Die inadäquate Sinustachykardie

 

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Zusammenfassung

Die inadäquate Sinustachykardie ist charakterisiert durch eine nicht erklärbare, anhaltende Beschleunigung des normalen Sinusrhythmus (> 100/min.) in Ruhe bzw. einen überschießenden Anstieg bei geringer Aktivität (Herzfrequenz-Mittelwert > 90/min./24 h). Sie geht mit variabler Symptomatik wie z. B. Herzrasen, Palpitationen, Müdigkeit, Schwäche und Schwindel einher. Sowohl Pathogenese als auch Langzeitprognose sind unvollständig verstanden, weshalb sich die Therapie der inadäquaten Sinustachykardie in der klinischen Routine oftmals schwierig gestaltet. Vor der Diagnosestellung und einer etwaigen Therapie-Initiierung müssen mögliche Ursachen einer sekundären Sinustachykardie ausgeschlossen werden. Therapeutisch werden körperliches Training, das Vermeiden von Auslösern und begünstigenden Faktoren sowie bradykardisierende Substanzen wie Betablocker oder Ivabradin empfohlen. Die Katheterablation zur Modifikation der Sinusknotenregion sollte nur als Ultima ratio zur Anwendung kommen.

Abstract

Inappropriate sinus tachycardia is characterized by an unexplained increase of the resting sinus rate (> 100 bpm) with excess increase in response to moderate activity (mean heart rate > 90 bpm/24 h). Affected patients may suffer from heart race, palpitations, fatigue, weakness and dizziness. The mechanisms underlying inappropriate sinus tachycardia and its long term prognosis are poorly understood. Thus, diagnosis and treatment are empiric and require the initial exclusion of potential causes of secondary sinus tachycardia. Therapeutic approaches include physical training, beta blockers or ivabradine. Radiofrequency catheter ablation should be restricted to patients with refractory and longstanding symptoms.

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