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Moderne Pharmakotherapie bei supraventrikulären und ventrikulären Herzrhythmusstörungen

Ein Update zur konventionellen Therapie

Modern pharmacotherapy of supraventricular and ventricular cardiac arrhythmia

An update for conventional therapy

  • Schwerpunkt: Herzrhythmusstörungen
  • Published:
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Zusammenfassung

Bei der Therapie supraventrikulärer Herzrhythmusstörungen haben sich in den letzten Jahren tief greifende Veränderungen ergeben: nichtmedikamentöse Strategien werden frühzeitiger eingesetzt und haben teilweise die medikamentösen Verfahren abgelöst. Häufig dient die medikamentöse Therapie, die über viele Jahre den Goldstandard darstellte, nur noch als Überbrückung bis zur kurativen Therapie durch Katheterablation des arrhythmogenen Substrates. Ein weiterer Schwerpunkt ist die adjuvante antiarrhythmische Therapie bei Patienten mit Cardioverter-Defibrillatoren. Bei der Akut- und Dauertherapie bestimmter Herzrhythmusstörungen, wie z. B. dem Vorhofflimmern, sind medikamentöse Ansätze unverzichtbar und weiterhin als primäre Therapie etabliert. Pharmaka, die zur Behandlung von Herzrhythmusstörungen eingesetzt werden, sind im Hinblick auf Struktur, Wirkmechanismus, potenzielle Nebenwirkungen und Interaktionen heterogen. Ihr Einsatz sollte nur bei strenger Indikationsstellung und engmaschiger kardiologischer Überwachung erfolgen. Angesichts ihrer häufig begrenzten therapeutischen Wirksamkeit ist die Nutzen-Risiko-Relation dieser Therapie besonders kritisch zu prüfen.

Abstract

Currently the pharmacological approach still represents the mainstay in the acute phase of arrhythmia management as well as in the chronic treatment phase of specific entities such as atrial fibrillation. However, non-pharmacological options have recently emerged as frequently used first-line tools for the treatment of various supraventricular and ventricular heart rhythm disturbances. Nevertheless, antiarrhythmic drug treatment is frequently used as a bridging or adjunctive therapy in conjunction with catheter ablation or implantable cardioverter defibrillators. Antiarrhythmic agents constitute a very heterogeneous group prone to various drug interactions and side-effects. Therefore, this article aims to summarise the most important facts and recent findings with regard to appropriate contemporary pharmacological therapy of atrial and ventricular arrhythmias in clinical practice.

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  1. Klinik für Kardiologie/Angiologie, Universitäres Herzzentrum, Martinistraße 52, 20246 , Hamburg, Deutschland

    D. Steven, B. Lutomsky, T. Rostock &  S. Willems

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Steven, D., Lutomsky, B., Rostock, T. et al. Moderne Pharmakotherapie bei supraventrikulären und ventrikulären Herzrhythmusstörungen. Internist 47, 1013–1023 (2006). https://doi.org/10.1007/s00108-006-1709-5

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