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Chirurgie bei tachykarden Rhythmusstörungen und Herzschrittmachertherapie

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Herzchirurgie

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Zusammenfassung

Eine Besonderheit des Herzmuskels besteht in seiner Fähigkeit, selbstständig Aktionspotenziale zu generieren und hierdurch das gesamte Organ zu erregen. Diese Autonomie kommt durch einen steten Anstieg des Ruhepotenzials zustande, der bei Überschreiten der Aktionspotenzialschwelle zu einer Erregung führt, die entsprechend über das gesamte Organ weitergeleitet wird. Damit diese Erregungen geordnet ablaufen und die Gesamtfunktion sowie insbesondere die Koordination der einzelnen Kammern des Herzens dadurch sichergestellt wird, existiert eine hierarchische Abstufung der intrinsischen Frequenzen. Die jeweils schnellste Region bestimmt die effektive Frequenz, da die von ihr ausgehende Erregung die untergeordneten Zentren erreicht, bevor deren Autonomie zu einer Erregung führt. Einen weiteren Einfluss auf die Autonomie und die daraus resultierende Frequenz hat das vegetative Nervensystem. Durch Parasymphathikuswirkung kommt es zu einer verringerten Autonomie sowie zu Bradykardien (negativ chronotrop) und einer verzögerten atrioventrikulären Leitung (negativ bathmotrop), durch Symphatikuswirkung zu einer gesteigerten Autonomie sowie zu Tachykardien (positiv chronotrop) und einer schnelleren atrioventrikulären Leitung (positiv bathmotrop).

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  1. Abteilung für Thorax-, Herz- und Gefäßchirurgie, Westfälische Wilhelms-Universität, Albert-Schweitzer-Str. 33, 48149, Münster

    Prof. Dr. med. H. H. Scheid

  2. Klinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum UKE Hamburg, Martinistr. 52, 20246, Hamburg

    Priv.-Doz. Dr. med. H. Gulbins

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Scheid, H.H., Gulbins, H. (2010). Chirurgie bei tachykarden Rhythmusstörungen und Herzschrittmachertherapie. In: Herzchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79713-5_26

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