Akuttherapie anhaltender hämodynamisch tolerierter Kammertachykardien

Zusammenfassung

Anhaltende Kammertachykardien sind potenziell lebensbedrohliche Herzrhythmusstörungen. Eine medikamentöse Behandlung mit dem Ziel der Terminierung der Rhythmusstörung kommt dann infrage, wenn sie hämodynamisch ausreichend toleriert wird. Ausgesprochen effektiv und dem Lidocain deutlich überlegen sind Klasse IC-Antiarrhythmika wie Flecainid und Propafenon oder auch Ajmalin (Klasse IA/IC). Sotalol ist zwar auch wirksam, aufgrund der beta-sympathikolytischen Wirkungskomponente ist aber Vorsicht geboten. Amiodaron wird gerne eingesetzt, obwohl systematische Studien zur Akutwirkung bei anhaltender Kammertachykardie fehlen. Wirksamkeitsbelege liegen für die Behandlung rezidivierender, hämodynamisch instabiler Tachykardien vor. Hat sich ein Antiarrhythmikum als unwirksam erwiesen, sollte auf weitere pharmakologische Therapieversuche verzichtet und eine elektrische Kardioversion durchgeführt werden.

Abstract

Sustained monomorphic ventricular tachycardia is a potentially life-threatening ventricular tachycardia. The arrhythmia can be treated with antiarrhythmic drugs, when the patient is hemodynamically stable. Class IC antiarrhythmic drugs like flecainide and propafenon or ajmaline (class IA/IC) are very effective. The use of lidocaine is obsolete. Sotalol is also effective, however, caution is advised because of its significant beta-sympatholytic properties. Amiodaron is frequently used, although it has never been studied in the setting of stable ventricular tachycardia. Earlier studies have demonstrated that it is effective in the treatment of recurrent, hemodynamically unstable ventricular tachycardia. When a particular drug does not terminate tachycardia, further drugs should not be given. Electrical cardioversion is preferred.

Ventrikuläre Tachykardie - Ajmalin - Flecainid - Propafenon - Amiodaron - Lidocain - Antiarrhythmika - elektrische Kardioversion

Ventricular tachycardia - ajmaline - amiodarone - flecainide - propafenone - lidocaine - antiarrhythmic drugs - electrical cardioversion

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