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Tachykardien bei pulmonalarterieller Hypertonie

Tachycardia and pulmonary arterial hypertension

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Seit dem 6. Weltsymposium wird eine pulmonale Hypertonie (PH) als eine Erhöhung des mittleren pulmonalarteriellen Drucks >20 mmHg und eines pulmonalvaskulären Widerstands ≥3 Wood-Einheiten definiert. Herzrhythmusstörungen sind ein zunehmendes Problem bei Patienten mit einer pulmonalen Hypertonie. Pathophysiologisch liegen eine durch die rechtsatriale Druckerhöhung und Dilatation bedingte atriale Fibrose und durch den erhöhten sympathischen Tonus bedingte Verlängerung des Aktionspotenzials sowie verzögerte Depolarisationen zugrunde, die zu Herzrhythmusstörungen führen. Die Behandlung umfasst eine medikamentöse Therapie mit einer Präferenz für Amiodaron und elektrophysiologische Maßnahmen, wie elektrische Kardioversionen und Ablationen, welche bei PH-Patienten technisch sicher durchführbar sind.

Abstract

Pulmonary hypertension is newly defined as an elevation of the mean pulmonary arterial pressure >20 mmHg and a pulmonary vascular resistance ≥3 Wood units. Arrhythmias are an increasing problem in patients with pulmonary hypertension. Pathophysiological aspects leading to supraventricular arrhythmias are atrial fibrosis caused by increased right atrial pressure and dilation. An increased sympathetic tone leads to prolongation of action potential and delayed polarisations causing arrhythmias. Therapy of arrhythmias includes drugs (preferred amiodarone) and electrophysiological therapy like electric cardioversion and ablation, which is safe in patients with pulmonary hypertension.

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Authors and Affiliations

  1. Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Deutschland

    D. Bandorski FACC, FESC, MHBA

  2. Intensivmedizin und internistische Diagnostik, Neurologische Klinik Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Deutschland

    D. Bandorski FACC, FESC, MHBA

  3. Abteilung für Kardiologie, Elektrophysiologie und Angiologie, Märkische Kliniken GmbH, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515, Lüdenscheid, Deutschland

    H. Bogossian

  4. Universität Witten/Herdecke, Witten, Deutschland

    H. Bogossian

  5. Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    A. Ghofrani

  6. Medizinische Klinik 1, Innere Medizin/Kardiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    J. Schmitt

  7. St. Agnes-Hospital Bocholt Rhede, Medizinische Klinik, Kardiologie/Elektrophysiologie, Klinikum Westmünsterland, Barloer Weg 125, 46397, Bocholt, Deutschland

    R. Höltgen

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  1. D. Bandorski FACC, FESC, MHBA
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  2. H. Bogossian
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Correspondence to D. Bandorski FACC, FESC, MHBA.

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Interessenkonflikt

D. Bandorski, H. Bogossian, A. Ghofrani, J. Schmitt und R. Höltgen geben an, dass kein Interessenkonflikt besteht.

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

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Bandorski, D., Bogossian, H., Ghofrani, A. et al. Tachykardien bei pulmonalarterieller Hypertonie. Herzschr Elektrophys 31, 33–38 (2020). https://doi.org/10.1007/s00399-020-00668-w

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  • DOI: https://doi.org/10.1007/s00399-020-00668-w

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