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Therapie — Rhythmusstörungen

  • C. Schmitt
Part of the Aktuelle Therapieprinzipien in Kardiologie und Angiologie book series (THERAPIEPRINZ.)

Zusammenfassung

Ludolf Krehl, einer der Erstbeschreiber der dilatativen Kardiomyopathien, wies schon 1891 in seinem „Beitrag zur Kenntniss der idiopathischen Herzmuskelerkrankungen“ [19] auf den Zusammenhang zwischen Herzinsuffizienz und plötzlichem Herztod hin. Auch knapp 100 Jahre später sind Herzrhythmusstörungen bei Herzinsuffizienz ein unverändert aktuelles Thema: 30–50% der Patienten mit Herzinsuffizienz versterben plötzlich infolge maligner Herzrhythmusstörungen [42] (Abb. 1). Zwar haben große Studien [9], etwa die Consensus-Studie 1987 [10], bei Patienten mit Herzinsuffizienz nach Therapie mit „Angiotensin-converting-enzyme-Hemmern“ (ACE-Hemmern) eine deutliche Reduktion der Gesamtmortalität ergeben, die Häufigkeit des Auftretens des plötzlichen Herztodes konnte dadurch jedoch nicht reduziert werden und dies, obwohl ACE-Hemmer, wie in einigen Publikationen [7, 26] nachgewiesen, zu einer Verminderung ventrikulärer Arrhythmien führen. So haben auch wir an einer kleinen Gruppe von Patienten mit dilatativer Kardiomyopathie eine Reduktion ventrikulärer Arrhythmien in einer jeweils 48 h dauernden Langzeit(LZ)-EKG-Registrierung vor und nach Neueinstellung mit ACE-Hemmern gesehen (Tabelle 1), die jedoch aufgrund der hohen Spontanvariabilität [32] von Arrhythmien im Langzeit-EKG als nicht signifikant gewertet werden muß.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • C. Schmitt

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