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Langzeitergebnisse der Katheterablation idiopathischer und struktureller Kammertachykardien

Long-term results of catheter ablation of idiopathic and structural ventricular tachycardia

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Zusammenfassung

Die Katheterablation von Kammertachykardien hat sich in den letzten Jahren durch zunehmende Erfahrung und technologische Fortschritte zu einer effektiven Behandlungsmodalität entwickelt. Die Katheterablation idiopathischer Kammertachykardien ist auch im Langzeitverlauf in Abhängigkeit der anatomischen Zielregion teils hocheffektiv und daher in bestimmten Fällen als Erstlinientherapie in den aktuellen Leitlinien der Fachgesellschaften verankert. Die Katheterablation bei Patienten mit Kammertachykardien und struktureller Herzerkrankung hat deutlich eingeschränkte Erfolgsaussichten. Die Katheterablation bei Patienten mit ischämischer Kardiomyopathie ist in mehreren randomisierten multizentrischen Studien evaluiert. Bei diesen Patienten konnte eine signifikant höhere Effektivität zur Reduktion von Arrhythmierezidiven durch die Ablation im Vergleich zu konservativen Behandlungen nachgewiesen werden. Die Katheterablation bei Patienten mit nichtischämischer Kardiomyopathie ist insbesondere im Langzeitverlauf mit hohen Rezidivraten vergesellschaftet. Der sichere Nachweis eines Mortalitätsbenefits durch die Katheterablation konnte bislang nicht erbracht werden. Die Ablation kann somit auch nur in Ausnahmefällen als Alternative zur Implantation eines Kardioverter-Defibrillators (ICD) gesehen werden.

Abstract

Catheter ablation of ventricular tachycardia (VTs) has emerged as an effective treatment modality. Ablation procedures for idiopathic VTs depends on the anatomical origin of the arrhythmias, is highly effective in certain cases, and has been implemented as a first-line therapy in recent European guidelines. In contrast, catheter ablation of VTs in patients with structural heart disease has a significant risk of arrhythmia recurrence. Interventional treatment for patients with ischemic cardiomyopathy was studied in multiple randomized multicenter trials and it was shown that catheter ablation was more effective in arrhythmia suppression compared to conservative treatment modalities. Catheter ablation of nonischemic cardiomyopathy suffers from far higher rates of arrhythmia recurrences as documented in several long-term studies and often needs complex procedures with or without epicardial mapping and ablation. There is still no clear proof of a mortality benefit from catheter ablation of VTs in patients with or without structural heart disease. Nevertheless, recent guidelines recommend catheter ablation as an alternative to implantation of cardioverter–defibrillators (ICD) in selected cases.

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  1. Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    Philipp Lucas, Vanessa Sciacca,  Philipp Sommer & Thomas Fink

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  1. Philipp Lucas
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  2. Vanessa Sciacca
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  3. Philipp Sommer
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Correspondence to Philipp Sommer.

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Interessenkonflikt

P. Sommer ist MItglied des Advisory Boards bei Abbott, Biosense Webster, Boston Scientific und Medtronic. P. Lucas, V. Sciacca und T. Fink keine Interessenskonflikte.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Lucas, P., Sciacca, V., Sommer, P. et al. Langzeitergebnisse der Katheterablation idiopathischer und struktureller Kammertachykardien. Herzschr Elektrophys 34, 298–304 (2023). https://doi.org/10.1007/s00399-023-00964-1

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