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Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 2/2016

20.05.2016 | Tachykarde Herzrhythmusstörungen | Übersichten

Ablation supraventrikulärer Tachykardien

Komplikationen und Notfälle

verfasst von: N. Sawan, C. Eitel, H. Thiele, PD Dr. med. univ. R. Tilz

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 2/2016

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Zusammenfassung

Die Katheterablation supraventrikulärer Tachykardien (SVT) hat sich in den vergangenen Jahren als Standardtherapieverfahren etabliert. Die Erfolgsraten der Ablationstherapie sind bei den meisten Formen der supraventrikulären Tachykardien hoch (i. d. R > 95 %). Komplikationen treten in ca. 3–5 % der Untersuchungen auf, wobei die Rate schwerwiegender Komplikationen bei ca. 0,8 % liegt. Prinzipiell unterscheidet man allgemeine Komplikationen, die z. B. durch die eingeführten Katheter bedingt sind, wie z. B. Hämatome, Embolie, Thrombose, sowie spezielle Risiken, wie z. B. der AV-Block bei der Ablation einer AV-Knoten-Reentry-Tachykardie. Besonders gefährdet sind ältere und multimorbide Patienten. Außerdem spielt die Erfahrung des durchführenden Untersuchers bzw. des Behandlungsteams eine wesentliche Rolle bezüglich der Komplikationsrate. Ziel der vorliegenden Übersicht ist es, Häufigkeiten, Ursachen und Management sowie Vermeidungsstrategien von Komplikationen und Notfällen der Katheterablation supraventrikulärer Tachykardien darzustellen.
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Literatur
1.
Zurück zum Zitat Hindricks G, Kottkamp H (2000) Komplikationen und Risiken der Hochfrequenzstrom-Katheterablation tachykarder Herzrhythmusstörungen. Z Kardiol 89(3):186–193CrossRefPubMed Hindricks G, Kottkamp H (2000) Komplikationen und Risiken der Hochfrequenzstrom-Katheterablation tachykarder Herzrhythmusstörungen. Z Kardiol 89(3):186–193CrossRefPubMed
2.
Zurück zum Zitat Joseph JP, Rajappan K (2012) Radiofrequency ablation of cardiac arrhythmias: past, present and future. QJM 105:303–314CrossRefPubMed Joseph JP, Rajappan K (2012) Radiofrequency ablation of cardiac arrhythmias: past, present and future. QJM 105:303–314CrossRefPubMed
3.
Zurück zum Zitat Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A (2005) Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111:1100–1105CrossRefPubMed Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A (2005) Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111:1100–1105CrossRefPubMed
4.
Zurück zum Zitat Zellerhoff S, Tilz R, Eckard L (2014) Komplikationen der Katheterablation von Vorhofflimmern. Herzschr Elektrophys 25:241–245CrossRef Zellerhoff S, Tilz R, Eckard L (2014) Komplikationen der Katheterablation von Vorhofflimmern. Herzschr Elektrophys 25:241–245CrossRef
5.
Zurück zum Zitat Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan GA, Gulizia M, Halvorsen S, Hindricks G, Kuck KH, Moya A, Potpara T, Roldan V, Tilz R, Lip GY, Esc Working Group Thrombosis, Heart Rhythm Society, Asia Pacific Heart Rhythm Society (Aphrs) (2015) Lip, and reviewers document, antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (Ehra) Position Document. Europace 17:1197–1214CrossRefPubMed Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan GA, Gulizia M, Halvorsen S, Hindricks G, Kuck KH, Moya A, Potpara T, Roldan V, Tilz R, Lip GY, Esc Working Group Thrombosis, Heart Rhythm Society, Asia Pacific Heart Rhythm Society (Aphrs) (2015) Lip, and reviewers document, antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (Ehra) Position Document. Europace 17:1197–1214CrossRefPubMed
6.
Zurück zum Zitat Hoffmann BA, Brachmann J, Andresen D, Eckardt L, Hoffmann E, Kuck KH, Schumacher B, Spitzer SG, Schirdewahn P, Tebbenjohanns J, Horack M, Senges J, Salukhe TV, Rostock T, Willems S (2011) Ablation of Atrioventricular nodal reentrant tachycardia in the elderly: results from the German ablation registry. Heart Rhythm 8:981–987CrossRefPubMed Hoffmann BA, Brachmann J, Andresen D, Eckardt L, Hoffmann E, Kuck KH, Schumacher B, Spitzer SG, Schirdewahn P, Tebbenjohanns J, Horack M, Senges J, Salukhe TV, Rostock T, Willems S (2011) Ablation of Atrioventricular nodal reentrant tachycardia in the elderly: results from the German ablation registry. Heart Rhythm 8:981–987CrossRefPubMed
