Niehues Philipp, Ellermann Christian, Eckardt Kai-Uwe, Eckardt Lars
Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland.
Med. Klinik m. Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Herzschrittmacherther Elektrophysiol. 2019 Sep;30(3):251-255. doi: 10.1007/s00399-019-0631-1. Epub 2019 Jul 23.
Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality, with the increased prevalence of supraventricular and ventricular arrhythmia being an important factor. The underlying pathomechanisms are diverse and mainly cause increasing atrial and ventricular fibrosis with so-called cardiac remodeling. In particular, patients with advanced kidney disease were excluded from many pioneering clinical trials, so there are no clear guidelines in the treatment of cardiac arrhythmia for these patients. The potential benefits of implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death or the benefits of anticoagulation for prevention of thromboembolic events in atrial fibrillation should therefore be evaluated individually for each patient with advanced kidney disease, taking comorbidities and the prognosis into account. When using antiarrhythmic drugs, a dose adjustment may be necessary depending on the pharmacokinetics and metabolism. Although atrial fibrillation treatment by means of pulmonary vein isolation can lead to an improvement in kidney function, the success rate seems to be significantly reduced in the presence of advanced kidney disease. Overall, an individual therapy and treatment concept for each patient with advanced chronic kidney disease is advisable.
慢性肾脏病患者心血管发病和死亡风险增加，室上性和室性心律失常患病率上升是一个重要因素。其潜在病理机制多种多样，主要导致心房和心室纤维化增加，即所谓的心脏重塑。特别是，许多开创性临床试验将晚期肾病患者排除在外，因此对于这些患者的心律失常治疗尚无明确指南。因此，对于每一位晚期肾病患者，应根据其合并症和预后情况，单独评估植入式心脏复律除颤器（ICD）预防心脏性猝死的潜在益处或抗凝预防房颤血栓栓塞事件的益处。使用抗心律失常药物时，可能需要根据药代动力学和代谢情况调整剂量。虽然通过肺静脉隔离治疗房颤可改善肾功能，但在晚期肾病患者中成功率似乎显著降低。总体而言，对于每一位晚期慢性肾脏病患者，采用个体化治疗和治疗方案是可取的。
