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Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 2/2014

01.06.2014 | Schwerpunkt

Elektrischer Sturm

Definition, Häufigkeit, Ursachen und prognostische Implikationen

verfasst von: PD Dr. med. Carsten W. Israel, Johannes C. Manegold

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 2/2014

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Zusammenfassung

Hintergrund

Der elektrische Sturm („electrical storm“, ES) bezeichnet einen Zustand kardialer elektrischer Instabilität, der sich in multiplen Episoden ventrikulärer Tachyarrhythmien (VTs) innerhalb kurzer Zeit äußert. Bei Patienten mit ICD wird ein ES durch ≥ 3 adäquate VT-Detektionen innerhalb von 24 h definiert, die durch antitachykarde Stimulation oder Schocks terminiert wurden. Inadäquate Detektionen und die Schockzahl sind für die ES-Definition irrelevant. Ein ES trat innerhalb von 3 Jahren bei etwa 25 % der ICD-Patienten mit einer sekundärprophylaktischen Indikation auf. Obwohl auch weniger schwere arrhythmische Ereignisse in die ES-Definition eingeschlossen werden, besteht er häufig aus bis zu 50 VTs. Mögliche Auslöser, die bei 20–65 % der Patienten gefunden wurden, schließen dekompensierte Herzinsuffizienz, Diarrhö/Hypokaliämie, Änderungen der Medikation, Zusammenhang mit anderen Erkrankungen und psychische Belastungen ein. Bei den meisten Patienten besteht ein ES aus monomorphen VTs, was für Reentry als Grundmechanismus spricht, während Kammerflimmern als Zeichen einer Ischämie selten beobachtet wird.

Material und Methoden

Der ES scheint eine niedrige unmittelbare Mortalität zu besitzen (1 %), führt jedoch oft (50–80 %) zu einer Hospitalisation. Die prognostische Langzeitbedeutung ist unklar. Die zentrale Therapie des ES besteht in einer Reduktion des erhöhten Sympathikotonus durch b-Blocker und Sedierung. Amiodaron i.v. ist effektiv in der Terminierung eines ES, während Klasse-I-Antiarrhythmika i. d. R. ineffektiv sind. Substratmapping und VT-Ablation scheinen in der Therapie und Prävention des ES wertvoll zu sein. Die Vermeidung eines ES ist durch eine ICD-Programmierung möglich mit Vermeidung unnötiger Schocks durch lange VT-Detektionszeiten und zahlreiche antitachykarde Stimulationsversuche vor Schockabgabe, die den Sympathikustonus anheizen und einen ES verlängern können.
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Metadaten
Titel
Elektrischer Sturm
Definition, Häufigkeit, Ursachen und prognostische Implikationen
verfasst von
PD Dr. med. Carsten W. Israel
Johannes C. Manegold
Publikationsdatum
01.06.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 2/2014
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-014-0321-y

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