7.
Zurück zum Zitat Hamdan M, Van Hare GF, Fisher W, Gonzalez R, Dorostkar P, Lee R, Lesh M, Saxon L, Kalman J, Scheinman M (1996) Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 78:1292–1297CrossRefPubMed Hamdan M, Van Hare GF, Fisher W, Gonzalez R, Dorostkar P, Lee R, Lesh M, Saxon L, Kalman J, Scheinman M (1996) Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 78:1292–1297CrossRefPubMed
8.
Zurück zum Zitat Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SK, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E, Atakr Multicenter Investigator Group (1999) Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the Atrioventricular junction: final results of a prospective, multicenter clinical trial. Circulation 99:262–270CrossRefPubMed Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SK, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E, Atakr Multicenter Investigator Group (1999) Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the Atrioventricular junction: final results of a prospective, multicenter clinical trial. Circulation 99:262–270CrossRefPubMed
9.
Zurück zum Zitat Bathina MN, Mickelsen S, Brooks C, Jaramillo J, Hepton T, Kusumoto FM (1998) Radiofrequency catheter ablation versus medical therapy for initial treatment of supraventricular tachycardia and its impact on quality of life and healthcare costs. Am J Cardiol 82:589–593CrossRefPubMed Bathina MN, Mickelsen S, Brooks C, Jaramillo J, Hepton T, Kusumoto FM (1998) Radiofrequency catheter ablation versus medical therapy for initial treatment of supraventricular tachycardia and its impact on quality of life and healthcare costs. Am J Cardiol 82:589–593CrossRefPubMed
10.
Zurück zum Zitat Kuck KH, Ernst S, Dorwarth U, Hoffmann E, Pitschner H, Tebbenjohanns J, Kottkamp H (2007) Guidelines for catheter ablation. Clin Res Cardiol 96:833–849CrossRefPubMed Kuck KH, Ernst S, Dorwarth U, Hoffmann E, Pitschner H, Tebbenjohanns J, Kottkamp H (2007) Guidelines for catheter ablation. Clin Res Cardiol 96:833–849CrossRefPubMed
11.
Zurück zum Zitat Kistler PM, Sanders P, Fynn SP, Stevenson IH, Hussin A, Vohra JK, Sparks PB, Kalman JM (2003) Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: acute and long-term outcomes of radiofrequency ablation. Circulation 108:1968–1975CrossRefPubMed Kistler PM, Sanders P, Fynn SP, Stevenson IH, Hussin A, Vohra JK, Sparks PB, Kalman JM (2003) Electrophysiological and electrocardiographic characteristics of focal atrial tachycardia originating from the pulmonary veins: acute and long-term outcomes of radiofrequency ablation. Circulation 108:1968–1975CrossRefPubMed
12.
Zurück zum Zitat Kovoor P, Ricciardello M, Collins L, Uther JB, Ross DL (1998) Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation 98:1534–1540CrossRefPubMed Kovoor P, Ricciardello M, Collins L, Uther JB, Ross DL (1998) Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia. Circulation 98:1534–1540CrossRefPubMed
13.
Zurück zum Zitat Gilligan DM, Zakaib JS, Fuller I, Shepard RK, Dan D, Wood MA, Clemo HF, Stambler BS, Ellenbogen KA (2003) Long-term outcome of patients after successful radiofrequency ablation for typical atrial flutter. Pacing Clin Electrophysiol 26:53–58CrossRefPubMed Gilligan DM, Zakaib JS, Fuller I, Shepard RK, Dan D, Wood MA, Clemo HF, Stambler BS, Ellenbogen KA (2003) Long-term outcome of patients after successful radiofrequency ablation for typical atrial flutter. Pacing Clin Electrophysiol 26:53–58CrossRefPubMed
14.
Zurück zum Zitat Bohnen M, Stevenson WG, Tedrow UB, Michaud GF, John RM, Epstein LM, Albert CM, Koplan BA (2011) Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm 8:1661–1666CrossRefPubMed Bohnen M, Stevenson WG, Tedrow UB, Michaud GF, John RM, Epstein LM, Albert CM, Koplan BA (2011) Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm 8:1661–1666CrossRefPubMed
