD-HeFT-Studie. Die sorgfältige Nachsorge des CRT-Patienten ist unumgänglich, und das neue Konzept des Home-Monitorings erscheint als eine vielversprechende Methode zur sicheren und schnellen Betreuung des CRT-Patienten.

Abstract

Cardiac resynchronization therapy (CRT) is a new concept in the treatment of patients with drug-refractory heart failure (HI). Candidates for CRT are HI patients with NYHA class III-IV, left bundle branch block and QRS width ≥0.12 s. CRT leads to improvements in hemodynamics both acutely and during long-term follow-up, resulting in better cardiopulmonary exercise tolerance. In addition, patients receiving CRT have a better survival rate with or without implantable cardiac defibrillator (ICD) back-up. CRT is possible in patients with atrial fibrillation. CRT with ICD back-up is indicated in patients with HI, low left ventricular function (EF), indication for CRT and coronary artery disease, whereas this question is not fully resolved in patients with dilated cardiomyopathy. CRT patients must be followed up; home monitoring is a very promising approach for quick and safe surveillance of these patients.

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  1. Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    H.-J. Trappe

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Trappe, HJ. Kardiale Resynchronisationstherapie. Kardiologe 2, 407–416 (2008). https://doi.org/10.1007/s12181-008-0105-x

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