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DOI: 10.1055/s-2007-966601
© Georg Thieme Verlag KG Stuttgart · New York
Invasive Diagnostik und Therapie bei supraventrikulären Tachykardien
Publication History
Publication Date:
06 July 2007 (online)
![](https://www.thieme-connect.de/media/kardiologie-u2d/200702/lookinside/thumbnails/10.1055-s-2007-966601-1.jpg)
Kernaussagen
Paroxysmale Tachykardien sind häufig, treten teilweise bei ansonsten herzgesunden Patienten auf und gehen mit teilweise ausgeprägter Symptomatik einher.
Nachdem lange Zeit die medikamentöse antiarrhythmische Therapie bei der Rezidivprophylaxe im Vordergrund stand, stellt heute die Katheterablation die Therapie der ersten Wahl bei symptomatischen Patienten dar.
Dabei hat diese kurative Form der Therapie zusätzlich zur Verbesserung des pathophysiologischen Verständnis beigetragen.
Bei regelmäßigen Tachykardien ist die Ablation heute bereits die Therapie der ersten Wahl. Bei Vorhofflimmern befindet sich diese Therapie noch in der Entwicklung; wenn die technische Entwicklung weiter fortschreitet, wird sie in Zukunft auch bei dieser Arrhythmie mehr und mehr in den Vordergrund treten.
Literatur
- 1 Akhtar M, Jazayeri M R, Sra J, Blanck Z, Deshpande S, Dhala A. Atrioventricular nodal reentry. Clinical, electrophysiological, and therapeutic considerations. Circulation. 1993; 88 282-295
- 2 Deshpande S, Jazayeri M, Dhala A, Blanck Z, Sra J, Akhtar M. Catheter ablation in supraventricular tachyarrhythmias. J Interv Cardiol. 1995; 8 59-67
- 3 Fischer B, Jais P, Shah D. et al . Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol. 1996; 7 1225-1233
- 4 Haissaguerre M, Gaita F, Fischer B. et al . Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation. 1992; 85 2162-2175
- 5 Haissaguerre M, Saoudi N. Role of catheter ablation for supraventricular tachyarrhythmias, with emphasis on atrial flutter and atrial tachycardia. Curr Opin Cardiol. 1994; 9 40-52
- 6 Hindricks G. The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J. 1993; 14 1644-1653
- 7 Jackman W M, Wang X Z, Friday K J. et al . Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991; 324 1605-1611
- 8 Jackman W M, Beckman K J, McClelland J H. et al . Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992; 327 313-318
- 9 Jazayeri M R, Hempe S L, Sra J S. et al . Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation. 1992; 85 1318-1328
- 10 Kay G N, Epstein A E, Dailey S M, Plumb V J. Role of radiofrequency ablation in the management of supraventricular arrhythmias: experience in 760 consecutive patients. J Cardiovasc Electrophysiol. 1993; 4 371-389
- 11 Kuck K H, Schluter M, Geiger M, Siebels J, Duckeck W. Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet. 1991; 337 1557-1561
- 12 Kuck K H, Schluter M. Radiofrequency catheter ablation of accessory pathways. Pacing Clin Electrophysiol. 1992; 15 1380-1386
- 13 Kuck K H, Schluter M. Junctional tachycardia and the role of catheter ablation. Lancet. 1993; 341 1386-1391
- 14 Shah D C, Haissaguerre M, Jais P. et al . Simplified electrophysiologically directed catheter ablation of recurrent common atrial flutter. Circulation. 1997; 96 2505-2508
- 15 Haissaguerre M, Jais P, Shah D C. et al . Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998; 339 659-666
- 16 Haissaguerre M, Shah D C, Jais P. et al . Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. Am J Cardiol. 2000; 86 9K-19K
- 17 Natale A. Radiofrequency ablation of the pulmonary veins: can it stop atrial fibrillation at its source?. Cleve Clin J Med. 2001; 68 17, 21-22, 24
- 18 Oral H, Pappone C, Chugh A. et al . Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006; 354 934-941
- 19 Pappone C, Oreto G, Lamberti F. et al . Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation. 1999; 100 1203-1208
- 20 Pappone C, Rosanio S, Oreto G. et al . Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000; 102 2619-2628
- 21 Denes P, Wu D, Dhingra R, Leon F, Wyndham C, Rosen K M. Dual atrioventricular nodal pathways. A common electrophysiological response. Br Heart J. 1975; 37 1069-1076
- 22 Wu D, Denes P, Leon F. et al . Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol. 1978; 41 1045-1051
- 23 Denes P, Wu D, Dhingra R C, Chuquimia R, Rosen K M. Demonstration of dual A-V nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation. 1973; 48 549-555
- 24 Mendez C, Moe G K. Demonstration of a dual A-V nodal conduction system in the isolated rabbit heart. Circ Res. 1966; 19 378-393
- 25 Moe G K, Mendez C. The physiologic basis of reciprocal rhythm. Prog Cardiovasc Dis. 1966; 8 461-482
- 26 Wu D, Denes P, Wyndham C, Leon F, Dhingra R C, Rosen K M. Demonstration of dual atrioventricular nodal pathways utilizing a ventricular extrastimulus in patients with atrioventricular nodal re-entrant paroxysmal supraventricular tachycardia. Circulation. 1975; 52 789-798
