Therapie von „Non-Respondern“ einer kardialen Resynchronisation

Zusammenfassung

Die kardiale Resynchronisationstherapie (CRT) ist ein etabliertes Verfahren in der Therapie der Herzinsuffizienz. Trotzdem liegt die Rate der Patienten, die nicht von dieser Therapie profitieren, je nach Studie um die 30%. Klinische Effekte der CRT-Therapie zeigen sich erst innerhalb mehrerer Monate nach der Implantation des Aggregats und können individuell verschieden stark ausgeprägt sein. Risikogruppen sollten in der Nachverfolgung besonders berücksichtigt werden. Bei Nonresponse sollte eine vollständige Evaluation des klinischen Status und eine Kontrolle des CRT-Aggregats erfolgen. Die Therapie der Nonresponse dient zunächst der Optimierung des biventrikulären Stimulationsanteils. Zudem ist die adäquate Programmierung der Zeitsteuerung unter echokardiografischer Kontrolle oder nicht invasiver Blutdruckmessung zielführend. Allerdings sind auch eine optimale Patientenauswahl, eine fachgerechte Implantation und eine individuelle Aggregatprogrammierung entscheidend für das Erreichen eines Therapieerfolgs.

Abstract

Cardiac resynchronization therapy (CRT) is an established treatment for heart failure. Despite dedicated guidelines for the application of CRT there is a non-responder-rate of about 30% in several clinical trials. The clinical benefit of CRT shows within several months after implantation of the device with variable effect in individual patients. Certain attention should be paid to high risk populations for non-response. After the diagnosis of non-response full clinical evaluation of the patient and interrogation of the device should be performed to rule out incompliance and malfunction of the device. Therapy of non-response should be focused on increasing true biventricular pacing in the first place. An additional optimization of CRT-timing may be performed guided by echocardiac imaging or noninvasive blood pressure measurement. Further action is advised depending on clinical necessity. Optimal patient selection, state of the art implantation and individual programming of the implanted device are important measures to prevent non-response.

Schlüsselwörter

Herzinsuffizienz - Nonresponder - kardiale Resynchronisationstherapie

Key words

chronic heart failure - non-responder - cardiac resynchronization therapy

• Literatur

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