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Manual zur Diagnostik und Therapie von Synkopen

Manual on diagnosis and treatment of syncope

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Dieses Manual ist eine erweiterte und ausführlichere Version des DGK-Kommentars zur ESC-Leitlinie 2018 zur Diagnostik und Therapie von Synkopen. Es bietet dem Leser praxistaugliche Anregungen und Erläuterungen zur effektiven und effizienten Abklärung von Patienten mit Synkopen. Zentrale Aspekte umfassen Risikostratifizierung und Entscheidungsstrategien in der primären Evaluation, kritische Wertung diagnostischer Verfahren (u. a. implantierbarer Loop-Rekorder [ILR] als wichtigste Diagnostik bei rezidivierenden, ungeklärten Synkopen, Kipptischuntersuchung und Karotissinusmassage als Bestätigungsteste, nicht Suchteste), Therapieoptionen bei Reflexsynkope und orthostatischer Hypotonie, Schrittmacher- und ICD-Indikationen sowie Synkopeneinheiten als neuartige Versorgungsstrukturen. Die ESC-Leitlinie und die zugehörigen Practical Instructions bieten eine ausgezeichnete und spezifische Anleitung zum sicheren Management von Patienten mit Synkopen. Manche Empfehlungen bedürfen jedoch einer kritischen Bewertung. Besonders nachteilig in Deutschland sind die unzureichende Verfügbarkeit und Vergütungssituation wichtiger diagnostischer Verfahren wie Kipptischuntersuchung und ILR.

Abstract

This manual is an extended and more detailed version of the German Society of Cardiology (DGK) comments on the European Society of Cardiology (ESC) 2018 guidelines on the diagnosis and management of syncope. It provides the reader with explanations and algorithms for a comprehensive work-up of patients with syncope. Key aspects include risk stratification and decision strategies in the initial evaluation, a critical appraisal of diagnostic procedures, e. g. implantable loop recorder (ILR) as the most important diagnostic tool for recurrent, unexplained syncope, tilt table testing and carotid sinus massage as a confirmation test, not a screening test, therapeutic options for reflex syncope and orthostatic hypotension, indications for pacemaker and implantable cardioverter defibrillator (ICD) treatment and syncope units as a new organizational structure. The ESC guidelines and the accompanying practical instructions provide an excellent and specific guidance for a safe and successful management of patients with syncope. Some recommendations, however, need a critical discussion. Major drawbacks in Germany include the inadequate availability and reimbursement of key diagnostic procedures, such as tilt table testing and especially ILR.

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Abbreviations

AF:

Vorhofflimmern („atrial fibrillation“)

ARVC:

arrhythmogene rechtsventrikuläre Kardiomyopathie

A&U:

Anamnese und körperliche Untersuchung

AV:

atrioventrikulär

BBB:

Schenkelblock („bundle branch block“)

BP:

Blutdruck („blood pressure“)

bpm:

Schläge pro Minute („beats per minute“)

CI-CSS:

kardioinhibitorisches Karotissinussyndrom („cardioinhibitory carotid sinus syndrome“)

CRT-D:

kardialer Resynchronisationstherapiedefibrillator

CSM:

Karotissinusmassage

CSS:

Karotissinussyndrom

DCM:

dilatative Kardiomyopathie

ED:

Notaufnahme („emergency department“)

EEG:

Elektroenzephalogramm

EKG:

Elektrokardiogramm

EPU:

elektrophysiologische Untersuchung

ESC:

European Society of Cardiology

HCM:

hypertrophe Kardiomyopathie

HF:

Herzfrequenz

ICD:

implantierbarer Kardioverter/Defibrillator

ILR:

implantierbarer Loop-Rekorder („implantable loop recorder“)

KTU:

Kipptischuntersuchung

LOC:

Bewusstseinsverlust („loss of consciousness“)

LQTS:

Long-QT-Syndrom

LVEF:

linksventrikuläre Ejektionsfraktion

OH:

orthostatische Hypotonie

PCM:

isometrische Gegenregulationsmanöver („physical counter-pressure maneuvers“)

POTS:

posturales orthostatisches Tachykardiesyndrom

PPS:

psychogene Pseudosynkope

SCD:

plötzlicher Herztod („sudden cardiac death“)

SVT:

supraventrikuläre Tachykardie

TIA:

transitorische ischämische Attacke

TLOC:

vorübergehender Bewusstseinsverlust („transient loss of consciousness“)

UKG:

Echokardiogramm

VA:

ventrikuläre Arrhythmie

VF:

Kammerflimmern („ventricular fibrillation“)

VT:

Kammertachykardie (ventrikuläre Tachykardie)

VVS:

vasovagale Synkope („vasovagal syncope“)

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Author information

Authors and Affiliations

  1. I. Medizinische Klinik, Herzzentrum Augsburg-Schwaben, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    W. von Scheidt

  2. Cardio Centrum Ludwigsburg-Bietigheim, Ludwigsburg, Deutschland

    R. Bosch

  3. Praxis für Kardiologie Bonn und ambulante Herzkatheter-Kooperation Bonn, Bonn, Deutschland

    T. Klingenheben

  4. Medizinische Klinik, Friedrich-Ebert-Krankenhaus Neumünster, Neumünster, Deutschland

    A. Schuchert

  5. Kommission für Klinische Kardiovaskuläre Medizin, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland

    C. Stellbrink

  6. Medizinische Klinik I, Havelland-Kliniken, Nauen, Deutschland

    M. Stockburger

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  1. W. von Scheidt
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  2. R. Bosch
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  4. A. Schuchert
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Correspondence to W. von Scheidt.

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Den Interessenkonflikt der Autoren finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/ bei der entsprechenden Publikation.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Der Kommentar zu den Leitlinien (2018) der ESC zur Diagnostik und Therapie von Synkopen ist in Ausgabe 03/2019 von Der Kardiologe erschienen [1]

Aus Gründen der Lesbarkeit wird darauf verzichtet, geschlechterspezifische Formulierungen zu verwenden. Soweit personenbezogene Bezeichnungen nur in männlicher Form angeführt sind, beziehen sie sich auf alle Geschlechter.

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von Scheidt, W., Bosch, R., Klingenheben, T. et al. Manual zur Diagnostik und Therapie von Synkopen. Kardiologe 13, 198–215 (2019). https://doi.org/10.1007/s12181-019-0319-0

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