Welche Antiarrhythmika sind in der Intensivmedizin nach den ESC-Leitlinien 2015 noch sinnvoll? Welche nicht?

Die medikamentöse, antiarrhythmische Therapie ventrikulärer Arrhythmien in der Intensivmedizin ist einfacher geworden. Eine zentrale Rolle nehmen Antiarrhythmika der Klasse II und III nach Vaughan-Williams ein; besonders das Amiodaron spielt in der Akuttherapie eine herausragende Rolle. Der Einsatz von Klasse-I-Antiarrhythmika ist auf besondere Indikationen (z. B. Terminierung von VT ̶ ventrikuläre Tachykardie) beschränkt und sollte bei Patienten mit akutem Koronarsyndrom bzw. schwer eingeschränkter, linksventrikulärer Pumpfunktion nur sehr zurückhaltend erfolgen. Dabei ist die medikamentöse Therapie immer eingebettet in ein Gesamtkonzept, das auch die nicht-medikamentöse Therapie einschließt. So kann etwa beim Patienten mit bereits implantiertem Defibrillator die Wahl des Antiarrhythmikums durchaus auch Klasse-I-Antiarrhythmika im Einzelfall einschließen. Auf der anderen Seite spielt die Katheterablation ventrikulärer Tachykardien sowohl in der Behandlung der idiopathischen VT als auch der VT bei struktureller Herzerkrankung eine zunehmende Rolle.

The drug-mediated antiarrhythmic therapy for ventricular arrhythmia in intensive care medicine has become simpler. Antiarrhythmic agents of the classes II and III according to Vaughan-Williams play a central role; amiodarone in particular has an outstanding position in acute medicine. The use of class I antiarrhythmic agents is restricted to special indications (e.g., termination VT – ventricular tachycardia) and should be employed with extreme caution in patients with acute coronary syndrome or, respectively, severely impaired left ventricular pump function. In such cases, drug therapy is always embedded in an overall plan that also incorporates no-drug-mediated therapies. Thus, for example, for patients with an already implanted defibrillator the choice of antiarrhythmic agent can also include class I drugs in individual cases. On the other hand catheter ablation for ventricular tachycardia is gaining increasing importance not only in the treatment of idiopathic VT but also of VT in cases of structural heart disease.

Key words

Antiarrhythmic agents - ventricular arrhythmia - intensive care medicine - acute therapy - ventricular tachycardia (VT)

• Literatur

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