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Indikationsbereiche von Klasse-I-Antiarrhythmika — differentialtherapeutische Aspekte bei ventrikulären Herzrhythmusstörungen

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Medikamentöse Behandlung des Postinfarktpatienten nach CAST

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Zusammenfassung

Während Anfang der achtziger Jahre die prognostische Bedeutung ventrikulärer Arrhythmieformen als weitgehend gesichert angesehen und eine entsprechende antiarrhythmischen Therapie verhältnismäßig freizügig gehandhabt wurde, hat sich dies in den beiden letzten Jahren grundlegend geändert (2, 30). Insbesondere die Ergebnisse des „Cardiac Arrhythmia Suppression Trial“(CAST, 46) und einiger vorausgehender Studien (5, 8, 11, 16, 20, 36, 39, 50) haben zu dieser Entwicklung beigetragen. Keine dieser — überwiegend bei Patienten mit potentiell malignen ventrikulären Arrhythmien durchgeführten — Studien konnte eine Prognoseverbesserung durch die Gabe von Antiarrhythmika der Klasse I belegen. In frühen Studien (Tabelle 1) wurde dies auf die Verwendung weniger potenter Substanzen der Klasse IA und IB zurückgeführt CAST hat jedoch gezeigt, daß auch neuere und hinsichtlich einer Arrhythmiesuppression als potent angesehene Antiarrhythmika der Klasse IC hierzu nicht in der Lage zu sein scheinen (46). Flecainid und Encainid führen im Mittel zwar zu einer mehr als 80prozentigen Reduktion nahezu aller ventrikulären Arrhythmieformen. Dennoch erwies sich in CAST, daß eine nach diesen Kriterien erfolgreiche Einstellung eines Patienten nicht zur Reduktion der Häufigkeit des plötzlichen Herztodes führt. Im Gegenteil, bei Patienten nach Myokardinfarkt zeigte sich unter Klasse-IC-Antiarrhythmika eine — im Vergleich zu Placebo — deutliche Zunahme plötzlicher Todesfälle (46). Es ergeben sich somit begründete Zweifel

Letalität und Häufigkeit des plötzlichen Herztodes in kontrollierten Studien mit Klasse-I-Antiarrythmika bei koronarer Herzkrankheit (PHT plötzlicher Herztod)

am Nutzen einer antiarrythmischen Therapie mit Substanzen der Klasse I, dei ein Überdenken der bisherigen Therapieindikation und die Berücksichtigung alternativer Therapiemöglichkeiten erfordern.

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Authors and Affiliations

  1. Innere Medizin III, Universitätsklinik Freiburg, Hugstertterstr. 55, 7800, Freiburg, Germany

    Dr. M. Zehender, S. Hohnloser & H. Jus

  2. II. Medizinische Klinik, Allgemeines Krankenhaus St. Georg, Hamburg, Germany

    T. Meinertz

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  1. Dr. M. Zehender
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  2. S. Hohnloser
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  3. T. Meinertz
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  4. H. Jus
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Editors and Affiliations

  1. I. Medizinische Klinik, Technischen Universität München Klinikum rechts der Isar, Ismaninger Straße 22, 8000, München 80, Germany

    Georg Schmidt

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© 1991 Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt

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Zehender, M., Hohnloser, S., Meinertz, T., Jus, H. (1991). Indikationsbereiche von Klasse-I-Antiarrhythmika — differentialtherapeutische Aspekte bei ventrikulären Herzrhythmusstörungen. In: Schmidt, G. (eds) Medikamentöse Behandlung des Postinfarktpatienten nach CAST. Steinkopff. https://doi.org/10.1007/978-3-642-85414-9_4

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  • DOI: https://doi.org/10.1007/978-3-642-85414-9_4

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