Publikationsserver der Universitätsbibliothek Marburg
Titel:Bedeutung der AV-und VV Optimierung bei biventrikulären Schrittmachersystemen
Autor:Jahnecke, Marcus
Weitere Beteiligte: Lauer, Bernward (Prof. Dr.)
Veröffentlicht:2010
URI:https://archiv.ub.uni-marburg.de/diss/z2010/0177
URN: urn:nbn:de:hebis:04-z2010-01771
DOI: https://doi.org/10.17192/z2010.0177
DDC: Medizin
Titel (trans.):Importance of AV and VV optimization during biventricular pacing systems
Publikationsdatum:2010-03-15
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
AV-and VV Times, AV-und VV-Zeiten, Linksventrikuläre Anstiegsgeschwindigkeit, Millarkatheter, HZV, CRT, CRT, Kardiale Resynchronisationstherapie

Zusammenfassung:
Bei Patienten mit fortgeschrittener und therapierefraktärer chronischer Herzinsuffizienz eröffnete sich mit der Einführung der biventrikulären Stimulation die kardiale Resynchronisationstherapie als ein neuer viel versprechender therapeutischer Ansatz und wurde in die Behandlungsrichtlinien aufgenommen. Die modernen Therapiedevices bieten mittlerweile die Möglichkeit eine individuelle biventrikuläre Stimulation mit unterschiedlicher zeitlicher Aktivierung des Linken und rechten Ventrikel (VV-Intervall) und der Zeitintervalle zwischen Vorhöfen und Ventrikel (AV Intervall) im Rahmen der sogenannten sequentiellen biventrikulären Stimulation durchzuführen. Die akuten hämodynamischen Auswirkungen der sequentiellen CRT, aber auch eventuelle Änderungen im zeitlichen Verlauf wurden im Rahmen dieser Arbeit untersucht. Die invasive Messung der linksventrikulären maximalen Anstiegsgeschwindigkeit ergab sowohl nach einem Monat (+ 12,1%) als auch nach vier Monaten (+ 3,33 %) eine Zunahme unter simultaner biventrikulärer Stimulation als Ausdruck der gesteigerten Inotropie. Erfolgte dann eine Optimierung der AV und VV Zeiten zeigte sich in der 1 Monatskontrolle eine weitere Zunahme von dp/dt um 6,11 % gegenüber der simultanen biventrikulären Stimulation. Dieser Effekt der Optimierung ließ sich auch nach 4 Monaten nachweisen, hier ergab sich eine Zunahme der Anstiegsgeschwindigkeit um 6,99 % durch eine Optimierung gegenüber der simultanen Stimulation. Im zeitlichen Verlauf konnte durch eine erneute Optimierung des biventrikulären Systems eine Zunahme der linksventrikulären Anstiegsgeschwindigkeit von 4,1% gegenüber der ursprünglich optimierten Programmierung erzielt werden.

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