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Anästhesiol Intensivmed Notfallmed Schmerzther 2005; 40(4): 207-212
DOI: 10.1055/s-2004-826217
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Akuttherapie anhaltender hämodynamisch tolerierter Kammertachykardien

Acute Treatment of Stable Hemodynamically Tolerable Ventricular TachycardiaW.  Haverkamp1 , S.  Rolf1 , M.  Stockburger1 , R.  Dietz1
  • 1Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin
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Publication History





Publication Date:
15 April 2005 (online)

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Zusammenfassung

Anhaltende Kammertachykardien sind potenziell lebensbedrohliche Herzrhythmusstörungen. Eine medikamentöse Behandlung mit dem Ziel der Terminierung der Rhythmusstörung kommt dann infrage, wenn sie hämodynamisch ausreichend toleriert wird. Ausgesprochen effektiv und dem Lidocain deutlich überlegen sind Klasse IC-Antiarrhythmika wie Flecainid und Propafenon oder auch Ajmalin (Klasse IA/IC). Sotalol ist zwar auch wirksam, aufgrund der beta-sympathikolytischen Wirkungskomponente ist aber Vorsicht geboten. Amiodaron wird gerne eingesetzt, obwohl systematische Studien zur Akutwirkung bei anhaltender Kammertachykardie fehlen. Wirksamkeitsbelege liegen für die Behandlung rezidivierender, hämodynamisch instabiler Tachykardien vor. Hat sich ein Antiarrhythmikum als unwirksam erwiesen, sollte auf weitere pharmakologische Therapieversuche verzichtet und eine elektrische Kardioversion durchgeführt werden.

Abstract

Sustained monomorphic ventricular tachycardia is a potentially life-threatening ventricular tachycardia. The arrhythmia can be treated with antiarrhythmic drugs, when the patient is hemodynamically stable. Class IC antiarrhythmic drugs like flecainide and propafenon or ajmaline (class IA/IC) are very effective. The use of lidocaine is obsolete. Sotalol is also effective, however, caution is advised because of its significant beta-sympatholytic properties. Amiodaron is frequently used, although it has never been studied in the setting of stable ventricular tachycardia. Earlier studies have demonstrated that it is effective in the treatment of recurrent, hemodynamically unstable ventricular tachycardia. When a particular drug does not terminate tachycardia, further drugs should not be given. Electrical cardioversion is preferred.

Schlüsselwörter

Ventrikuläre Tachykardie - Ajmalin - Flecainid - Propafenon - Amiodaron - Lidocain - Antiarrhythmika - elektrische Kardioversion

Key words

Ventricular tachycardia - ajmaline - amiodarone - flecainide - propafenone - lidocaine - antiarrhythmic drugs - electrical cardioversion

