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Diagnostik und interventionelle Behandlung von AV-Knoten-Reentry-Tachykardien

Diagnosis and interventional treatment of AV node reentry tachycardia

  • Interventionelle Elektrophysiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die AV-Knoten-Reentry-Tachykardien (AVNRT) sind gutartige, anfallsartig auftretende supraventrikuläre Tachykardien und durch einen plötzlichen Beginn und Ende charakterisiert. Ursächlich besteht eine sog. funktionelle Längsdissoziation des AV-Knotens mit schnell und langsam leitenden Anteilen. Das EKG zeigt eine regelmäßige Tachykardie mit schmalem QRS-Komplex. Die Akuttherapie umfasst zunächst vagale Manöver (Karotisdruck etc.) oder die Bolusgabe von Adenosin i.v. Zur Rezidivprophylaxe spielt heute die dauerhafte Medikamenteneinnahme keine Rolle mehr. Die Katheterablation des langsamen Leitungsweges ist die Therapie der ersten Wahl bei rezidivierend symptomatischen Patienten. Die Erfolgsraten liegen bei annähernd 100%, die Komplikationen eines hochgradigen AV-Blocks mit Schrittmacherbedürftigkeit bei <1%. Die Häufigkeit einer AVNRT-Ablation bezogen auf alle durchgeführten Katheterablationen in Deutschland liegt bei fast 25%.

Abstract

Atrioventricular nodal reciprocating tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia. It is characterized by palpitations, dizziness and pulsation at the neck. It is more common in females. AVNRT involves reciprocation between two functionally and anatomically distinct pathways within the perinodal atrial tissue. They extend as a fast pathway superior to Koch’s triangle and as a slow pathway infero-posterior to the compact AV node. Electrocardiography (ECG) during AVNRT shows a regular tachycardia with narrow QRS complexes. Acute treatment involves vagal maneuvers and intravenous adenosine. Catheter ablation targeting the slow pathway is the treatment of choice in symptomatic patients with recurrent episodes of AVNRT. Success rates are as high as almost 100%, whereas the complication rate is low. The only significant complication is a <1% incidence of third-degree AV block. Catheter ablation in AVNRT is performed in almost 25% of all ablation procedures in Germany.

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  1. Med. Klinik I – Kardiologie, Angiologie und Intensivmedizin, Klinikum Hildesheim, Weinberg 1, 31134, Hildesheim, Deutschland

    J. Tebbenjohanns & K. Rühmkorf

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  1. J. Tebbenjohanns
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  2. K. Rühmkorf
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Correspondence to J. Tebbenjohanns.

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Tebbenjohanns, J., Rühmkorf, K. Diagnostik und interventionelle Behandlung von AV-Knoten-Reentry-Tachykardien. Kardiologe 3, 296–308 (2009). https://doi.org/10.1007/s12181-009-0202-5

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  • DOI: https://doi.org/10.1007/s12181-009-0202-5

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