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Übersicht zur Katheterablation ventrikulärer Arrhythmien

Overview on catheter ablation for ventricular arrhythmias

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Zusammenfassung

Ventrikuläre Arrhythmien sind lebensbedrohlich und die wesentlichste Ursache des plötzlichen Herztodes. Ihre medikamentöse Behandlung mittels Antiarrhythmika hat meistens begrenzten Erfolg und ein relevantes Nebenwirkungsspektrum. In den letzten Jahrzehnten hat die interventionelle Therapie mittels Katheterablation einen festen Stellenwert in der Therapie ventrikulärer Rhythmusstörungen eingenommen. Mit verbesserter Technik und zunehmender Erfahrung hat sich gezeigt, dass die Ablation der medikamentösen Therapie in vielen Fällen hinsichtlich der Rezidivfreiheit und des langfristigen Nebenwirkungsprofils überlegen geworden ist. Die Technik und die Ergebnisse variieren in Abhängigkeit hauptsächlich von der zugrunde liegenden Grunderkrankung. Die Ergebnisse sind exzellent in idiopathischen ventrikulären Arrhythmien, also bei Patienten ohne strukturelle Herzerkrankung, während bei Patienten mit struktureller Herzerkrankung die Erfolgsraten deutlich niedriger und die Rezidivraten deutlich höher liegen. Das Behandlungsspektrum ist in den letzten Jahren durch neue strahlentherapeutische Verfahren ergänzt worden, deren Stellenwert noch nicht abschließend beurteilt werden kann.

Abstract

Ventricular arrhythmias are life-threatening and the main cause of sudden cardiac death. The medicinal treatment, mostly with antiarrhythmic drugs has limited success and a relevant range of side effects. Over the last few decades, interventional treatment using catheter ablation has become an established procedure for ventricular arrhythmias. With improved techniques and increasing experience, ablation has in many settings become superior to drug treatment with respect to freedom from recurrences and the long-term side effect profile. The technique and results of catheter ablation vary depending mainly on the underlying disease. The results for idiopathic ventricular arrhythmias , i.e., in patients without structural heart disease, are excellent whereas in patients with structural heart disease success rates are significantly lower and recurrence rates significantly higher. The treatment spectrum of ventricular arrhythmias has been expanded in recent years by new radiotherapeutic procedures, the significance of which cannot be conclusively assessed yet.

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Authors and Affiliations

  1. Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland

    Daniel Steven,  Jakob Lüker &  Jonas Wörmann

  2. Campus Mitte, Deutsches Herzzentrum der Charité (DHZC), Luisenstr. 7, 10115, Berlin, Deutschland

    Verena Tscholl,  Robert Hättasch,  Philipp Attanasio,  Nikolaos Dagres &  Gerhard Hindricks

Authors
  1. Daniel Steven
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  2. Verena Tscholl
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  3. Jakob Lüker
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  4. Robert Hättasch
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  5. Jonas Wörmann
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  6. Philipp Attanasio
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  7. Nikolaos Dagres
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  8. Gerhard Hindricks
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Corresponding author

Correspondence to Gerhard Hindricks.

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Interessenkonflikt

D. Steven: Advisory: Abbott und Biosense; Lecture: Abbott, Biosense, Pfizer; Research Grant: Abbott, Boston, Medtronic. V. Tscholl: Lecture: Medtronic, Biotronik, Pfizer. P. Attanasio: Lecture: Medtronic, Biotronik, Biosense; Research Grant: Abbott. J. Lüker: Lecture: Johnson & Johnson, Abbott, Boston Scientific. R. Hättasch: Support for attending meetings: Biosense Webster. J. Wörmann, N. Dagres und G. Hindricks geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Steven, D., Tscholl, V., Lüker, J. et al. Übersicht zur Katheterablation ventrikulärer Arrhythmien. Kardiologie 18, 162–169 (2024). https://doi.org/10.1007/s12181-024-00678-9

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  • DOI: https://doi.org/10.1007/s12181-024-00678-9

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