15.
Zurück zum Zitat Kolluri R, Fowler B, Nandish S (2013) Vascular access complications: diagnosis and management. Curr Treat Options Cardiovasc Med 15:173–187CrossRefPubMed Kolluri R, Fowler B, Nandish S (2013) Vascular access complications: diagnosis and management. Curr Treat Options Cardiovasc Med 15:173–187CrossRefPubMed
16.
Zurück zum Zitat Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NA 3rd, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM, American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Heart Rhythm Society (2015) Acc/Aha/Hrs guideline for the management of adult patients with supraventricular tachycardia. J Am Coll Cardiol. 2015 Sep 16. pii: S0735-1097(15)06203-8. doi: 10.1016/j.jacc.2015.09.019. [Epub ahead of print]PubMedCentral Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NA 3rd, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM, American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Heart Rhythm Society (2015) Acc/Aha/Hrs guideline for the management of adult patients with supraventricular tachycardia. J Am Coll Cardiol. 2015 Sep 16. pii: S0735-1097(15)06203-8. doi: 10.1016/j.jacc.2015.09.019. [Epub ahead of print]PubMedCentral
17.
Zurück zum Zitat Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Ricci C, Skanes A, Ranucci M (2011) Delayed cardiac tamponade after radiofrequency catheter ablation of atrial fibrillation: a worldwide report. J Am Coll Cardiol 58:2696–2697CrossRefPubMed Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Ricci C, Skanes A, Ranucci M (2011) Delayed cardiac tamponade after radiofrequency catheter ablation of atrial fibrillation: a worldwide report. J Am Coll Cardiol 58:2696–2697CrossRefPubMed
18.
Zurück zum Zitat Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW Jr, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, Cardiology American College, Guidelines American Heart Association Task Force on Practice, Arrhythmias European Society of Cardiology Committee for Practice Guidelines, American College of Cardiology/American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias (2003) Writing committee to develop guidelines for the management of patients with supraventricular, Acc/Aha/Esc guidelines for the management of patients with supraventricular arrhythmias – executive summary. Circulation 108:1871–1909CrossRefPubMed Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW Jr, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, Cardiology American College, Guidelines American Heart Association Task Force on Practice, Arrhythmias European Society of Cardiology Committee for Practice Guidelines, American College of Cardiology/American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias (2003) Writing committee to develop guidelines for the management of patients with supraventricular, Acc/Aha/Esc guidelines for the management of patients with supraventricular arrhythmias – executive summary. Circulation 108:1871–1909CrossRefPubMed
19.
Zurück zum Zitat Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, Moulton KP, Twidale N, Hazlitt HA, Prior MI et al (1992) Treatment of supraventricular tachycardia due to Atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med 327:313–318CrossRefPubMed Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, Moulton KP, Twidale N, Hazlitt HA, Prior MI et al (1992) Treatment of supraventricular tachycardia due to Atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med 327:313–318CrossRefPubMed
20.
Zurück zum Zitat Yune S, Lee WJ, Hwang JW, Kim E, Ha JM, Kim JS (2014) Acute myocardial infarction after radiofrequency catheter ablation of typical atrial flutter. J Korean Med Sci 29:292–295CrossRefPubMedPubMedCentral Yune S, Lee WJ, Hwang JW, Kim E, Ha JM, Kim JS (2014) Acute myocardial infarction after radiofrequency catheter ablation of typical atrial flutter. J Korean Med Sci 29:292–295CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Perez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA (2009) Long-term outcomes after catheter ablation of Cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythm Electrophysiol 2:393–401CrossRefPubMed Perez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA (2009) Long-term outcomes after catheter ablation of Cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythm Electrophysiol 2:393–401CrossRefPubMed