- 27 Moe G K, Mendez C. Physiologic basis of premature beats and sustained tachycardias. N Engl J Med. 1973; 288 250-254
- 28 Rosen K M, Mehta A, Miller R A. Demonstration of dual atrioventricular nodal pathways in man. Am J Cardiol. 1974; 33 291-294
- 29 Wu D, Denes P, Dhingra R, Wyndham C, Rosen K M. Determinants of fast- and slow-pathway conduction in patients with dual atrioventricular nodal pathways. Circ Res. 1975; 36 782-790
- 30 Wu D, Denes P, Amat Y L, Wyndham C R, Dhingra R, Rosen K M. An unusual variety of atrioventricular nodal re-entry due to retrograde dual atrioventricular nodal pathways. Circulation. 1977; 56 50-59
- 31 Nakagawa H, Lazzara R, Khastgir T. et al . Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation. 1996; 94 407-424
- 32 Waldo A L, Wells Jr J L, Plumb V J, Cooper T B, MacLean W A. Studies of atrial flutter following open heart surgery. Annu Rev Med. 1979; 30 259-268
- 33 Waldo A L. Mechanisms of atrial flutter: implications for ablative therapy. J Interv Cardiol. 1995; 8 701-707
- 34 Waldo A L. Pathogenesis of atrial flutter. J Cardiovasc Electrophysiol. 1998; 9 S18-S25
- 35 Denes P, Wu D, Rosen K M. Demonstration of dual A-V pathways in a patient with Lown-Ganong-Levine syndrome. Chest. 1974; 65 343-346
- 36 Kay G N, Pressley J C, Packer D L, Pritchett E L, German L D, Gilbert M R. Value of the 12-lead electrocardiogram in discriminating atrioventricular nodal reciprocating tachycardia from circus movement atrioventricular tachycardia utilizing a retrograde accessory pathway. Am J Cardiol. 1987; 59 296-300
- 37 Sung R J, Waxman H L, Saksena S, Juma Z. Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways. Circulation. 1981; 64 1059-1067
- 38 Keim S, Werner P, Jazayeri M, Akhtar M, Tchou P. Localization of the fast and slow pathways in atrioventricular nodal reentrant tachycardia by intraoperative ice mapping. Circulation. 1992; 86 919-925
- 39 Kay G N, Epstein A E, Dailey S M, Plumb V J. Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit. Circulation. 1992; 85 1675-1688
- 40 Kottkamp H, Hindricks G, Willems S. et al . An anatomically and electrogram-guided stepwise approach for effective and safe catheter ablation of the fast pathway for elimination of atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1995; 25 974-981
- 41 Geller J C, Goette A, Reek S, Funke C, Hartung W M, Klein H U. Changes in AV node conduction curves following slow pathway modification. Pacing Clin Electrophysiol. 2000; 23 1651-1660
- 42 Kay G N, Plumb V J. The present role of radiofrequency catheter ablation in the management of cardiac arrhythmias. Am J Med. 1996; 100 344-356
- 43 Kottkamp H, Hindricks G, Borggrefe M, Breithardt G. Radiofrequency catheter ablation of the anterosuperior and posteroinferior atrial approaches to the AV node for treatment of AV nodal reentrant tachycardia: techniques for selective ablation of „fast” and „slow” AV node pathways. J Cardiovasc Electrophysiol. 1997; 8 451-468
- 44 Kuck K H, Schluter M, Gursoy S. Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways. Circulation. 1992; 86 1743-1752
- 45 Jazayeri M R, Dhala A, Deshpande S, Blanck Z, Sra J, Akhtar M. Posteroseptal accessory pathways: an overview of anatomical characteristics, electrocardiographic patterns, electrophysiological features, and ablative therapy. J Interv Cardiol. 1995; 8 89-101
- 46 Deshpande S S, Bremner S, Sra J S. et al . Ablation of left free-wall accessory pathways using radiofrequency energy at the atrial insertion site: transseptal versus transaortic approach. J Cardiovasc Electrophysiol. 1994; 5 219-231
- 47 Natale A, Wathen M, Yee R, Wolfe K, Klein G. Atrial and ventricular approaches for radiofrequency catheter ablation of left-sided accessory pathways. Am J Cardiol. 1992; 70 114-116
- 48 Shah D C, Haissaguerre M, Jais P, Takahashi A, Clementy J. Atrial flutter: contemporary electrophysiology and catheter ablation. Pacing Clin Electrophysiol. 1999; 22 344-359
- 49 Shah D C, Takahashi A, Jais P, Hocini M, Clementy J, Haissaguerre M. Local electrogram-based criteria of cavotricuspid isthmus block. J Cardiovasc Electrophysiol. 1999; 10 662-669
- 50 Pappone C, Manguso F, Santinelli R. et al . Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med. 2004; 351 1197-1205
- 51 Pappone C, Santinelli V. Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson-White syndrome? Catheter ablation should be performed in asymptomatic patients with Wolff-Parkinson-White syndrome. Circulation. 2005; 112 2207-2215
Prof. Dr. med. J. Christoph Geller
Zentralklinik Bad Berka GmbH
Klinik für Kardiologie
Robert Koch Allee 9
99437 Bad Berka
Email: c.geller.kar@zentralklinik-bad-berka.de