Zusammenfassung
Die Therapie der Herzinsuffizienz mittels implantierbarer Defibrillatoren (ICDs) und Systemen zur kardialen Resynchronisation (CRT) stellt ein etabliertes Verfahren mit positiven Daten aus klinischen Studien dar, auch wenn für den Alltag noch Fragen bestehen (Patientenauswahl, Bildgebung, Elektrodenpositionierung). Darüber hinaus sind weitere Verfahren entwickelt worden, über eine Modulation der Kalziumfreisetzung bzw. der sympathovagalen Balance einen positiven Einfluss auf den Verlauf einer Herzinsuffizienz zu nehmen. Für die „cardiac contractility modulation“ (CCM) stehen hierzu erste Daten aus randomisierten Untersuchungen zur Verfügung. Auch die Vagusstimulation wird bereits im Rahmen von Studien in Deutschland eingesetzt. Weitere Ansätze wie die Stimulation von Sympathikusganglien im Koronarsinus und linksventrikuläres „multisite pacing“ über Ultraschall sind noch im Stadium der Akuttestung.
Abstract
Implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) represent established treatments for heart failure with positive results from clinical trials. However, for daily practice, several questions on the optimal use remain (e.g., patient selection, imaging, pacing sites). In addition, new treatment options which attempt to improve heart failure by modulating cellular calcium handling and autonomic dysbalance have recently been developed. For cardiac contractility modulation, initial results from randomized trials have been published. At present, the use of vagal stimulation is also being studied in clinical trials in Germany. New approaches refer to stimulation of sympathetic ganglia in the coronary sinus and left ventricular multisite pacing by ultrasound, but are still in the stage of acute testing.
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Israel, C. Elektrotherapie der Herzinsuffizienz. Herzschr. Elektrophys. 22, 34–38 (2011). https://doi.org/10.1007/s00399-011-0121-6
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DOI: https://doi.org/10.1007/s00399-011-0121-6
Schlüsselwörter
- Herzinsuffizienz
- Elektrische implantierbare Systeme
- Kardiale Kontraktilitätsmodulation
- Vagusstimulation