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DOI: 10.1055/s-0033-1360043
Bradykarde Rhythmusstörungen
Teil 2: TherapieBradycardic arrhythmiasPart 2: treatmentPublication History
22 April 2013
19 November 2013
Publication Date:
11 February 2014 (online)
Zusammenfassung
Klinisch symptomatische bradykarde Herzrhythmusstörungen aufgrund von Reizbildungs- und Reizleitungsstörungen führen in der Regel zur Indikation einer Schrittmacherimplantation. Es gibt aber auch eine Reihe von prognostischen Indikationen für eine Schrittmacherimplantation bei asymptomatischen Patienten, allerdings häufig mit einem niedrigeren Empfehlungsgrad. Nach akutem Myokardinfarkt bzw. herzchirurgischen Eingriffen kann bei Auftreten von Bradykardien die Implantation eines Schrittmachers notwendig werden. Vor einer definitiven Schrittmacherimplantation müssen reversible bzw. vermeidbare Ursachen abgeklärt bzw. behandelt werden. Nur zur Akuttherapie symptomatischer Bradykardien kann als überbrückende Maßnahme eine medikamentöse Therapie in Betracht kommen. Zur Schrittmacherversorgung stehen verschiedene Systeme zur Verfügung. Es werden temporäre von permanenten sowie Ein-, Zwei- und Dreikammersysteme unterschieden. Darüber hinaus werden sondenlose Schrittmachersysteme erprobt.
Abstract
Clinically symptomatic bradycardia arrhythmias due to disorders of impulse formation and conduction usually lead to an indication for pacemaker implantation. On the other hand, there are also a number of prognostic indications for pacemaker implantation in asymptomatic patients, but often with a lower class of recommendation. After acute myocardial infarction or cardiac surgery the implantation of a pacemaker may be necessary for the occurrence of bradycardia. Prior to a definitive pacemaker implantation reversible or preventable causes must be investigated and treated. Only for acute treatment of symptomatic bradycardia as a bridging measure drug therapy can be considered. For pacemaker supply various systems are available. We distinguish temporary from permanent systems and one-, two-and three-chamber systems. In addition, leadless pacemaker systems are tested.
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