Herzschrittmachertherapie bei Sinusknotenerkrankung, Reflexsynkopen, seltenen Herzerkrankungen & besonderen Situationen

Zusammenfassung

Durch die neuen ESC-Leitlinien zur Herzschrittmacher- und kardialen Resynchronisationstherapie ändert sich die Indikationsstellung nur in wenigen Bereichen. Für Patienten mit Tachykardie-Bradykardie-Syndrom, bei denen Vorhofflimmern nicht primär mit Katheterablation behandelt werden soll, wird die Indikation zur Schrittmachertherapie erleichtert. Gleiches gilt aber auch für Patienten mit Sinusknotenerkrankung und vermutetem Symptom-EKG-Zusammenhang, die nun im Gegensatz zu den Leitlinien von 2013 auch bei leichter Symptomatik und ohne definierte Pausenlänge im Einzelfall einen Schrittmacher erhalten können. Bei Verdacht auf Reflexsynkopen wird analog zur Synkopenleitlinie von 2018 ein diagnostischer Algorithmus aus Kipptischuntersuchung, Karotis-Druckversuch und – im Fall von nicht diagnostischen Ergebnissen – Implantation eines Ereignisrekorders empfohlen. Erstmals finden sich auch eigenständige Indikationen zur Schrittmachertherapie nach Implantation von Transkatheter-Aortenklappen.

Abstract

In general, pacemaker indications were only slightly changed through the 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. For patients with bradycardia-tachycardia syndrome, who are not candidates for catheter ablation of atrial fibrillation, pacemaker indication is facilitated. Same is true for patients with sinus node disease, in whom a correlation between ECG findings and symptoms is only suspected: in contrast to the 2013 ESC guidelines, a pacemaker may be implanted even in absence of severe symptoms and without evidence of pauses increasing a defined length. Similar to 2018 ESC guidelines on syncopes, an algorithm is recommended for patients suspected for reflex syncopes compromising tilt table testing, carotis sinus massage and – in case of negative or unclear results – implantation of a loop recorder. For the first time, special indications for pacemaker implantation after transcatheter aortic valve replacement were recommended.

Schlüsselwörter

Sinusknotenerkrankung - Indikation zur Schrittmachertherapie in besonderen Situationen - Reflexsynkopen

Keywords

sinus node dysfunction - indications for pacing in specific conditions - reflex syncope

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