Literatur

  • 1 Bayes D L, Coumel P, Leclercq J F. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases.  Am Heart J. 1989;  117 151-159
    CrossrefPubMedGoogle Scholar
  • 2 Domanovits H, Paulis M, Nikfardjam M, Holzer M, Stuhlinger H G, Hirschl M M. et al . Sustained ventricular tachycardia in the emergency department.  Resuscitation. 1999;  42 19-25
    CrossrefPubMedGoogle Scholar
  • 3 Armengol R E, Graff J, Baerman J M, Swiryn S. Lack of effectiveness of lidocaine for sustained, wide QRS complex tachycardia.  Ann Emerg Med. 1989;  18 254-257
    PubMedGoogle Scholar
  • 4 Nasir N Jr, Taylor A, Doyle T K, Pacifico A. Evaluation of intravenous lidocaine for the termination of sustained monomorphic ventricular tachycardia in patients with coronary artery disease with or without healed myocardial infarction.  Am J Cardiol. 1994;  74 1183-1186
    CrossrefPubMedGoogle Scholar
  • 5 Reinelt P, Karth G D, Geppert A, Heinz G. Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU.  Intensive Care Med. 2001;  27 1466-1473
    CrossrefPubMedGoogle Scholar
  • 6 Stewart R B, Bardy G H, Greene H L. Wide complex tachycardia: misdiagnosis and outcome after emergent therapy.  Ann Intern Med. 1986;  104 766-771
    CrossrefPubMedGoogle Scholar
  • 7 Rankin A C, Rae A P, Cobbe S M. Misuse of intravenous verapamil in patients with ventricular tachycardia.  Lancet. 1987;  2 472-474
    PubMedGoogle Scholar
  • 8 Belhassen B, Shapira I, Pelleg A, Copperman I, Kauli N, Laniado S. Idiopathic recurrent sustained ventricular tachycardia responsive to verapamil: an ECG-electrophysiologic entity.  Am Heart J. 1984;  108 1034-1037
    CrossrefPubMedGoogle Scholar
  • 9 The American Heart Association in Collaboration with the International Laison Committee on Resuscitation. Part 6: Advanced Cardiovascular Life Support: Section 5: Pharmacology I: Agents for Arrhythmias.  Resuscitation. 2000;  46 135-153
    CrossrefPubMedGoogle Scholar
  • 10 The American Heart Association in Collaboration with the International Laison Committee on Resuscitation. Part 6: Advanced Cardiovascular Life Support: Section 7: Algorithm Approach to ACLS Emergencies 7D: The Tachycardia Algorithms.  Resuscitation. 2000;  46 185-193
    CrossrefPubMedGoogle Scholar
  • 11 Roden D M. Antiarrhythmic drugs. Clinical pharmacology of the old and the new agents.  Postgrad Med. 1985;  78 28-37
    PubMedGoogle Scholar
  • 12 Manz M, Mletzko R, Jung W, Lüderitz B. Electrophysiological and haemodynamic effects of lidocaine and ajmaline in the management of sustained ventricular tachycardia.  Eur Heart J. 1992;  13 1123-1128
    PubMedGoogle Scholar
  • 13 Gorgels A P, van den Dool A, Hofs A, Mulleneers R, Smeets J L, Vos M A. et al . Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia.  Am J Cardiol. 1996;  78 43-46
    CrossrefPubMedGoogle Scholar
  • 14 Ho D S, Zecchin R P, Richards D A, Uther J B, Ross D L. Double-blind trial of lignocaine versus sotalol for acute termination of spontaneous sustained ventricular tachycardia.  Lancet. 1994;  344 18-23
    CrossrefPubMedGoogle Scholar
  • 15 Dirks B. Leitlinien des European Resuscitation Council 2000 für erweiterte lebensrettende Maßnahmen beim Erwachsenen.  Stellungnahme der Advanced Life Support Group nach Verabschiedung durch das Executive Committee des European Resuscitation Council Intensivmed. 2002;  39 274-285
    PubMedGoogle Scholar
  • 16 Wettrell G, Andersson K E. Cardiovascular drugs. I: Antidysrhythmic drugs.  Ther Drug Monit. 1986;  8 59-77
    PubMedGoogle Scholar
  • 17 Chen X, Borggrefe M, Martinez-Rubio A, Hief C, Haverkamp W, Hindricks G. et al . Efficacy of ajmaline and propafenone in patients with accessory pathways: a prospective randomized study.  J Cardiovasc Pharmacol. 1994;  24 664-669
    PubMedGoogle Scholar
  • 18 Honerjäger P, Schmidt G. Pharmacology of modern anti-arrhythmia drugs in therapy of supraventricular tachycardia.  Z Gesamte Inn Med. 1993;  48 425-429
    PubMedGoogle Scholar
  • 19 Haverkamp W, Mönnig G, Kirchhof P, Eckardt L, Borggrefe M, Breithardt G. Torsade de pointes induced by ajmaline.  Z Kardiol. 2001;  90 586-590
    CrossrefPubMedGoogle Scholar
  • 20 Harron D W, Brogden R N. Propafenone. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in the treatment of arrhythmias.  Drugs. 1987;  34 617-647
    PubMedGoogle Scholar
  • 21 Estes N A, III , Garan H, Ruskin J N. Electrophysiologic properties of flecainide acetate.  Am J Cardiol. 1984;  53 26B-29B
    CrossrefPubMedGoogle Scholar
  • 22 Nathan A W, Camm A J, Bexton R S, Hellestrand K J. Intravenous flecainide acetate for the clinical management of paroxysmal tachycardias.  Clin Cardiol. 1987;  10 317-322
    PubMedGoogle Scholar
  • 23 Griffith M J, Linker N J, Garratt C J, Ward D E, Camm A J. Relative efficacy and safety of intravenous drugs for termination of sustained ventricular tachycardia.  Lancet. 1990;  336 670-673