22.
Zurück zum Zitat Ferrero de Loma-Osorio A, Diaz-Infante E, Macias Gallego A, Collaborators Spanish Catheter Ablation Registry (2012) 12th official report of the Spanish society of cardiology working group on electrophysiology and arrhythmias. Rev Esp Cardiol (Engl Ed) 66(2013):983–992 Ferrero de Loma-Osorio A, Diaz-Infante E, Macias Gallego A, Collaborators Spanish Catheter Ablation Registry (2012) 12th official report of the Spanish society of cardiology working group on electrophysiology and arrhythmias. Rev Esp Cardiol (Engl Ed) 66(2013):983–992
23.
Zurück zum Zitat Haissaguerre M, Warin JF, Lemetayer P, Saoudi N, Guillem JP, Blanchot P (1989) Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med 320:426–433CrossRefPubMed Haissaguerre M, Warin JF, Lemetayer P, Saoudi N, Guillem JP, Blanchot P (1989) Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med 320:426–433CrossRefPubMed
24.
Zurück zum Zitat Spector SP, Reynolds MR, Calkins H, Sondhi M, Xu Y, Martin A, Williams CJ, Sledge I (2009) Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 104:671–677CrossRefPubMed Spector SP, Reynolds MR, Calkins H, Sondhi M, Xu Y, Martin A, Williams CJ, Sledge I (2009) Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol 104:671–677CrossRefPubMed
25.
Zurück zum Zitat Blanc JJ, Almendral J, Brignole M, Fatemi M, Gjesdal K, Gonzalez-Torrecilla E, Kulakowski P, Lip GY, Shah D, Wolpert C, Association Scientific Initiatives Committee of the European Heart Rhythm (2008) Consensus document on antithrombotic therapy in the setting of electrophysiological procedures. Europace 10:513–527CrossRefPubMed Blanc JJ, Almendral J, Brignole M, Fatemi M, Gjesdal K, Gonzalez-Torrecilla E, Kulakowski P, Lip GY, Shah D, Wolpert C, Association Scientific Initiatives Committee of the European Heart Rhythm (2008) Consensus document on antithrombotic therapy in the setting of electrophysiological procedures. Europace 10:513–527CrossRefPubMed
26.
Zurück zum Zitat Jais P, Shah DC, Haissaguerre M, Hocini M, Peng JT, Takahashi A, Garrigue S, Le Metayer P, Clementy J (2000) Mapping and ablation of left atrial flutters. Circulation 101:2928–2934CrossRefPubMed Jais P, Shah DC, Haissaguerre M, Hocini M, Peng JT, Takahashi A, Garrigue S, Le Metayer P, Clementy J (2000) Mapping and ablation of left atrial flutters. Circulation 101:2928–2934CrossRefPubMed
27.
Zurück zum Zitat Fenelon G, d’Avila A, Malacky T, Brugada P (1995) Prognostic significance of transient complete atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia. Am J Cardiol 75:698–702CrossRefPubMed Fenelon G, d’Avila A, Malacky T, Brugada P (1995) Prognostic significance of transient complete atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia. Am J Cardiol 75:698–702CrossRefPubMed
28.
Zurück zum Zitat Moubarak G, Bonhomme S, Vedrenne G, Bouleti C, Ollitrault J, Priollet P, Cador R, Cazeau S (2013) Femoral Vein Thrombosis after Right-Sided Electrophysiological Procedures. J Interv Card Electrophysiol 38:155–158CrossRefPubMed Moubarak G, Bonhomme S, Vedrenne G, Bouleti C, Ollitrault J, Priollet P, Cador R, Cazeau S (2013) Femoral Vein Thrombosis after Right-Sided Electrophysiological Procedures. J Interv Card Electrophysiol 38:155–158CrossRefPubMed
Metadaten
Titel
Ablation supraventrikulärer Tachykardien
Komplikationen und Notfälle
verfasst von
N. Sawan
C. Eitel
H. Thiele
PD Dr. med. univ. R. Tilz
Publikationsdatum
20.05.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 2/2016
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-016-0422-x

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