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Anwendung der Magnetokardiographie in der klinischen Kardiologie

Aktueller Stand und Ausblick in die Zukunft

Use of magnetocardiography in clinical cardiology

Current status and future outlook

Zusammenfassung

Die Magnetokardiographie (MKG) ist eine berührungs- und strahlungsfreie, nichtinvasive Methode zur Erfassung der elektromagnetischen Aktivität des Herzens. Theoretische Gesichtspunkte und vergleichende Untersuchungen deuten auf einen unterschiedlichen Informationsgehalt von MKG und Elektrokardiogramm (EKG) hin. Obwohl eine Vielzahl von Fragestellungen der kardialen Elektrophysiologie und Pathophysiologie durch magnetokardiographische Untersuchungen beantwortet werden kann, ist die Methode immer noch weitgehend unbekannt. Im Vergleich zum EKG ist der Betrieb eines Magnetokardiographen durch Verwendung supraleitender Sensoren mit der Notwendigkeit zur Kühlung mit flüssigem Helium und aufwendiger magnetischer Abschirmung um ein Vielfaches teurer und nicht am Patientenbett verfügbar. Der Gewinn an diagnostischer Information lässt den Aufwand jedoch als gerechtfertigt erscheinen, da die Sensitivität für ischämisches Myokard sowohl in Ruhe als auch unter Belastung deutlich höher ist als die des EKG. Im Hinblick auf die Risikostratifizierung für den plötzlichen Herztod erlaubt die Magnetfeldanalyse möglicherweise eine genauere Indikationsstellung für die prophylaktische Defibrillatorimplantation. Die räumliche Auflösung ist hoch genug für eine nichtinvasive Lokalisation arrhythmogener Foki, was die Methode insbesondere für das Management von Vorhofflimmerablationen interessant macht. Prospektive und ausreichende klinische Daten fehlen jedoch bisher weitgehend. Es gibt ausreichend Raum für Fantasien über weitere Fragestellungen der klinischen Kardiologie, die mit der MKG beantwortet werden können.

Abstract

Magnetocardiography (MCG) is a noncontact, radiation-free, noninvasive method to measure the electromagnetic activity of the heart. Theoretical aspects and comparative investigations suggest that MCG and electrocardiography (ECG) provide different information. Although many questions regarding cardiac electrophysiology and pathophysiology can be answered by MCG examinations, the method remains largely unknown. In comparison to ECG, MCG is performed using supraconducting sensors requiring cooling with liquid helium and complex magnetic shielding making it considerably more expensive and not available for use at the bedside. However, the gain in diagnostic information obtained would seem to justify the efforts expended, since the sensitivity for detecting ischemic myocardium, both at rest and during stress, is clearly higher than with ECG. With regard to risk stratification for sudden cardiac death, magnetic field analysis possibly facilitates establishing a more precise indication for implantation of a prophylactic defibrillator. The spatial resolution is high enough to noninvasively locate arrhythmogenic foci rendering the method particularly interesting for management of atrial fibrillation ablations. However, prospective and adequate clinical data are still lacking to a large extent. There is room enough to fantasize about further problems in clinical cardiology that might be solved by MCG.

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Leithäuser, B., Jung, F. & Park, J. Anwendung der Magnetokardiographie in der klinischen Kardiologie. Kardiologe 6, 128–134 (2012). https://doi.org/10.1007/s12181-012-0401-3

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Schlüsselwörter

  • Magnetokardiographie
  • Koronare Herzerkrankung
  • Ischämie
  • Arrhythmie
  • Vorhofflimmern

Keywords

  • Magnetocardiography
  • Coronary heart disease
  • Ischemia
  • Arrhythmia
  • Atrial fibrillation