Der rhythmologische Notfall – Wie helfen Algorithmen bei Diagnose und Therapie?

Herzrhythmusstörungen können ein variables klinisches Bild von unspezifischen Symptomen bis hin zum plötzlichen Herztod zeigen. Eine Herausforderung liegt in der Einordnung und Initialtherapie der unterschiedlichen Herzrhythmusstörungen mittels der in der Akutsituation begrenzten diagnostischen und therapeutischen Möglichkeiten. Hilfreich sind dabei vereinfachende Algorithmen zur raschen Ableitung der therapeutischen Maßnahmen. Zentrale Bedeutung kommt der Einschätzung der hämodynamischen Stabilität des Patienten zu, da sich danach die Dringlichkeit der antiarrhythmischen Therapie richtet. Neben der akuten elektrischen Kardioversion können in der Notfallmedizin mit einer eingeschränkten Auswahl an antiarrhythmischen Wirkstoffen die meisten klinisch relevanten Arrhythmien suffizient behandelt werden.

Cardiac arrhythmias may offer variable clinical presentations, ranging from unspecific symptoms to sudden cardiac death. Rapid diagnosis and initiation of appropriate treatment in the acute setting can be challenging. Algorithms are helpful to facilitate therapeutic decisions. Urgency of antiarrhythmic therapy depends primarily on the hemodynamic stability of the patient. Possible treatment options include urgent electrical cardioversion and a limited selection of antiarrhythmic drugs. These options offer sufficient treatment of most relevant arrhythmias in the acute setting.

Key words

Bradycardia - tachycardia - antiarrhythmic therapy - cardioversion

• Literatur

• 1 Nolan JP, Soar J, Zideman DA et al. ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010. Resuscitation 2010; 81: 1219-1276
• 2 Camm AJ, Kirchhof P, Lip GY et al. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369-23429
• 3 Singer DE, Albers GW, Dalen JE et al. American College of Chest Physicians. Recommendations for Long-Term Management of Atrial Flutter; Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed.). Chest 2008; 133 (Suppl. 06)
• 4 Hindricks G, Willems S, Kautzner J et al. EuroFlutter Investigators. Effect of electroanatomically guided versus conventional catheter ablation of typical atrial flutter on the fluoroscopy time and resource use: a prospective randomized multicenter study. J Cardiovasc Electrophysiol 2009; 20: 734-740
• 5 Blomström-Lundqvist C, Scheinman MM, Aliot EM et al. American College of Cardiology, American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 2003; 108: 1871-1909
• 6 Zipes DP, Camm AJ, Borggrefe M et al. American College of Cardiology/American Heart Association Task Force, European Society of Cardiology Committee for Practice Guidelines, European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). Circulation 2006; 114: 385-484
• 7 Brignole M, Auricchio A, Baron-Esquivias G et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2281-2329
• 8 Sommer P, Hindricks G. Herzrhythmusstörungen. Notfallmedizin up2date 2012; 7: 243-254