Kardiale Resynchronisationstherapie und Arrhythmien

Zusammenfassung Die kardiale Resynchronisationstherapie hat sich in den letzten 10 Jahren zu einem etablierten Verfahren zur Therapie der fortgeschrittenen Herzinsuffizienz bei Patienten mit Linksschenkelblock entwickelt.Wenngleich in Einzelfällen eine Proarrhythmie beschrieben wurde, so konnte doch in größeren Serien keine Häufung ventrikulärer Tachyarrhythmie-Episoden gefunden werden. Persistierendes Vorhofflimmern konvertiert zumindest bei einem Teil der durch biventrikuläre Stimulation behandelten Patienten wieder in Sinusrhythmus, möglicherweise abhängig von der Dauer des Vorhofflimmerns.     

Arrhythmien aus dem rechten Ventrikel

Right ventricular arrhythmias predominantly occur in young patients with rare cardiac diseases. Underlying cardiac conditions include idiopathic right ventricular outflow-tract tachycardia (RVOT-VT), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, and postoperative congenital heart disease (i.e. tetralogy of Fallot). According to the underlying cardiac disease, there are significant differences in the diagnostic and therapeutic management and prognosis which is mainly determined by life-threatening ventricular arrhythmia recurrences and sudden cardiac death. To provide optimal treatment for affected patients, a detailed diagnostic evaluation and risk stratification is mandatory. Tailored treatment strategies aim at the suppression or effective termination of recurrent ventricular tachyarrhythmias and prevention of sudden death by antiarrhythmic drug therapy, catheter ablation, and the implantation of cardioverter-defibrillators.This review summarizes the current knowledge on pathogenesis, diagnosis, treatment and prognosis of those conditions that are associated with arrhythmias originating from the right ventricle.     

Arrhythmien bei Patienten mit operativ korrigierter Fallot-Tetralogie

The population of adults with surgically corrected tetralogy of Fallot (TOF) is increasing. Atrial and ventricular arrhythmias are prevalent, and therapeutical approaches including implantable cardioverter-defibrillators and radiofrequency catheter ablation need to be considered carefully for the prevention of hemodynamic deterioration and sudden cardiac death. Complex anatomy, myocardial hypertrophy, and broad channels of slow conduction may in part explain some challenges regarding risk stratification, and identification/modification of the arrhythmogenic substrate in these patients. The aim of this brief review is 2-fold: (1.) To present insights into characteristics of typical TOF related arrhythmias and (2.) to reflect therapeutical concepts targeting tachyarrhythmias in these patients by focusing on catheter ablation.     

Arrhythmien bei Erwachsenen mit angeborenen Herzfehlern

Arrhythmia management is one of the main challenges in the treatment of adult patients with congenital heart disease (ACHD). Apart from heart failure, arrhythmias are mainly responsible for morbidity and mortality in these patients. Supraventricular tachycardia is more frequent than ventricular arrhythmias and is not only associated with debilitating symptoms, but is often as threatening as ventricular tachycardia. The incidence depends on the underlying defect, type, and time of repair. For the overall ACHD population the incidence of supraventricular tachycardia is up to 50?% and increases with age and time since surgery. Arrhythmia substrate relates to structural abnormalities due to the congenital defect and most importantly to the amount of incisions and material used for repair. In addition, poor hemodynamic conditions influence substrate through dilatation, hypertrophy, and fibrosis. Both supraventricular and ventricular arrhythmias are due to a macroreentrant mechanism in the vast majority of patients, but focal arrhythmias occasionally occur as well.     

Neue Therapiemöglichkeiten für Arrhythmien durch Katheterablation

Radiofrequency current ablation has been developed over the last 20 years to be the standard approach for treating tachycardia by catheter ablation. By combining new 3-D imaging technology (CT and MRI) with 3-D electrophysiologic mapping systems, a new tool has been created to display the cardiac activation sequence of the individual. These technologies are extremely important for the treatment of complex arrhythmias such as the catheter ablation of atrial fibrillation. Instead of the conventional “point by point” linear ablation procedure, balloon catheters have been applied to a circumferential linear lesion in a “single shot” procedure using, for example, cryothermia, ultrasound or laser energy. Finally, magnetic navigation is a new steering tool for performing ablation procedures, leading to reduced exposure to ionizing radiation.     

Dysphagie: Diagnostik auf der IntensivstationVideoendoskopische und akustische Diagnostik

Zusammenfassung Schluckst?rungen sind in der Neurologie ein sehr h?ufiges Problem. Unabh?ngig von der Grunderkrankung kann es aber auf jeder Intensivstation im Zuge nachlassender Vigilanz des Patienten zu Schluckst?rungen kommen. Von den verschiedenen diagnostischen M?glichkeiten ist die videoendoskopische Pharyngoskopie diejenige, die am ehesten auf einer Intensivstation eingesetzt werden kann. Zusammen mit Schluckger?uschen liefert sie eine Reihe von Informationen über Art und Ausma? der Schluckst?rung. Es ist eine komplikationsarme und einfach zu handhabende Untersuchungsmethode. Eingegangen: 20. Dezember 2000 /Akzeptiert: 21. M?rz 2001