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01.06.2009 | Interventionelle Elektrophysiologie

Mapping und Katheterablation von Kammertachykardien bei Patienten mit ischämischer Kardiomyopathie

Ein Update

verfasst von: Dr. D. Steven, T. Rostock, B.A. Hoffmann, H. Servatius, K. Müllerleile, T. Meinertz, S. Willems

Erschienen in: Die Kardiologie | Ausgabe 3/2009

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Zusammenfassung

Das Vorliegen einer ischämischen Kardiomyopathie begünstigt das Auftreten von Kammertachykardien (VT). Diese stellen in den meisten Fällen eine Notfallsituation dar und können bei Patienten mit implantiertem Defibrillator (ICD) zu rezidivierenden Schockabgaben führen. Der zugrunde liegende Mechanismus ist hierbei häufig eine durch einen Myokardinfarkt bedingte Zone langsamer Leitung im Bereich des narbig veränderten Ventrikelmyokards, welche die Entstehung und Aufrechterhaltung einer Reentry-Tachykardie ermöglicht. Diese kann bei ausreichender hämodynamischer Toleranz im elektrophysiologischen Labor konventionell mittels Entrainment und Stimulationsmapping charakterisiert werden. Darüber hinaus stehen heute 3-dimensionale Mappingsysteme zur Verfügung, die das Verständnis des Substrates und der häufig instabilen und multiplen Tachykardien verbessern helfen können. Die heute meist zur ICD-Therapie adjuvante Katheterablation verhindert mit einer Erfolgsrate von ca. 70–80% das erneute Auftreten von VTs, die häufig der Schockentladung bedürfen. In 10–15% der Fälle ist eine Kombination von endo- und epikardialer Ablation erforderlich. Selten kann auch die Ablation mittels intrakoronarer Ethanolapplikation notwendig sein. In Zukunft könnten verbesserte Kathetertechnologie, neue Mappingsysteme und robotische Navigationsmöglichkeiten die Erfolgsraten der VT-Ablation bei Patienten mit ischämischer Kardiomyopathie weiter verbessern helfen.
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Metadaten
Titel
Mapping und Katheterablation von Kammertachykardien bei Patienten mit ischämischer Kardiomyopathie
Ein Update
verfasst von
Dr. D. Steven
T. Rostock
B.A. Hoffmann
H. Servatius
K. Müllerleile
T. Meinertz
S. Willems
Publikationsdatum
01.06.2009
Verlag
Springer-Verlag
Erschienen in
Die Kardiologie / Ausgabe 3/2009
Print ISSN: 2731-7129
Elektronische ISSN: 2731-7137
DOI
https://doi.org/10.1007/s12181-008-0156-z

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