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Die neue ESC-Leitlinie zum Management ventrikulärer Tachyarrhythmien

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The new ESC guidelines on the management of ventricular tachyarrhythmias

Implications for daily practice

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Zusammenfassung

Die vor Kurzem veröffentlichte Leitlinie der European Society of Cardiology (ESC) für das Management von Patienten mit ventrikulären Arrhythmien (VA) und zur Prävention des plötzlichen Herztodes aktualisiert die Leitlinie aus dem Jahr 2015. Erstmals wird die Laienreanimation Leitlinienthema. In der Akuttherapie von VA wird die Elektrokardioversion aufgewertet, zudem liegt ein neuer Fokus auf dem Management des elektrischen Sturms. Neu ist die Gliederung der Empfehlungen zur umfassenden Diagnostik von Patienten mit Erstmanifestation von VA anhand häufiger klinischer Szenarien. Sowohl die genetische Diagnostik als auch die kardiale Magnetresonanztomographie werden aufgewertet, nicht nur für die Diagnostik, sondern auch zur Risikostratifikation. In der Langzeittherapie werden Empfehlungen zur Pharmakotherapie an aktuelle Herzinsuffizienzleitlinien angeglichen. Die Katheterablation gewinnt nicht nur bei rezidivierenden ventrikulären Tachykardien unter Amiodarontherapie und als Alternative zur Implantation eines implantierbaren Kardioverter-Defibrillators (ICD) bei ausgewählten Patienten mit koronarer Herzkrankheit, sondern insbesondere bei der Behandlung idiopathischer ventrikulärer Extrasystolen und Tachykardien an Bedeutung. Die ICD-Therapie bleibt essenzieller Bestandteil der Primär- und Sekundärprävention des plötzlichen Herztodes. Bemerkenswert ist hier die Abwertung der ICD-Empfehlung für Patienten mit dilatativer Kardiomyopathie und linksventrikulärer Ejektionsfraktion (LVEF) von ≤35 %sowie die Einbeziehung einer Kombination von Risikofaktoren und -kalkulatoren neben der LVEF in die Empfehlungen zur primärprophylaktischen ICD-Implantation. Durch zahlreiche Übersichtstabellen und Algorithmen ist die Leitlinie insgesamt zu einem praxisnahen Nachschlagewerk geworden.

Abstract

The recently published guidelines of the European Society of Cardiology (ESC) on the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death is an update of the 2015 guideline. For the first time a new section is dedicated to public basic life support. In the acute treatment of ventricular arrhythmias electrical cardioversion is upgraded, and there is a new focus on the management of electrical storm. Recommendations for the comprehensive diagnostic evaluation of patients with first manifestations of ventricular arrhythmias structured according to common clinical scenarios are also new. Both genetic testing and cardiac magnetic resonance imaging are upgraded, not only for diagnostic evaluation but also for risk stratification. In the long-term management, recommendations for pharmacotherapy are aligned with current heart failure guidelines. Catheter ablation has gained relevance not only for recurrent ventricular tachycardia under amiodarone treatment and as an alternative to implantable cardioverter defibrillation (ICD) implantation in selected patients with coronary artery disease but also particularly in the treatment of idiopathic ventricular extrasystoles and tachycardia. The ICD treatment remains an essential component of primary and secondary prevention of sudden cardiac death. Of note, the recommendation on primary preventive ICD treatment for patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) ≤ 35% has been downgraded. In addition to LVEF a combination of risk factors and risk calculators is included in the recommendations on primary prophylactic ICD implantation. Overall, due to numerous tables and practical algorithms, the guidelines have become a user-oriented reference book.

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Authors and Affiliations

  1. Klinik für Kardiologie – Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    Hilke Könemann, Gerrit Frommeyer & Lars Eckardt

  2. Department für Kardiologie, Universitätsklinikum Leiden, Leiden, Niederlande

    Katja Zeppenfeld

Authors
  1. Hilke Könemann
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  2. Gerrit Frommeyer
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  3. Katja Zeppenfeld
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  4. Lars Eckardt
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Correspondence to Hilke Könemann.

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Interessenkonflikt

K. Zeppenfeld: Biosense Webster (Forschung). L. Eckardt: Abbott, Bayer, Boston Scientific, Daiichi Sankyo, Medtronic, Biotronik, Sanofi-Aventis, Bristol-Myers Squibb (Vorträge). H. Könemann und G. Frommeyer 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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Die Verwendung des generischen Maskulinums dient ausschließlich der besseren Lesbarkeit. Angesprochen sind explizit alle Geschlechter (w/m/d).

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Könemann, H., Frommeyer, G., Zeppenfeld, K. et al. Die neue ESC-Leitlinie zum Management ventrikulärer Tachyarrhythmien. Herz 48, 3–14 (2023). https://doi.org/10.1007/s00059-022-05148-0

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