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Langzeitergebnisse der Katheterablation von Vorhofflimmern

Heilung oder doch nur Palliation?

Long-term results of catheter ablation of atrial fibrillation

Cure or just palliation?

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die Kenntnis über die Stolpersteine bei der Beurteilung von Langzeitergebnissen nach der Ablationsbehandlung von Vorhofflimmern ermöglicht ein kritisches Hinterfragen der in Studien erzielten Resultate. Dennoch ist die Katheterablation ein sicheres und langfristig zielführendes Verfahren bei der Therapie des symptomatischen Vorhofflimmerns v. a. für Patienten mit paroxysmalem Vorhofflimmern. Bei Patienten mit persistierendem symptomatischem Vorhofflimmern muss die Entscheidung zur Ablationsbehandlung aufgrund der höheren Rezidivraten und häufigeren Notwendigkeit wiederholter Eingriffe mit Bedacht getroffen werden.

Abstract

Knowing the pitfalls when evaluating the long-term results after catheter ablation of atrial fibrillation enables a critical analysis of the outcome presented in numerous studies on this topic. Nevertheless, catheter ablation is a long-term successful and safe therapeutic procedure for symptomatic atrial fibrillation, especially for patients with paroxysmal atrial fibrillation. In patients with persistent symptomatic atrial fibrillation, the decision for ablation has to be made with caution due to a higher recurrence rate and higher likelihood for multiple procedures.

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Literatur

  1. Arbelo E, Brugada J, Hindricks G et al  (2014) The atrial fibrillation ablation pilot study: an European survey on methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J 35:1466–1478

  2. Botto GL, Padeletti L, Santini M et al (2009) Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events. J Cardiovasc Electrophysiol 20:241–248

    Article  PubMed  Google Scholar 

  3. Brooks AG, Stiles MK, Laborderie J et al (2010) Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review. Heart Rhythm 7:835–846

    Article  PubMed  Google Scholar 

  4. Bunch TJ, Crandall BG, Weiss JP et al (2011) Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol 22:839–845

    Article  PubMed  Google Scholar 

  5. Cappato R, Calkins H, Chen SA et al (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3:32–38

    Article  PubMed  Google Scholar 

  6. Chao TF, Tsao HM, Lin YJ et al (2012) Clinical outcome of catheter ablation in patients with nonparoxysmal atrial fibrillation: results of 3-year follow-up. Circ Arrhythm Electrophysiol 5:514–520

    Article  PubMed  Google Scholar 

  7. Connolly SJ (2014) Real-world experience with atrial fibrillation ablation: cause for concern. Eur Heart J 35:1430–1432

  8. Dagres N, Kottkamp H, Piorkowski C et al (2010) Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. Int J Cardiol 139:305–306

    Article  PubMed  Google Scholar 

  9. Eitel C, Hindricks G, Piorkowski C (2009) Vorhofflimmern – Neue Aspekte für Diagnostik und Follow-up. Herzzschrittmacher und Elektrophysiologie 20:173–178

    Article  CAS  Google Scholar 

  10. Gaita F, Sardi D, Battaglia A et al (2014) Incidence of cerebral thromboembolic events during long-term follow-up in patients treated with transcatheter ablation for atrial fibrillation. Europace 16(7):980–986. doi:10.1093/europace/eut406

  11. Ganesan AN, Shipp NJ, Brooks AG et al (2013) Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc 2:e004549

    Article  PubMed Central  PubMed  Google Scholar 

  12. Hindricks G, Piorkowski C, Tanner H et al (2005) Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation 112:307–313

    Article  PubMed  Google Scholar 

  13. Hunter RJ, Berriman TJ, Diab I et al (2014) A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol 7:31–38

    Article  CAS  PubMed  Google Scholar 

  14. Israel CW, Gronefeld G, Ehrlich JR et al (2004) Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care. J Am Coll Cardiol 43:47–52

    Article  PubMed  Google Scholar 

  15. Jais P, Cauchemez B, Macle L et al (2008) Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 118:2498–2505

    Article  PubMed  Google Scholar 

  16. Lip Gy, Frison L, Halperin JL et al (2010) Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 41:2731–2738

    Article  CAS  PubMed  Google Scholar 

  17. Matsuo S, Wright M, Knecht S et al (2010) Peri-mitral atrial flutter in patients with atrial fibrillation ablation. Heart Rhythm 7:2–8

    Article  PubMed  Google Scholar 

  18. Medi C, Sparks PB, Morton JB et al (2011) Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up. J Cardiovasc Electrophysiol 22:137–141

