CRT „reloaded“ 2022 – die neuen Guidelines und technische Innovationen

Zusammenfassung

Die kardiale Resynchronisationstherapie (cardiac resynchronization therapy, CRT) stellt für Patienten mit symptomatischer Herzinsuffizienz und Linksschenkelblock eine etablierte und erfolgreiche Therapieoption dar, wenn die konservative medikamentöse Therapie ausgeschöpft ist und alle anderen kausalen Ursachen wie Ischämie, Klappenfehler und Rhythmusstörungen behandelt worden sind. Die aktuellen Pacing-Guidelines der ESC betonen erneut den Stellenwert der CRT als primäre interventionelle Herzinsuffizienztherapie, besonders bei Sinusrhythmus, einer LVEF ≤ 35% und typischem Linksschenkelblock ≥ 150 ms. Bei gleichzeitig bestehendem unkontrollierbarem Vorhofflimmern gewinnt die AV-Knoten-Ablation an Bedeutung. Für den nicht zu vernachlässigenden Anteil von Herzinsuffizienzpatienten ohne klare CRT-Indikation oder mit unzureichender CRT-Response kann eine multimodale Bildgebung zusätzliche Informationen liefern. Alternative Pacingmethoden sollten bei anatomischen Hindernissen erwogen werden. Die Wahl eines zusätzlichen Defibrillators ist auch nach der aktuellen Studienlage häufig schwierig und bleibt individuell abzuwägen.

Abstract

Cardiac resynchronization therapy (CRT) is an established and successful therapeutic option for patients with symptomatic heart failure and left bundle branch block when conservative medical therapy has been exhausted and all other causes such as ischemia, valvular defects, and arrhythmias have been treated. The current ESC pacing guidelines reemphasize the value of CRT as primary interventional heart failure therapy, especially in the presence of sinus rhythm, an LVEF ≤ 35%, and typical left bundle branch block ≥ 150 ms. In the presence of concomitant uncontrolled atrial fibrillation, AV junction ablation is gaining importance. For the non-negligible proportion of heart failure patients without clear CRT indication or with inadequate CRT response, multimodal imaging might add information or alternative pacing methods may be considered. The choice of an additional defibrillator often remains difficult and has to be weighed individually.

Schlüsselwörter

CRT - Leitlinien - Indikationen - Implantationsstrategie

Keywords

CRT - latest guidelines - implantation strategy - indications - cardiac resynchronization therapy

• Literatur

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