    CrossrefPubMedGoogle Scholar
  • 24 Mestre J L, Moro C, Madrid A H, Novo L, Marin-Huerta E. The efficacy and safety of intravenous propafenone in the acute treatment of spontaneous sustained ventricular tachycardia.  Rev Esp Cardiol. 1994;  47 461-467
    PubMedGoogle Scholar
  • 25 Hohnloser S, Zeiher A, Hust M H, Wollschlager H, Just H. Flecainide-induced aggravation of ventricular tachycardia.  Clin Cardiol. 1983;  6 130-135
    PubMedGoogle Scholar
  • 26 Furlanello F, Gramegna L, Dal Forno P, Vergara G, Bettini R, Inama G. et al . Worsening of arrhythmias during pharmacological treatment.  G Ital Cardiol. 1984;  14 798-803
    PubMedGoogle Scholar
  • 27 Tjandra-Maga T B, Verbesselt R, van Hecken A, Mullie A, de Schepper P J. Flecainide: single and multiple oral dose kinetics, absolute bioavailability and effect of food and antacid in man.  Br J Clin Pharmacol. 1986;  22 309-316
    PubMedGoogle Scholar
  • 28 Hollmann M, Brode E, Hotz D, Kaumeier S, Kehrhahn O H. Investigations on the pharmacokinetics of propafenone in man.  Arzneimittelforschung. 1983;  33 763-770
    PubMedGoogle Scholar
  • 29 Hohnloser S H, Woosley R L. Sotalol.  N Engl J Med. 1994;  331 31-38
    CrossrefPubMedGoogle Scholar
  • 30 Marill K A, Runge T. Meta-analysis of the Risk of Torsades de Pointes in patients treated with intravenous racemic sotalol.  Acad Emerg Med. 2001;  8 117-124
    PubMedGoogle Scholar
  • 31 Scheinman M M, Levine J H, Cannom D S, Friehling T, Kopelman H A, Chilson D A. et al . Dose-ranging study of intravenous amiodarone in patients with life-threatening ventricular tachyarrhythmias. The Intravenous Amiodarone Multicenter Investigators Group.  Circulation. 1995;  92 3264-3272
    PubMedGoogle Scholar
  • 32 Kowey P R, Levine J H, Herre J M, Pacifico A, Lindsay B D, Plumb V J. et al . Randomized, double-blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent, hemodynamically destabilizing ventricular tachycardia or fibrillation. The Intravenous Amiodarone Multicenter Investigators Group.  Circulation. 1995;  92 3255-3263
    PubMedGoogle Scholar
  • 33 Levine J H, Massumi A, Scheinman M M, Winkle R A, Platia E V, Chilson D A. et al . Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias. Intravenous Amiodarone Multicenter Trial Group.  J Am Coll Cardiol. 1996;  27 67-75
    PubMedGoogle Scholar
  • 34 Kudenchuk P J, Cobb L A, Copass M K, Cummins R O, Doherty A M, Fahrenbruch C E. et al . Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.  N Engl J Med. 1999;  341 871-878
    Google Scholar
  • 35 Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.  N Engl J Med. 2002;  346 884-890
    Google Scholar
  • 36 Gallik D M, Singer I, Meissner M D, Molnar J, Somberg J C. Hemodynamic and surface electrocardiographic effects of a new aqueous formulation of intravenous amiodarone.  Am J Cardiol. 2002;  90 964-968
    CrossrefPubMedGoogle Scholar
  • 37 Hohnloser S H, Meinertz T, Dammbacher T, Steiert K, Jahnchen E, Zehender M. et al . Electrocardiographic and antiarrhythmic effects of intravenous amiodarone: results of a prospective, placebo-controlled study.  Am Heart J. 1991;  121 89-95
    CrossrefPubMedGoogle Scholar
  • 38 Kulakowski P, Karczmarewicz S, Karpinski G, Soszynska M, Ceremuzynski L. Effects of intravenous amiodarone on ventricular refractoriness, intraventricular conduction, and ventricular tachycardia induction.  Europace. 2000;  2 207-215
    CrossrefPubMedGoogle Scholar
  • 39 North N E, Crandall B G, Halperin B D, Kron J, McAnulty J. A double blind randomized trial of magnesium sulfate for ventricular tachycardia.  Circulation. 1993;  88 (Suppl) I-446 (Abstract)
    PubMedGoogle Scholar
  • 40 Manz M, Jung W, Tebbenjohanns J, Pfeiffer D, May F, Lüderitz B. Magnesium: Einfluss einer hochdosierten intravenösen Applikation auf monomorphe ventrikuläre Tachykardien.  Z Kardiol. 1994;  83 (Suppl) I-124 (Abstract)
    PubMedGoogle Scholar
  • 41 Farouque H M, Sanders P, Young G D. Intravenous magnesium sulfate for acute termination of sustained monomorphic ventricular tachycardia associated with coronary artery disease.  Am J Cardiol. 2000;  86 1270-1272
    CrossrefPubMedGoogle Scholar
  • 42 Haverkamp W, Mönnig G, Schulze-Bahr E, Haverkamp F, Breithardt G. Physician-induced Torsade de Pointes - therapeutic implications.  Cardiovasc Drugs Ther. 2002;  16 101-109
    CrossrefPubMedGoogle Scholar
  • 43 Joglar J A, Page R L. Treatment of cardiac arrhythmias during pregnancy: safety considerations.  Drug Saf. 1999;  20 85-94
    PubMedGoogle Scholar

Priv.-Doz. Dr. med. Wilhelm Haverkamp

Med. Klinik mit Schwerpunkt Kardiologie, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum

Augustenburger Platz 1 · 13353 Berlin ·

Email: wilhelm.haverkamp@charite.de