Rhythmogene Synkopen - Wann sind sie prognostisch unbedeutend, wann lebensbedrohlich? - Auslöser sind brachykarde oder tachykarde Herzrhythmusstörungen

Rhythmogene Synkopen sind die zweithäufigste Ursache synkopaler Zustände. Abhängig von der Art und Frequenz der Arrhythmie und dem kardialen Erkrankungszustand können sowohl bradykarde als auch tachykarde Herzrhythmusstörungen zu einem Low-Output-Syndrom, zerebraler Minderperfusion und schließlich transienter Bewusstlosigkeit führen. Durch ihr sporadisches Auftreten und die meist fehlende EKG-Dokumentation ist die Diagnosestellung oftmals schwierig, nichtsdestotrotz aber enorm wichtig, da rhythmogene Synkopen als Prodromi lebensbedrohlicher ventrikulärer Arrhythmien auftreten können. Die Therapie richtet sich nach der Art und Schwere der symptomatischen Arrhythmie mit dem Ziel, die Gefährdung des Patienten durch den plötzlichen Herztod zu minimieren, Rezidive von Synkopen zu vermeiden sowie die Lebensqualität der Patienten zu verbessern. Neben dem Einsatz von Medikamenten steht heute als Therapieoption die Katheterablation vor allem bei regelmäßigen supraventrikulären Arrhythmien zur Verfügung, die Schrittmachertherapie bei Bradyarrhythmien sowie die Implantation eines Kardioverters/Defibrillators bei Hochrisikopatienten mit ventrikulären Tachyarrhythmien.

Cardiac arrhythmias are the second most frequent cause of syncope in clinical practice. Depending on the type and rate of the arrhythmia as well as on the disease state of the patient bradyarrhythmias as well as tachyarrhythmias can lead to a low-output-syndrome, cerebral hypoperfusion and finally transient loss of consciousness. Their sporadic occurrence and the missing ECG documentation of the arrhythmia during syncope make the diagnosis often difficult, but important since syncopal events can present as prodromi of life-threatening ventricular arrhythmias. The therapy of cardiac arrhythmias is guided by the type and severity of the symptomatic arrhythmia and aims at prevention of sudden cardiac death, recurrence of syncope and improvement in quality of life. Besides the usage of pharmacological therapies, catheter ablation for supraventricular tachycardias and pacemaker therapy in patients with bradyarrhythmias as well as the implantation of the cardioverter/defibrillator are currently available therapy options in patients with ventricular arrhythmias as the primary cause of syncope.

Key words

syncope - arrhythmia - sudden cardiac death - defibrillator - pacemaker - catheter ablation

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