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Aktuelle Kardiologie 2016; 5(04): 248-254
DOI: 10.1055/s-0042-111334
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

VES im Langzeit-EKG: Was tun?

VPB During Holter Monitoring: What to Do?
T. Klingenheben
Praxis für Kardiologie/Ambulante Herzkatheterkooperation Bonn, und Goethe-Universität Frankfurt am Main
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Publication History

Publication Date:
12 August 2016 (online)

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Zusammenfassung

Die Bedeutung ventrikulärer Extrasystolen (VES) im Langzeit-EKG hat in den letzten 25 Jahren einen gewissen Wandel erfahren. Die prognostische Wertigkeit scheint stark abhängig von der Häufung der Arrhythmie und einer etwaigen begleitenden kardialen Grunderkrankung. Zudem scheint das Fehlen von Symptomen durch VES zumindest bei Patienten mit deutlich gehäufter Extrasystolie eher auf eine ungünstige Prognose hinzuweisen. Ebenso weisen jüngere Untersuchungen darauf hin, dass häufige VES bei Patienten ohne strukturelle Herzerkrankungen möglicherweise ein Risiko für spätere kardiale Endpunktereignisse indizieren, mutmaßlich durch die Entwicklung einer Tachymyopathie. Der Analyse der Kopplungsintervalle von VES und nicht anhaltenden VT kommt in diesem Kontext besondere Bedeutung zu, da kurz angekoppelte VES einen Marker für maligne ventrikuläre Tachyarrhythmien – wie bspw. bei idiopathischem Kammerflimmern – darstellen können.

Abstract

The clinical relevance of ventricular premature beats (VPB) detected during 24 h Holter monitoring has undergone a change. The prognostic significance depends on the frequency of the arrhythmia and the presence or absence of underlying structural heart disease. A lack of symptoms does not necessarily correlate with a good prognosis – at least if VPBs are frequent. For instance, very frequent ventricular ectopy (≥ 20 % VPBs out of all RR intervals) indicate a risk for future cardiac events, particularly due to development of VPB-induced cardiomyopathy (‘tachymyopathy’). Analysis of the VPB coupling intervals is also vital with regard to risk stratification, since short-coupled VPBs are associated with malignant ventricular tachyarrhythmias, e.g. idiopathic ventricular fibrillation.

Schlüsselwörter

ventrikuläre Extrasystolie - Langzeit-EKG - Kardiomyopathie - plötzlicher Herztod

Key words

ventricular premature beats - Holter recording - cardiomyopathy - sudden cardiac death
 

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