Conduction System Pacing: historische und aktuelle Entwicklungen der Schrittmachertherapie

Zusammenfassung

Die Schrittmachertherapie mittels Stimulation des spezifischen Reizleitungssystems (Conduction System Pacing) nimmt Fahrt auf. Die randomisierten Studien, die den tatsächlichen Nutzen dieser Methode beweisen sollen, sind schon unterwegs. Die bisherigen Daten weisen auf relevante Vorteile gegenüber konventionellen Methoden hin, jedoch bleiben die anfallenden Zusatzkosten, aufwendige Implantationstechnik und die im Vergleich zur rechtsventrikulären Stimulation niedrigere Erfolgsrate neben den noch fehlenden Empfehlungen der ESC-Schrittmacherleitlinie die entscheidenden Hindernisse für die breitere Verwendung des Conduction System Pacing in Deutschland. In Anbetracht des 2023 zu diesem Thema publizierten Konsensuspapiers der EHRA möchten wir nun die Erfahrungen der letzten Jahrzehnte im Bereich der Herzschrittmachertherapie und die aktuellen Entwicklungen zusammenfassen.

Abstract

Pacemaker therapy through stimulation of the specific conduction system is picking up momentum as randomized studies aiming to substantiate its actual benefits are still ongoing. While existing data suggest notable advantages over conventional methods, additional costs, intricate implantation techniques, lower success rates compared to right ventricular stimulation, and the absence of recommendations from the ESC pacemaker guidelines hinder its wider adoption in Germany. Considering the recent EHRA consensus paper on this topic, we seek to compile experiences from recent decades in pacemaker therapy and summarize current developments.

Was ist wichtig?

Die Stimulation des Reizleitungssystems (Conduction System Pacing, CSP) ist eine physiologischere Alternative zur rechtsventrikulären Stimulation.

Die richtige Technik ist eine wichtige Voraussetzung für eine sichere und effektive Therapie.

Es bedarf noch weiterer, auch Langzeitstudien zu Sicherheit, Effektivität und Outcome, bevor diese Stimulationsmethoden breite Anwendung in Deutschland finden werden.

Schlüsselwörter

Schrittmacher - Linksschenkelblock - Kardiomyopathie - physiologische Stimulation

Keywords

left bundle branch block - cardiomyopathy - physiological pacing - pacemaker

Publication History

Article published online:
08 February 2024

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