Kardiale Resynchronisation

Zusammenfassung

Die kardiale Resynchronisationstherapie ist eine Option zur Therapie der Herzinsuffizienz, die über eine Korrektur der häufig assoziierten Erregungsleitungsstörungen zu einer Verbesserung der kardialen Hämodynamik und Belastbarkeit führt. Besonders profitieren Patienten mit einer Herzinsuffizienz vom Stadium III nach der New York Heart Association (NYHA), systolisch eingeschränkter linksventrikulärer Funktion, verbreitertem QRS-Komplex mit Linksschenkelblock-Morphologie und erhaltenem Sinusrhythmus. Daneben sind eine Herzdilatation, eine eingeschränkte Kontraktilität, das Vorhandensein einer funktionellen Mitralinsuffizienz und eine eingeschränkte maximale Sauerstoffaufnahme im kardiopulmonalen Belastungstest vor der Implantation wichtige prädiktive Faktoren. In Zukunft wird vermutlich die Echokardiographie eine größere Rolle zur Patientenidentifikation und Therapiesteuerung einnehmen. Noch nicht hinreichend geklärt ist der Nutzen bei Patienten mit Vorhofflimmern, auch die Frage zum optimalen Stimulationsmodus (bi- oder linksventrikulär) ist noch offen. Momentan wird noch untersucht, ob die kardiale Resynchronisation die Letalität beeinflussen kann. Dennoch besteht bereits eine mögliche Indikation zum Einsatz der Therapie nach den aktualisierten Leitlinien der amerikanischen Fachgesellschaften für geeignete Patienten nach Ausschöpfung der medikamentösen Therapie. Auch die „Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung” hat kürzlich eine Therapieempfehlung publiziert.

Summary

Cardiac resynchronisation is an option in the treatment of heart failure which, by correcting the commonly associated conduction disturbances, improves cardiac haemodynamics and performance. This treatment benefits in particular patients with stage III heart failure (New York Heart Association), reduced left ventricular systolic function, widened QRS complex with left bundle block morphology and preserved sinus rhythm. Major predictors are dilated cardiomyopathy, impaired contractility, presence of functional mitral valve insufficiency and reduced maximal oxygen uptake as recorded in cardiopulmonary tests prior to implantation. It is to be expected that, in future, echocardiography will play a greater role in the identification of patients and treatment management. The benefit to patients with atrial fibrillation remains uncertain, and the question as to what constitutes optimal stimulation (biventricular or left-ventricular) has not yet been fully clarified. Currently, the possible impact of cardiac resynchronisation on mortality is under investigation. Nevertheless, we already have a possible indication for this therapeutic option in accordance with the updated guidelines of relevant American associations, for suitable patients in whom the possibilities of pharmacotherapy have been exhausted. A recommendation by the German Society of Cardiology and Cardiocirculatory Research was also published recently.

Key Words

cardiac resynchronisation - heart failure - conduction disturbances - cardiac haemodynamics

Literatur

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1 cardiac resynchronisation in heart failure

2 comparison of medical therapy, pacing, and defibrillation in chronic heart failure

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