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Therapiekontrolle: Langzeitelektrokardiographie oder programmierte Stimulation?

  • K.-P. Bethge
  • B.-D. Gonska
Conference paper

Zusammenfassung

Beginn und Verlauf einer antiarrhythmischen Behandlung sind stets mit der Frage nach ihrer Effektivität verbunden. Die Kenntnis der elektropharmakologischen Eigenschaften der eingesetzten Substanz ist hierbei hilfreich. Dennoch hat sich die ursprüngliche Hoffnung, aus der Zuordnung von elektropharmakologischen Eigenschaften eines Präparates mit den elektrophysiologischen Bedingungen einer Rhythmusstörung den Therapieerfolg vorhersagen zu können, nicht erfüllt. Die Erfahrung mit zahlreichen Antiarrhythmika hat vielmehr gelehrt, daß diese Voraussage grundsätzlich nicht möglich ist. Somit bleibt stets zu klären, ob unter laufender Therapie die Rhythmusstörungen unverändert fortbestehen oder erfolgreich eliminiert werden konnten. Mehr noch, diese Kontrollpflicht ergibt sich auch aus der Beobachtung, daß alle bisher überprüften Antiarrhythmika einschließlich der Betablocker in 6–16% aller behandelten Fälle einen sogenannten proarrhythmischen Effekt aufweisen können, der nicht vorhersehbar mit einer wesentlichen Verschlechterung des Arrhythmieprofils einhergeht (29, 44). Wird berücksichtigt, daß hämodynamische oder prognostische Aspekte von Rhythmusstörungen Anlaß zur Therapie sind, wird man dem Fortbestehen und erst recht der Verschlechterung von Arrhythmien einen ungünstigen Stellenwert beimessen müssen. Mit der Einleitung einer antiarrhythmischen Therapie ist somit die nachfolgende Therapiekontrolle obligat.

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Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1987

Authors and Affiliations

  • K.-P. Bethge
    • 2
  • B.-D. Gonska
    • 1
  1. 1.Abteilung für Kardiologie und PulmonologieMedizinische Klinik und Poliklinik der Universität GöttingenGermany
  2. 2.Abteilung für Kardiologie und PulmonologieMedizinische Klinik und Poliklinik der Universität GöttingenGöttingenGermany

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