Zusammenfassung
Die Indikation zur medikamentösen Therapie von Herzrhythmusstörungen hat sich in den letzten Jahren durch die Entwicklung invasiver Therapieverfahren stark gewandelt. Dennoch haben Antiarrhythmika auch weiterhin einen hohen Stellenwert in der Akutbehandlung sowie Rezidivprophylaxe von Rhythmusstörungen. Neben den „klassischen” Antiarrhythmika Klasse IC und III können primär oder additiv auch Betablocker, ACE-Hemmer sowie AT1-Antagonisten eingesetzt werden, da sie über eine geringere kardiale Nebenwirkungsrate verfügen. Bei Patienten mit Vorhofflimmern konnten neuere Studien keine Überlegenheit einer Rhythmuskontrolle gegenüber einer Frequenzkontrolle nachweisen. Dennoch erscheint eine Rhythmuskontrolle mit Antiarrhythmika bei stark symptomatischen bzw. hämodynamisch beeinträchtigten Patienten sinnvoll. Die medikamentöse Hybridtherapie und die „Pill in the pocket”-Strategie stellen neue Therapieansätze dar, die bei bestimmten Patientenkollektiven angewendet werden können.
Summary
Over the last years the indication for antiarrythmic therapy has changed due to the development of other therapeutic approaches. However, antiarrhythmics are important in the acute treatment as well as the prevention of recurrent rhythm disorders. In line with the antiarrhythmic agents of class IC and III also beta-blockers, ACE inhibitors and AT1 antagonists can be used primarily with a lower risk of severe cardiac side effects. Recent studies demonstrate that for patients with atrial fibrillation there was no benefit of rhythm control versus rate control. However, rhythm control with antiarrhythmics is beneficial in the treatment of highly symptomatic or hemodynamically compromised patients. Hybrid therapy and the „pill in the pocket”-strategy seem to be potent new therapeutic options.
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Dr. med. Monica Patten
Universitäres Herzzentrum, Kardiologie, Universitätsklinikum Hamburg-Eppendorf
Martinistraße 52
20246 Hamburg
Telefon: 040/428035989
Fax: 040/428034884
eMail: patten@uke.uni-hamburg.de
