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Vorhofflimmern

Atrial fibrillation

  • Schwerpunkt: Herzrhythmusstörungen
  • Published:
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Zusammenfassung

Vorhofflimmern stellt die Rhythmusstörung dar, die am häufigsten zur Krankenhausaufnahme führt. Aufgrund der Altersstruktur unserer Gesellschaft und der zunehmenden Morbidität und Komorbidität muss davon ausgegangen werden, dass diese Arrhythmie in ihrer Prävalenz noch zunehmen wird. Die therapeutischen Erfolge sind oft unbefriedigend. In 1. Linie muss die Grundkrankheit erkannt und behandelt werden. In 2. Linie muss bei symptomatischen Patienten eine antiarrhythmische Therapie überdacht werden. Eine elektrische Kardioversion bei der persistierenden Form sollte initial und bei Symptomatik durchgeführt werden. Repetitive Kardioversionen bei asymptomatischen Patienten bringen keinen Mortalitätsgewinn. Die antiarrhythmische Therapie umfasst Medikamente der Klassen Ia, Ic und III. Eine begleitende Antikoagulation ist unbedingt notwendig, ASS alleine nur bei fehlender struktureller Herzerkrankung und fehlenden thrombembolischen Risikofaktoren indiziert. Sollten Risikofaktoren vorliegen, muss eine effektive Antikoagulation mit Kumarinderivaten eingeleitet werden. Die Therapie mit ACE-Hemmern und AT-Antagonisten bringt bei Patienten mit arterieller Hypertonie und/oder Herzinsuffizienz deutliche Vorteile im Hinblick auf den Erhalt des Sinusrhythmus nach Kardioversion und auf die Inzidenz der Herzrhythmusstörung. Neue Medikamente zur Antikoagulation und neue Antiarrhythmika bergen die Hoffnung, zukünftig Patienten effektiver und nebenwirkungsärmer behandeln zu können.

Abstract

Atrial fibrillation represents the arrhythmia that most frequently leads to hospital admission. Due to the age structure of our population and the increasing morbidity and comorbidity, one has to assume that this arrhythmia will reach an even higher prevalence. The therapeutic successes are often insufficient. First of all, it is important to diagnose and treat the underlying disease. Secondly, antiarrhythmic therapy has to be considered in symptomatic patients. In those patients and in the case of a persistent form, electrical cardioversion should be performed. Repetitive cardioversions in asymptomatic patients yield no advantage for mortality. Antiarrhythmic therapy consists of drugs of the classes Ia, Ic, and III. Concomitant anticoagulation is necessary; ASS in indicated only in patients without structural heart disease and lacking thromboembolic risk factors. If risk factors are present, effective therapy with coumarin derivatives is required. Therapy with ACE inhibitors and AT blockers leads to an advantage in patients with arterial hypertension and/or heart failure concerning the stability of sinus rhythm after cardioversion and the incidence of arrhythmia. Newer medications for anticoagulation and newer antiarrhythmic drugs raise the hope of a future therapy with higher efficacy and lower rate of side effects.

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  1. Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Moorenstraße 5, 40225 , Düsseldorf, Deutschland

    M. G. Hennersdorf & B. E. Strauer

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  1. M. G. Hennersdorf
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  2. B. E. Strauer
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Correspondence to M. G. Hennersdorf.

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Hennersdorf, M.G., Strauer, B.E. Vorhofflimmern. Internist 47, 990–1000 (2006). https://doi.org/10.1007/s00108-006-1693-9

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