    Article  CAS  PubMed  Google Scholar 

  19. Nademanee K, Mckenzie J, Kosar E et al (2004) A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 43:2044–2053

    Article  PubMed  Google Scholar 

  20. Narayan SM, Krummen DE, Shivkumar K et al (2012) Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial. J Am Coll Cardiol 60:628–636

    Article  PubMed Central  PubMed  Google Scholar 

  21. Nedios S, Sommer P, Dagres N et al (2014) Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: the importance of rhythm and rate control. Heart Rhythm 11:344–351

    Article  PubMed  Google Scholar 

  22. Noheria A, Kumar A, Wylie JV Jr et al (2008) Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med 168:581–586

    Article  PubMed  Google Scholar 

  23. Oral H, Chugh A, Good E et al (2006a) A tailored approach to catheter ablation of paroxysmal atrial fibrillation. Circulation 113:1824–1831

    Article  Google Scholar 

  24. Oral H, Pappone C, Chugh A et al (2006b) Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med 354:934–941

    Article  CAS  Google Scholar 

  25. Ouyang F, Tilz R, Chun J et al (2010) Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 122:2368–2377

    Article  PubMed  Google Scholar 

  26. Page RL, Wilkinson WE, Clair WK et al (1994) Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 89:224–227

    Article  CAS  PubMed  Google Scholar 

  27. Page RL, Tilsch TW, Connolly SJ et al (2003) Asymptomatic or „silent“ atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation 107:1141–1145

    Article  PubMed  Google Scholar 

  28. Pappone C, Augello G, Sala S et al (2006) A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 48:2340–2347

    Article  CAS  PubMed  Google Scholar 

  29. Piccini JP, Lopes RD, Kong MH et al (2009) Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol 2:626–633

    Article  PubMed  Google Scholar 

  30. Reynolds MR, Gunnarsson CL, Hunter TD et al (2012) Health outcomes with catheter ablation or antiarrhythmic drug therapy in atrial fibrillation: results of a propensity-matched analysis. Circ Cardiovasc Qual Outcomes 5:171–181

    Article  PubMed  Google Scholar 

  31. Sanders P, Berenfeld O, Hocini M et al (2005) Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans. Circulation 112:789–797

    Article  PubMed  Google Scholar 

  32. Saririan M, Eisenberg MJ (2003) Myocardial laser revascularization for the treatment of end-stage coronary artery disease. J Am Coll Cardiol 41:173–183

    Article  PubMed  Google Scholar 

  33. Sorgente A, Tung P, Wylie J et al (2012) Six year follow-up after catheter ablation of atrial fibrillation: a palliation more than a true cure. Am J Cardiol 109:1179–1186

    Article  PubMed  Google Scholar 

  34. Thomas D, Katus H, Becker R (2013) Katheterablation des Vorhofflimmerns: Chancen und Herausforderungen im Jahr 2013. Kardiologe 7:115–121

    Article  Google Scholar 

  35. Tilz RR, Rillig A, Thum AM et al (2012) Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol 60:1921–1929

    Article  PubMed  Google Scholar 

  36. Tsadok MA, Jackevicius CA, Essebag V et al (2012) Rhythm versus rate control therapy and subsequent stroke or transient ischemic attack in patients with atrial fibrillation. Circulation 126:2680–2687

    Article  PubMed  Google Scholar 

  37. Wazni OM, Marrouche NF, Martin DO et al (2005) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 293:2634–2640

    Article  CAS  PubMed  Google Scholar 

  38. Weerasooriya R, Khairy P, Litalien J et al (2011) Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol 57:160–166

    Article  PubMed  Google Scholar 

  39. Yoshida K, Chugh A, Good E et al (2010) A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation. Heart Rhythm 7:295–302

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt

K. Bode, S. Rolf und S. Richter geben an, dass kein Interessenskonflikt besteht. P. Sommer gibt Beratertätigkeiten für St. Jude Medical an, G. Hindricks für Biosense Webster und St. Jude Medical.

Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Herzzentrum Leipzig, Abteilung für Rhythmologie, Universität Leipzig, Strümpellstraße 39, 04289, Leipzig, Deutschland

    Kerstin Bode, Sascha Rolf, Philipp Sommer, Sergio Richter & Gerhard Hindricks

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  1. Kerstin Bode
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  2. Sascha Rolf
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  3. Philipp Sommer
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  5. Gerhard Hindricks
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Correspondence to Kerstin Bode.

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Bode, K., Rolf, S., Sommer, P. et al. Langzeitergebnisse der Katheterablation von Vorhofflimmern. Herzschr Elektrophys 25, 246–251 (2014). https://doi.org/10.1007/s00399-014-0328-4

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  • DOI: https://doi.org/10.1007/s00399-014-0328-4

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