Herzrhythmusstörungen und deren Therapie entsprechend aktuellen Empfehlungen

Zusammenfassung

Die Therapie von Herzrhythmusstörungen hat sich in den letzten Jahren erheblich verändert: nichtmedikamentöse Verfahren wie die Katheterablation werden frühzeitiger eingesetzt und haben teilweise die medikamentöse Therapie abgelöst. Häufig dient die medikamentöse Therapie noch als Überbrückung bis zur definitiven Therapie durch Katheterablation. Ein weiterer Schwerpunkt ist die begleitende antiarrhythmische Behandlung bei Patienten mit implantierbaren Cardioverter-Defibrillatoren (ICD). Bei der Akutbehandlung einiger Herzrhythmusstörungen, wie z. B. dem Vorhofflimmern, sind medikamentöse Ansätze unverzichtbar und weiterhin als primäre Therapie etabliert. Die medikamentöse Therapie mit den „klassischen” ionenkanalblockierenden Substanzen ist in der Effektivität limitiert und birgt insbesondere das Risiko der Proarrhythmie. Pharmaka haben in der Langzeittherapie jedoch häufig nur eine eingeschränkte Wirksamkeit und potenzielle Nebenwirkungen. Aus diesem Grund sollte eine Dauertherapie nur bei strenger Indikationsstellung und engmaschiger kardiologischer Überwachung erfolgen. Wegen dieser Limitationen wird nach Alternativen der pharmakologischen Behandlungsprinzipien (nicht-ionenkanalblockierende Substanzen wie z. B. ACE-Hemmer, Sartane, Statine) gesucht. Anders als klassische Antiarrhythmika beruht ihr Wirkprinzip vor allem in der Beeinflussung von strukturellen kardialen Veränderungen.

Abstract

Therapy guidelines for treating heart rhythm disturbances have changed substantially within the last years: Catheter ablation treatment strategies support or even replace classical pharmacological treatment. Nowadays, medical therapy is commonly used as bridging therapy until definite catheter ablation therapy is performed. Yet, pharmacological treatment remains a cornerstone of concomitant treatment in patients with implantable cardioverters/defibrillators (ICD). In acute onset atrial fibrillation, pharmacological treatment is still indispensable as established first line strategy. However, medical therapy with „classical” ion channel blocking agents has limited effects and even proarrhythmic propensity. Indication for long-term pharmacological treatment should be thoroughly checked and patients should be closely monitored, as such treatment comes along with undesired side effects. Therefore, novel pharmacological treatment strategies with non-ion channel blocking agents such as ACE-inhibitors, Sartans, and Statins may be an option. Different from classical antiarrhythmic agents, these agents have an impact on structural changes of the diseased heart.

Schlüsselwörter

Arrhythmie - Antiarrhythmika - Herz - Defibrillator - Katheterablation

Keywords

arrhythmia - antiarrhythmic agents - catheter ablation - heart - defibrillator

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