Zusammenfassung
Die Katheterablation stellt eine wichtige Therapieoption in der Behandlung ventrikulärer Arrhythmien dar. Sogar in Zentren mit spezieller Erfahrung birgt die Ablation ventrikulärer Tachykardien ein kleines, aber relevantes Komplikationsrisiko. Hierbei ist zu denken an vaskuläre und thromboembolische Komplikationen, Luftembolie, Volumenüberlastung mit Dekompensation einer Herzinsuffizienz, Herztamponade durch Katheterperforation oder Gasbläschenexplosion ("steam pop") bei Radiofrequenz-Energieabgabe, Einreißen von Klappen oder -halteapparat, Beschädigung des Überleitungssystems mit AVBlock, Verletzung der Koronararterien bei Ablation im Bereich der Aortenklappensegel oder beim Versuch des retrograden Zugangs zum linken Ventrikel, kardiogener Schock bei Ablation kontraktilen Myokards bei Patienten mit kritisch eingeschränkter Pumpleistung und erfolglose Kardioversion bzw. Wiederbelebung bei Patienten mit zahlreichen Tachykardie- Induktionen. Zusätzlich muss bei epikardialer Ablation an Komplikationen des Zugangsweges und Verletzung der Koronarien bzw. des N. phrenicus gedacht werden. Die Kenntnis dieser Risiken ist von entscheidender Bedeutung für deren Vermeidung; durch eine sorgfältige Planung und eine spezielle Technik bei der Intervention kann das Komplikationsrisiko minimiert werden.
Abstract
Ablation is an important management tool for the treatment of ventricular arrhythmias. Even at experienced centers ventricular tachycardia ablation carries a minor but significant risk for potential complications, including vascular and thomboembolic complications, air embolism, volume overload and the precipitation of congestive heart failure, cardiac tamponade from catheter perforation or from steam pop with RF energy delivery, valve or subvalvular support structure disruption, conduction system disruption with development of heart block, coronary artery injury when ablating in the coronary cusps region or trying to gain access to the LV chamber, precipitation of cardiogenic shock from ablation of viable myocardium in patients with marginal reserve and failure to resuscitate or precipitation of cardiogenic shock from repeated VT induction, and with epicardial ablation the potential complications of epicardial access, coronary arteries and phrenic nerve damage. Recognition of these risks is paramount for their avoidance with careful pre-procedure planning and intraprocedural technique being essential to minimize the potential for complications.
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Garcia, F.C., Valles, E., Dhruvakumar, S. et al. Ablation of ventricular tachycardia. Herzschr. Elektrophys. 18, 225–233 (2007). https://doi.org/10.1007/s00399-007-0583-8
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DOI: https://doi.org/10.1007/s00399-007-0583-8