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Herzschrittmachertherapie + Elektrophysiologie

, Volume 30, Issue 3, pp 234–239 | Cite as

Herzrhythmusstörungen bei Patienten mit pulmonaler Hypertonie und Lungenerkrankungen

  • Dirk BandorskiEmail author
  • Reinhard Höltgen
  • Ardeschir Ghofrani
  • Viktoria Johnson
  • Jörn Schmitt
Schwerpunkt
  • 86 Downloads

Zusammenfassung

Im Jahr 2018 wurde der Schwellenwert des mittleren pulmonalarteriellen Drucks für die Definition des Vorliegens einer pulmonalen Hypertonie (PH) geändert; demnach liegt die Prävalenz der PH nun bei etwa 1 % der globalen Bevölkerung. Eine wichtige Rolle bei der Entstehung von Arrhythmien bei PH-Patienten spielen die erhöhte Aktivität des sympathischen Nervensystems, elektrisches Remodeling und in dessen Folge eine relative Ischämie des rechten Vorhofs. Supraventrikuläre Arrhythmien wurden in einigen Studien hinsichtlich ihres Einflusses auf den Verlauf bei PH-Patienten untersucht, für ventrikuläre Arrhythmien ist die Datenlage unzureichend. Arrhythmien führen zu einer klinischen Verschlechterung, haben eine hohe Rezidivrate und treten im fortgeschrittenen Stadium der PH auf. Anhaltende Arrhythmien sind mit einer schlechten Prognose verbunden. Bei Tachykardien mit klar definierten Mechanismen (AV-Knoten-Reentry-Tachykardie [AVNRT] oder Vorhofflattern) sollte auch bei diesen Patienten primär eine Ablation erfolgen. Bei Patienten mit Vorhofflimmern sollte primär eine Rhythmuskontrolle (Kardioversion, Antiarrhythmika) durchgeführt werden. Die Therapie ventrikulärer Arrhythmien erfolgt individuell, eine prophylaktische Therapie sollte nicht erfolgen. In der Literatur finden sich wenige Daten zu Arrhythmien bei Patienten mit Lungenerkrankungen. Für Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) gibt es eine gute Datenlage. COPD-Patienten haben häufig eine koronare Herzerkrankung, Vorhofflimmern und ventrikuläre Tachykardien. Betablocker haben eine große Bedeutung für COPD-Patienten, auch während einer Exazerbation. Interventionelle Therapien sind sicher möglich, wobei sich nicht selten arrhythmogene Foci außerhalb der Pulmonalvenen (im rechten Vorhof) finden.

Schlüsselwörter

Pulmonale Hypertonie Chronisch-obstruktive Lungenerkrankung Arrhythmie Tachykardie Bradykardie 

Arrhythmias in patients with pulmonary hypertension and chronic lung disease

Abstract

Pulmonary arterial hypertension (PAH) occurs in 1% of the global population and can be divided in different disease groups. Pathophysiological aspects leading to supraventricular arrhythmias in these patients are due to increased pulmonary and right atrial pressure, increased activity of the sympathetic nervous system leading to right atrial electrical remodeling and ischemia in the right atrium. In the clinical setting these patients present with atrial flutter, atrial fibrillation or with ectopic atrial tachycardia. Regarding ventricular tachycardia there is a lack of data. Occurrence of arrhythmia in these patients leads to a deterioration of PAH, so rhythm control should be the aim. This can be achieved by right atrial ablation, especially in patients presenting with atrial flutter; electric cardioversion or antiarrhythmic drug therapy are without definite guideline recommendations since there are too few clinical trials. Ablation with a transseptal approach in the left atrium is considered rather dangerous and should be avoided. Regarding arrhythmias in patients with chronic lung disease, few data are available. For patients with chronic obstructive pulmonary disease (COPD), there are good data available. These patients often suffer from coronary heart disease, atrial fibrillation, and ventricular tachycardia. Beta-blockers play an important role in COPD patients, even during exacerbation. Interventional therapies are safe but the arrhythmogenic foci often located outside of the pulmonary veins (in the right atrium).

Keywords

Pulmonary hypertension Chronic obstructive lung disease Arrhythmia Tachycardia Bradycardia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Bandorski, R. Höltgen, A. Ghofrani, V. Johnson und J. Schmitt geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Dirk Bandorski
    • 1
    • 2
    Email author
  • Reinhard Höltgen
    • 3
  • Ardeschir Ghofrani
    • 4
  • Viktoria Johnson
    • 5
  • Jörn Schmitt
    • 5
  1. 1.Medizinische FakultätSemmelweis Universität, Campus HamburgHamburgDeutschland
  2. 2.Intensivmedizin und internistische DiagnostikAsklepios Neurologische Klinik Bad SalzhausenNiddaDeutschland
  3. 3.Medizinische Klinik, Kardiologie/ElektrophysiologieKlinikum Westmünsterland, St. Agnes-Hospital Bocholt RhedeBocholtDeutschland
  4. 4.Medizinische Klinik und Poliklinik IIUniversitätsklinikum GießenGießenDeutschland
  5. 5.Medizinische Klinik 1, Innere Medizin/KardiologieUniversitätsklinikum GießenGießenDeutschland

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