Lown classification

from Wikipedia, the free encyclopedia

The Lown classification (also: Lown classification ) is used in medicine to classify tachycardiac ventricular extrasystoles (VES). The scheme introduced in 1971 by the American cardiologist Bernard Lown at Harvard Medical School in Boston provides for a division into five categories, which are also referred to as Lown classes (or as degrees, degrees of severity , Lown grade ). The basis of the Lown classification is the knowledge that the extent of cardiac damage that has already occurred, even without a coronarography, and the risk of sudden cardiac death in patients with coronary heart disease can be roughly predicted on the basis of the type and frequency of PVCs in a long-term ECG .

classification

class Frequency and type of PVCs
0 no VES
1 occasional, individual PVCs (<30 / h)
2 frequent (monomorphic) PVCs (> 30 / h)
3
  a
  b 		polymorphic (polytopic) VES
  single
  ventricular bigeminus
4
  a
  b 		repetitive VES
  couplets
  volleys
5 early incident PVCs ( R-on-T phenomenon )

Another system has six classes with different numbering . Thereafter, class IIIa becomes class 3, IIIb becomes class 4, class IVa becomes class 5 and class IVb becomes class 6 (" triplets and salvos, ventricular tachycardias "). Classes 0 and V are missing.

meaning

The Lown classification system was criticized at an early stage. Clear treatment guidelines were required. In spite of this, especially in the 1980s, in the summarizing assessment of 24-hour electrocardiograms as a basis for therapy, the extent of ventricular extrasystole was regularly given in Lown degrees. This graduation is now considered out of date. In some cases, warnings are now being given against the uncritical interpretation of the Lown classification. Likewise, targeted antiarrhythmic medication for ventricular extrasystole is now considered obsolete .

Individual evidence

  1. ↑ Willibald Pschyrembel: Clinical Dictionary . 267th edition, Verlag Walter de Gruyter, Berlin / Boston 2017, ISBN 978-3-11-049497-6 , p. 1068.
  2. ↑ Maxim Zetkin , Herbert Schaldach: Lexicon of Medicine. 16th edition. Ullstein Medical, Wiesbaden 1999, ISBN 3-86126-126-X , p. 1192.
  3. ^ Roche Lexicon Medicine. 5th edition. Urban & Fischer , Munich / Jena 2003, ISBN 3-437-15156-8 , p. 1130.
  4. ^ Lexicon of Medicine. 4th edition. Elsevier Verlag, Munich without year [2005], ISBN 3-625-10768-6 , p. 1024.
  5. ↑ Peter Reuter: Springer Lexicon Medicine . Springer-Verlag, 2004, ISBN 3-540-20412-1 , p. 1270 (with table).
  6. ↑ Peter Reuter: Springer Clinical Dictionary 2007/2008. 1st edition. Springer-Verlag, Berlin 2007, ISBN 978-3-540-34601-2 , p. 1078.
  7. ↑ Myron G. Sulyma (Ed.): Dictionary of cardiology. Volume III, Medikon-Verlag, Munich 1983, ISBN 3-923866-07-0 , p. 437.
  8. ↑ Bernard Lown, M. Wolf: Approaches to sudden death from coronary heart disease . ( Memento of October 16, 2008 in the Internet Archive ) In: Circulation . Volume 44, 1971, pp. 130-142.
  9. ^ Bernard Lown : Sudden Cardiac Death - Management of the Patient at Risk. In: Current Problems in Cardiology. Volume 4, Number 12, 1980, pp. 51-62.
  10. ↑ Bernard Lown et al .: Monitoring for serious arrhythmias and high risk of sudden death. In: Circulation. Volume 52, 6 Suppl, 1975, pp. III 189-198. PMID 52414 .
  11. ↑ Gerd Herold : Internal Medicine 2020. Self-published , Cologne 2019, ISBN 978-3-9814660-9-6 , p. 277: "The Lown classification has no great prognostic value."
  12. ^ Hans Hochrein, Palle Bentsen, Cornelius Langescheid, Detlev Nunberger: Checklist cardiology. Georg Thieme Verlag , Stuttgart / New York 1988, ISBN 3-13-719901-8 , p. 77.
  13. ^ J. Thomas Bigger Jr, Francis M. Weld: Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction. Shortcomings of the low grading system. In: Heart . tape 45 , no. 6 , 1981, pp. 717-724 , doi : 10.1136 / hrt.45.6.717 .
  14. ^ Rainer Klinge: The electrocardiogram. 5th edition. Georg Thieme Verlag , Stuttgart / New York 1987, ISBN 3-13-554005-7 , p. 198.
  15. ↑ Thomas Budde: Cardiac Diseases . In: Peter Berlit (Ed.): Clinical Neurology . 2nd Edition. Springer, 2005, ISBN 978-3-540-01982-4 , pp. 1247 ( limited preview in Google Book search).
  16. ^ Georg Schmidt: Antiarrhythmic therapy. Schattauer Verlag , Stuttgart / New York 1989, ISBN 3-7945-1317-7 .
  17. ↑ Martin Schlepper, Bertil Olsson (Ed.): Cardiac arrhythmias. Springer-Verlag, Berlin / Heidelberg / New York 1983, ISBN 3-540-12148-X .
  18. ↑ Fred Sesto, Herbert Müller-Peltzer, Gerda von Philipsborn, Astrid Fischer (Eds.): Rytmonorm - Propafenon - Antiarrhythmic , Springer-Verlag, Berlin / Heidelberg / New York / Tokyo 1985, ISBN 3-540-13838-2 .
  19. ↑ Fred Sesto: Arrhythmia Compendium. 4 volumes, Volume I, 2nd edition. Springer-Verlag, Berlin / Heidelberg / New York / Tokyo 1987, ISBN 3-540-17460-5 .