Ventrikuläre Tachykardien bei Postinfarktpatienten und koronarer Herzkrankheit

Patients with coronary heart disease are subject to an increased risk for sudden cardiac death (SCD). Within the first 30-90 days after the myocardial infarct the risk is particularly high. In times of implantable cardioverter-defibrillator (ICD) on the one hand and the ability to bridge high-risk periods with e. g. wearable defibrillator vests on the other, adequate risk stratification is essential. Currently, the main parameter for this is the left ventricular ejection fraction (LVEF). However, risk stratification by measurement of the LVEF has severe limitations, especially since the majority of patients suffering from SCD have a normal LVEF. Various other methods like ventricular ectopy, signal-averaged ECG, QRS width, microvolt T-wave alternans and programmed ventricular stimulation have been previously evaluated. None of these methods alone or in combination with a left ventricular function assessment was capable of improving the predictability of arrhythmic events significantly. Considering the multiple mechanisms that can lead to SCD, a single risk stratifier seems unrealistic. However, patients with chronic total occlusion of a coronary artery and residual or provocable ischemia have an increased risk for SCD. Therefore a combination of clinical and angiographic parameters seems reasonable. Advanced echocardiographic parameters e.g. mechanical dispersion could be used on a complementary role.