Kardiale Resynchronisation (CRT)

Die Herzinsuffizienz ist eine der häufigsten Hauptdiagnosen bei der Krankenhauseinweisung in Deutschland. Die kardiale Resynchronisationstherapie CRT ist bei richtiger Indikationsstellung die einzige Device-Therapie, die die Morbidität und Mortalität der Herzinsuffizienz effektiv senken kann. Grundlagen für deren Indikationsstellung sind die klinische Sicherung und Klassifizierung der Herzinsuffizienz, die Kontrolle und Anpassung der medikamentösen Therapie sowie die genaue Analyse von EKG-Kriterien.

Die kardiale Asynchronie und deren Korrekturfähigkeit durch CRT lassen sich ausreichend gut anhand der EKG-Kriterien abschätzen. Dabei spielen Parameter wie Linksschenkelblock, QRS-Breite und PR-Intervall eine wichtige Rolle. Die chronische rechtsventrikuläre Stimulation bei schwerer Herzinsuffizienz stellt eine weitere Indikation zur CRT dar.

Heart Failure is one of the most frequent diagnoses for hospital admission in Germany. In addition to optimal drug therapy cardiac resynchronisation therapy (CRT) is an established effective device based therapy for patients with reduced LVEF and prolonged QRS duration. Particular the left bundle branch block (LBBB) in heart failure patients with reduced left ventricular ejection fraction is one of the key indications for CRT. Based on cardiac asynchrony measured in ECG the reduction of asynchrony by left ventricular pacing is the main mechanism of CRT. Furthermore persistent right ventricular pacing in heart failure with reduced ejection fraction is an important indication for CRT.

Key words

Heart failure - cardiac resynchronization CRT - left bundle branch block LBBB - right ventricular pacing - asynchrony

• Literatur

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