Idiopathisches Kammerflimmern – wie behandeln?

Zusammenfassung

Der plötzliche Herztod ist ein relativ häufiges Ereignis. Ein nur geringer Teil dieser plötzlichen Todesfälle betrifft allerdings idiopathisches Kammerflimmern. Von „idiopathischem“ Kammerflimmern sollte nur gesprochen werden, wenn eine strukturelle Herzerkrankung ebenso wie primäre Arrhythmiesyndrome ausgeschlossen werden konnten. In wenigen Einzelfällen ist eine Katheterablation früh einfallender ventrikulärer Extrasystolen ein kurativer Behandlungsansatz; ebenso kann im Einzelfall eine antiarrhythmische Therapie wirksam sein, wie Chinidin beim Syndrom der frühen Repolarisation. Eine Versorgung mit einem ICD-System zum Schutz vor einem plötzlichen Herztod ist daher in nahezu allen Fällen zwingend erforderlich.

Abstract

Sudden cardiac death is a regular occurrence in clinical medicine. Idiopathic ventricular fibrillation (VF) is a relatively rare subgroup, because it requires exclusion of structural heart disease as well as primary arrhythmia syndromes to establish this diagnosis. In some cases, catheter ablation of premature ventricular complexes may be curative. Moreover, some pharmacological treatment options like quinidine in early repolarization syndrome show promising preliminary results. However, ICD implantation is in all but very few cases of patients with idiopathic VF absolutely indispensable.

Schlüsselwörter

Kammerflimmern - idiopathisch - plötzlicher Herztod - Syndrom der frühen Repolarisation - Katheterablation

Key words

ventricular fibrillation - idiopathic - sudden cardiac death - early repolarization - catheter ablation

• Literatur

• 1 Martens E, Sinner MF, Siebermair J et al. Incidence of sudden cardiac death in Germany: results from an emergency medical service center in Lower Saxony. Europace 2014; 16: 1752-1758
• 2 Myerburg RJ. Sudden cardiac death: exploring the limits of our knowledge. J Cardiovasc Electrophysiol 2001; 12: 369-381
• 3 Priori SG, Blomström-Lundqvist C. 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death summarized by co-chairs. Eur Heart J 2015; 36: 2757-2759
• 4 Belhassen B, Viskin S. Idiopathic ventricular tachycardia and fibrillation. J Cardiovasc Electrophysiol 1993; 4: 356-368
• 5 Priori SG, Wilde AA, Horie M et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm 2013; 10: 1932-1963
• 6 Visser M, van der Heijden JF, Doevendans PA et al. Idiopathic ventricular fibrillation: The struggle for definition, diagnosis, and follow-up. Circ Arrhythm Electrophysiol 2016;
• 7 Eckardt L, Wasmer K, Kobe J et al. Frühe Repolarisation. Ein Dilemma der Risikostratifikation. Herzschrittmacherther Elektrophysiol 2013; 24: 115-122
• 8 Haissaguerre M, Derval N, Sacher F et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008; 358: 2016-2023
• 9 Connolly SJ, Hallstrom AP, Cappato R et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs. Implantable Defibrillator Study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J 2000; 21: 2071-2078
• 10 Haissaguerre M, Shoda M, Jais P et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation 2002; 106: 962-967
• 11 Haissaguerre M, Sacher F, Nogami A et al. Characteristics of recurrent ventricular fibrillation associated with inferolateral early repolarization role of drug therapy. J Am Coll Cardiol 2009; 53: 612-619
• 12 Ozaydin M, Moazzami K, Kalantarian S et al. Long-term outcome of patients with idiopathic ventricular fibrillation: a meta-analysis. J Cardiovasc Electrophysiol 2015; 26: 1095-1104
• 13 Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation 2012; 125: 620-637
• 14 Sears SF, Hauf JD, Kirian K et al. Posttraumatic stress and the implantable cardioverter-defibrillator patient: What the electrophysiologist needs to know. Circ Arrhythm Electrophysiol 2011; 4: 242-250
• 15 Knecht S, Sacher F, Wright M et al. Long-term follow-up of idiopathic ventricular fibrillation ablation: A multicenter study. J Am Coll Cardiol 2009; 54: 522-528
• 16 Ashida K, Kaji Y, Sasaki Y. Abolition of torsade de pointes after radiofrequency catheter ablation at right ventricular outflow tract. Int J Cardiol 1997; 59: 171-175
• 17 Kusano KF, Yamamoto M, Emori T et al. Successful catheter ablation in a patient with polymorphic ventricular tachycardia. J Cardiovasc Electrophysiol 2000; 11: 682-685
• 18 Noda T, Shimizu W, Taguchi A et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol 2005; 46: 1288-1294