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DOI: 10.1055/a-1579-0599
Tachykarde Rhythmusstörungen bei EMAH – Aspekte der katheterinterventionellen Therapie
Tachycardias in ACHD – Aspects of Catheter Ablation
Zusammenfassung
Tachykarde Rhythmusstörungen bei Erwachsenen mit angeborenem Herzfehler (EMAH) haben großen Einfluss auf Morbidität und Letalität dieser Patientengruppe. Sie basieren in der Mehrzahl auf erworbenen Substraten, die eine typische Langzeitfolge des angeborenen Herzfehlers (AHF) insbesondere nach herzchirurgischen Eingriffen darstellen. Antiarrhythmika können akut effektiv eingesetzt werden, sind aber als langfristige Behandlungsstrategie meist wenig verlässlich zur Unterdrückung von Tachykardierezidiven. Zusätzlich können Kontraindikationen bestehen bei eingeschränkter Ventrikelfunktion, hämodynamischen Rest-Fehlbelastungen, bradykardem Grundrhythmus sowie Arzneimittelnebenwirkungen. Vor diesem Hintergrund hat sich die katheterinterventionelle Ablationsbehandlung in den beiden letzten Jahrzehnten als Therapie der Wahl für die Mehrheit der Tachykardieformen bei EMAH mit zunehmend hohen Erfolgs- und niedrigen Komplikationsquoten etabliert.
Abstract
Tachyarrhythmias in adults with congenital heart disease (ACHD) contribute significantly to morbidity and mortality in this specific patient group. Mostly they are based on acquired substrates, a typical long-term consequence of congenital heart disease especially after corrective surgery. Antiarrhythmic drug therapy may be acutely effective but often lacks reliability to prevent tachyarrhythmic recurrences. Limitations may arise in view of impaired ventricular function, residual hemodynamic compromise, bradycardic basic rhythm or adverse drug effects. Not least against this background catheter-based ablation therapy has been established as a first line therapy during the last two decades for most tachyarrhythmias in ACHD due to excellent results and a low complication rate.
Tachyarrhythmien sind bei EMAH von großer klinischer Bedeutung. Die ursächlichen arrhythmogenen Substrate und Arrhythmiemechanismen sind bekannt. Die katheterbasierte Ablationsbehandlung stellt im Vergleich zur medikamentösen Behandlung eine akut und langfristig erfolgversprechende Therapieoption mit günstigem Risiko-Nebenwirkungs-Profil dar.
Publication History
Article published online:
11 October 2021
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