Zusammenfassung
Bradykarde Arrhythmien können vielfältige Ursachen haben, es handelt sich vor allem um Störungen der Reizbildung und/oder der Reizleitung. Sie äußern sich in der Regel durch Störungen im Sinusknoten, AV-Knoten oder Schenkelblockbilder. Die Therapie richtet sich nach der Symptomatik und den erhobenen klinischen und elektrokardiografischen Befunden und kann medikamentös oder mittels elektrotherapeutischer Strategien wie transkutaner, transösophagealer oder transvenöser Schrittmacherstimulation erfolgen. Die Extremformen Asystolie, Kammerflattern und Kammerflimmern sind akut lebensbedrohlich und erfordern umgehende therapeutische Maßnahmen.
Abstract
The incidence of bradyarrhythmias (BA) is caused by sinus node dysfunction (SND), high degree atrioventricular (AV) block or bundle branch blocks. SND are sinus bradycardia, SA block or sinus arrest. 1st degree AV-block occurs in 4 – 13% of patients with acute coronary syndrome (ACS) caused by rhythm disturbances in atrium, AV node, bundle of His or the Tawara system. 1st or 2nd degree AV block is seen very frequently within 24 h after beginning of ACS and these arrhythmias are frequently transient and no more present after 72 h. 3rd degree AV blocks are also frequently transient in patients with infero-posterior myocardial infarction (MI) and permanent in anterior MI patients. Left anterior fascicular block occurs in 5% of ACS, left posterior fascicular block is observed less frequently (incidence < 0.5%). Complete bundle branch block is present in 10 – 15% of ACS patients and right bundle branch block is more often (⅔) present than left bundle branch block (⅓). In patients with BA atropine i. v. is helpful in 70 – 80% of ACS patients and will lead to an increased heart rate. The need of pacemaker stimulation (PS) is different in patients with inferior (IMI) or anterior MI (AMI). Whereas BA are frequently transient in patients with IMI without the need of permanent PS, there is usually a need of permanent PS in patients with AMI. In these patients BA are mainly caused by a septal necrosis.
Schlüsselwörter
akutes Koronarsyndrom - bradykarde Arrhythmie - Elektrostimulation
Key words
acute coronary syndrome - bradyarrhythmias - tachyarrhythmias - electrostimulation
