Dtsch Med Wochenschr 2020; 145(08): 526-535
DOI: 10.1055/a-0969-6402
Dossier

Antiarrhythmika: Welche Rolle spielen sie heute noch?

Is There Still a Need for Medical Antiarrhythmic Therapy?
Thomas H Fischer

Abstract

The use of medical antiarrhythmic therapy apart from beta-blockers has been steadily decreasing in the recent past. This can partly be attributed to technological progress that has rendered the ablation of complex cardiac arrhythmias like atrial fibrillation, focal atrial tachycardias and ventricular arrhythmias feasible and efficacious. Furthermore, an awareness regarding pro-arrhythmic and toxic side-effects of antiarrhythmic medication has evolved. Nevertheless, medical antiarrhythmic therapy still plays a fundamental role in acute therapy of arrythmias as well as certain indications for long-term therapy. This review comprehensively summarizes the current role of medical antiarrhythmic therapy in daily clinical practice focusing on mechanisms and therapies of the most common cardiac arrythmias.

Der Gebrauch von Antiarrhythmika außerhalb einer Betablocker-Therapie ist in den letzten Jahren rückläufig. Gründe hierfür sind neben der sich stetig verbessernden Möglichkeit der Ablation von Herzrhythmusstörungen auch eine schlechtere Nutzen-Risiko-Relation einiger Antiarrhythmika. Dennoch besitzen sie in der Kardiologie einen festen Stellenwert und sind noch lange nicht verzichtbar.



Publication History

Article published online:
15 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18: 1609-1678
  • 2 Al-Khatib SM, Allen La Pointe NM, Chatterjee R. et al. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med 2014; 160: 760-773
  • 3 Morales DR, Jackson C, Lipworth BJ. et al. Adverse respiratory effect of acute beta-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials. Chest 2014; 145: 779-786
  • 4 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37: 2129-2200
  • 5 Ziff OJ, Lane DA, Samra M. et al. Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data. BMJ 2015; 351: h4451
  • 6 Van Gelder IC, Groenveld HF, Crijns HJ. et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363-1373
  • 7 Wang RX, Lee HC, Hodge DO. et al. Effect of pacing method on risk of sudden death after atrioventricular node ablation and pacemaker implantation in patients with atrial fibrillation. Heart Rhythm 2013; 10: 696-701
  • 8 Gitt AK, Smolka W, Michailov GA. et al. Types and outcomes of cardioversion in patients admitted to hospital for atrial fibrillation: results of the German RHYTHM-AF Study. Clin Res Cardiol 2013; 102: 713-723
  • 9 Packer DL, Mark DB, Robb RA. et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA 2019; 321: 1261-1274
  • 10 Marrouche NF, Kheirkhahan M, Brachmann J. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 379: 492
  • 11 January CT, Wann LS, Calkins HM. et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Heart Rhythm 2019; 16: e66-e93
  • 12 Køber L, Torp-Pedersen C, McMurray JJ. et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008; 358: 2678-2687
  • 13 Waldo AL, Camm AJ, deRuyter H. et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 1996; 348: 7-12
  • 14 Brubaker S, Long B, Koyfman A. et al. Alternative Treatment Options for Atrioventricular-Nodal-Reentry Tachycardia: An Emergency Medicine. Emerg Med 2018; 54: 198-206
  • 15 Priori SG, Blomström-Lundqvist C, Mazzanti A. et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2015; 36: 2793-2867
  • 16 Reddy VY, Reynolds MR, Neuzil P. et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med 2007; 357: 2657-2665
  • 17 Kuck KH, Schaumann A, Eckardt L. et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 2010; 375: 31-40
  • 18 Kuck KH, Tilz RR, Deneke T. et al. Impact of Substrate Modification by Catheter Ablation on Implantable Cardioverter-Defibrillator Interventions in Patients With Unstable Ventricular Arrhythmias and Coronary Artery Disease. Circ Arrhythm Electrophysiol 2017; DOI: 10.1161/CIRCEP.116.004422.
  • 19 Ruskin JN. The cardiac arrhythmia suppression trial (CAST). N Engl J Med 1989; 321: 386-388
  • 20 Singh SN, Fletcher RD, Fisher SG. et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med 1995; 333: 77-82
  • 21 Sapp JL, Wells GA, Parkash R. et al. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med 2016; 375: 111-121